Oral Cancer 101: A Guide to Risks, Symptoms and Treatments

By Al Haitham Al Shetawi, MD, DMD   |  4/5/2018

There were 49,670 new oral and oropharyngeal cancer cases in 2017, according to the American Cancer Society. Dr. Al Haitham Al Shetawi, MD, DMD, a maxillofacial, head and neck surgeon at Health Quest Medical Practice gives an overview about oral and oropharyngeal cancers.

The oral cavity

The oral cavity includes the lips, the inside lining of the lips and cheeks (buccal mucosa), the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth below the tongue, the bony roof of the mouth (hard palate) and the area behind the wisdom teeth (called the retromolar trigone).

The oropharynx

The oropharynx is the part of the throat just behind the mouth. It begins where the oral cavity stops. It includes the base of the tongue (the back third of the tongue), the soft palate (the back part of the roof of the mouth), the tonsils, and the side and back wall of the throat.

Squamous cell carcinoma

The oral cavity and oropharynx are lined by squamous epithelium, which is responsible for 90 percent of oral cavity and oropharyngeal cancers, known as squamous cell carcinoma.

Risk factors

The risk factors for oral and oropharyngeal cancer are tobacco use, alcohol use, infection with human papillomavirus, diet and a personal history of oral cancer. All forms of tobacco (such as cigarettes, cigars, pipes, snuffing and chewing tobacco) cause oral cancer. The risk for cancer is higher if tobacco is used with alcohol. In some parts of the world such as Southeast Asia, betel nut chewing is the most common cause of oral cancer.

The reduction in smoking tobacco in the United States has resulted in significant declines in most oral cavity cancers. However, recent studies have found an increase in the incidence of oral tongue (anterior two-thirds of the tongue) and oropharyngeal cancers. The reason for the increase in tongue cancer despite reduction of tobacco use is still under investigation. The incidence of oropharyngeal cancers has been attributed to human papillomavirus (HPV) infection.

Signs and symptoms

Early stage oral cancer may have no or minimal symptoms. Symptoms may include pain, earache, numbness to lower lip and chin, difficulty swallowing or pain on swallowing. Clinical signs of oral cancer can be white patches (leukoplakia), mixed red and white patches (erythroleukoplakia), red patches (erythroplakia), an ulcer that does not heal, bleeding from the mouth, loose teeth, and a lump in the neck. All these signs and symptoms should prompt the patient to see a healthcare professional to get a thorough examination.

Screening and detection

Thorough clinical examination is the best way to detect pre-cancerous lesions and early stage cancer. If clinical exam detects any suspicious lesion in the mouth, the first step is usually to perform a biopsy. A biopsy is the removal of a small piece of tissue to examine under a microscope to see if it is cancerous. If the tumor is in an inaccessible area like the base of tongue or tonsils, a direct laryngoscopy and biopsy is usually performed. In this procedure, the examination is done under general anesthesia to evaluate the upper aerodigestive tract and obtain a biopsy.

After confirming the diagnosis of cancer, the head and neck specialist usually obtains imaging studies (such as computed tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans) to get more information about the tumor and its possible spread.

Treatment options

After finishing the workup, the cancer team will decide the best treatment modality for that specific cancer type and stage. The treatment can be a single modality treatment (surgery alone or radiation therapy alone) or multimodality treatment (surgery, radiation and chemotherapy). Single modality treatment is usually used for early stage cancer, sparing the other modalities if needed in the future. In general, oral cancer is treated primarily with surgery, and oropharyngeal cancer is treated primarily with radiation. Radiation therapy minimizes the damage from surgery and allows for the possibility of organ preservation. If surgery results in losing a significant portion of the anatomic structures (like the tongue or the jaw), reconstructive surgery will be performed to restore that structure and maintain function and cosmetic appearance.

"In conclusion, the risks for developing these cancers can be greatly reduced by avoiding certain risk factors. Early screening and detection can significantly increase the chance of survival. With modern therapies and advanced reconstructive techniques, early stage cancer is curable." Dr. Al Shetawi says.

To schedule a consultation appointment, please call 845-483-6920 (TTY 1-800-421-1220) or visit Head and Neck Surgery.