Mouth cancer

Mouth cancerMouth cancer refers to cancer that develops in any of the parts that make up the mouth. Mouth cancer can occur on the:

  • Lips
  • Gums
  • Tongue
  • Inside lining of the cheeks
  • Roof of the mouth
  • Floor of the mouth

Cancer that occurs on the inside of the mouth is sometimes called oral cancer or oral cavity cancer.

Mouth cancer is one of several types of cancer grouped in a category called head and neck cancers. Mouth cancer and other head and neck cancers are often treated similarly.

Symptoms

Signs and symptoms of mouth cancer may include:

  • A sore that doesn’t heal
  • A lump or thickening of the skin or lining of your mouth
  • A white or reddish patch on the inside of your mouth
  • Loose teeth
  • Poorly fitting dentures
  • Tongue pain
  • Jaw pain or stiffness
  • Difficult or painful chewing
  • Difficult or painful swallowing
  • Sore throat

When to see a doctor

Make an appointment with your doctor or dentist if you have any persistent signs and symptoms that bother you and last more than two weeks. Your doctor will likely investigate other more common causes for your signs and symptoms first, such as an infection.

Causes

Mouth cancer occurs when cells on your lips or in your mouth develop changes (mutations) in their DNA. These mutations allow cancer cells to grow and divide when healthy cells would die. The accumulating mouth cancer cells can form a tumor. With time they may spread to other areas of the mouth and on to other areas of the head and neck or other parts of the body.

Mouth cancers most commonly begin in the flat, thin cells (squamous cells) that line your lips and the inside of your mouth. Most oral cancers are squamous cell carcinomas.

It’s not clear what causes the mutations in squamous cells that lead to mouth cancer. But doctors have identified factors that may increase the risk of mouth cancer.

Risk factors

Factors that can increase your risk of mouth cancer include:

  • Tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff, among others
  • Heavy alcohol use
  • Excessive sun exposure to your lips
  • A sexually transmitted virus called human papillomavirus (HPV)

Diagnosis

Tests and procedures used to diagnose mouth cancer include:

  • Physical exam. Your doctor or dentist will examine your lips and mouth to look for abnormalities — areas of irritation, such as sores and white patches (leukoplakia).
  • Removal of tissue for testing. If a suspicious area is found, your doctor or dentist may remove a sample of cells for laboratory testing in a procedure called a biopsy. Unusual cells can be scraped away with a brush or cut away using a scalpel. In the laboratory, the cells are analyzed for cancer or precancerous changes that indicate a risk of future cancer.

Mouth cancer stages

Once mouth cancer is diagnosed, your doctor works to determine the extent, or stage, of your cancer. Mouth cancer staging tests may include:

  • Using a scope to inspect your throat. During a procedure called endoscopy, your doctor may pass a lighted scope down your throat to look for signs that cancer has spread beyond your mouth.
  • Imaging tests. A variety of imaging tests may help determine whether cancer has spread beyond your mouth. Imaging tests may include X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, among others. Not everyone needs each test. Your doctor determines which tests are appropriate based on your condition.

Mouth cancer stages are indicated using Roman numerals I through IV. A lower stage, such as stage I, indicates a smaller cancer confined to one area. A higher stage, such as stage IV, indicates a larger tumor or that cancer has spread to other areas of the head or neck, or to other areas of the body. Your cancer’s stage helps your doctor determine your treatment options.

Treatment

Treatment for mouth cancer depends on your cancer’s location and stage, as well as your overall health and personal preferences. You may have just one type of treatment, or you may undergo a combination of cancer treatments. Discuss your options with your doctor.

Surgery

Surgery for mouth cancer may include:

  • Surgery to remove the tumor. Your surgeon may cut away the tumor and a margin of healthy tissue that surrounds it. Smaller cancers may be removed through minor surgery. Larger tumors may require more-extensive procedures. For instance, removing a larger tumor may involve removing a section of your jawbone or a portion of your tongue.
  • Surgery to remove cancer that has spread to the neck. If cancer cells have spread to the lymph nodes in your neck, your surgeon may recommend a procedure to remove cancerous lymph nodes and related tissue in the neck (neck dissection).
  • Surgery to reconstruct the mouth. After an operation to remove your cancer, your surgeon may recommend reconstructive surgery to restore the appearance of your face or to help you regain the ability to talk and eat. Your surgeon may transplant grafts of skin, muscle or bone from other parts of your body to reconstruct your face. Dental implants may replace your natural teeth.

Surgery carries a risk of bleeding and infection. Surgery for mouth cancer often affects your appearance, as well as your ability to speak, eat and swallow. Your doctor may refer you to specialists who can help you cope with these changes.

Radiation therapy

Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. Radiation therapy can be delivered from a machine outside of your body (external beam radiation) or from radioactive seeds and wires placed near your cancer (brachytherapy).

Radiation therapy may be the only treatment you receive if you have an early-stage mouth cancer. Radiation therapy can also be used after surgery. In other cases, radiation therapy may be combined with chemotherapy. This combination increases the effectiveness of radiation therapy, but it also increases the side effects you may experience. In cases of advanced mouth cancer, radiation therapy may help relieve signs and symptoms caused by the cancer, such as pain.

The side effects of radiation therapy to your mouth may include dry mouth, tooth decay, mouth sores, bleeding gums, jaw stiffness, fatigue and red, burn-like skin reactions.

Chemotherapy

Chemotherapy is a treatment that uses chemicals to kill cancer cells. Chemotherapy drugs can be given alone, in combination with other chemotherapy drugs or in combination with other cancer treatments. Chemotherapy may increase the effectiveness of radiation therapy, so the two are often combined.

The side effects of chemotherapy depend on which drugs you receive. Common side effects include nausea, vomiting and hair loss.

Targeted drug therapy

Targeted drugs treat mouth cancer by altering specific aspects of cancer cells that fuel their growth. Cetuximab (Erbitux) is one targeted therapy approved for treating head and neck cancers in certain situations. Cetuximab stops the action of a protein that’s found in many types of healthy cells, but is more prevalent in certain types of cancer cells.

Other targeted drugs are being studied in clinical trials. Targeted drugs can be used in combination with chemotherapy or radiation therapy.

Alternative medicine

No complementary or alternative medicine treatments can cure mouth cancer. But complementary and alternative medicine treatments may help you cope with mouth cancer and the side effects of cancer treatment, such as fatigue.

Many people undergoing radiation therapy for cancer experience fatigue. Your doctor can treat underlying causes of fatigue, but the feeling of being utterly worn out may persist despite treatments. Complementary therapies can help you cope with fatigue.

Ask your doctor about trying:

  • Exercise. Try gentle exercise for 30 minutes on most days of the week. Moderate exercise, such as brisk walking, during and after cancer treatment reduces fatigue. Talk to your doctor before you begin exercising, to make sure it’s safe for you.
  • Massage therapy. During a massage, a massage therapist uses his or her hands to apply pressure to your skin and muscles. Some massage therapists are specially trained to work with people who have cancer. Ask your doctor for names of massage therapists in your community.
  • Relaxation. Activities that help you feel relaxed may help you cope. Try listening to music or writing in a journal.

Sources: Mayo Clinic

My Piano Music (^_^) – All I Ask Of You (Andrew Lloyd Webber), https://www.youtube.com/watch?v=8nRTCVopb7A

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