Lip and Oral

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Overview

Lip and oral cavity cancer is a type of head and neck cancer. Men in the United States are diagnosed with this type of cancer about 2.3 times more often than women. Lip and oral cancer can form in several different areas including the tissues of the lips, oral cavity (the mouth) or the oropharynx (the part of the throat at the back of the mouth).

The oral cavity includes the following:

  • Lips
  • Teeth
  • Hard palate (the roof of the mouth)
  • Soft palate and (the muscle back portion of the roof of the mouth)
  • Retromolar trigone (the small area behind the wisdom teeth)
  • Front two-thirds of the tongue
  • Gingiva (gums)
  • Uvula (the fleshy extension off of the soft palate that hangs above the throat)
  • Tonsils
  • Buccal mucosa (the lining of the inside of the cheeks and lips)
  • Floor (bottom) of the mouth under the tongue
  • Salivary glands (glands that make saliva)

Visit the National Cancer Institute where this information and more can be found about Lip and Oral Cancer or ask your cancer care team questions about your individual situation.

Risk Factors for Lip & Oral Cancers

Tobacco and alcohol use are the two main factors that seem to affect the risk of developing lip and oral cavity cancer. Most patients diagnosed with this disease are over 60 years old. Always consult your doctor if you think you may be at risk for cancer.

Risk factors for lip and oral cavity cancer include the following:

  • Using tobacco products of any type
  • Heavy alcohol use
    • For women: having more than three drinks on any day or more than seven drinks per week
    • For men: have more than four drinks on any day or more than 14 drink per week
  • Overexposure to natural sunlight or artificial sunlight (such as from tanning beds) without UV protection
  • Being male
  • Being infected with human papillomavirus (HPV)

If you have risk factors it does not mean that you will definitely develop cancer. And at the same time, having no risk factors present is not a guarantee that you won’t develop a type of lip or oral cancer. That’s why it’s important to know how to spot signs and symptoms.

Signs and Symptoms of Lip & Oral Cancers

Many of the following symptoms are not from oral cancer. However, if you have any of the listed symptoms, you should contact your physician or dentist so they can diagnose and treat the areas of concern as soon as possible.

Symptoms of oral cancer include:

  • Sores in the mouth or on the lips that will not heal.
  • Lumps or thickening on the lips, gums, or in the mouth.
  • Red or white patches on the gums, tongue, or lining of the mouth that do not heal.
    • White patches are the most common and can become cancerous.
    • Mixed red and white patches are more likely than white patches to develop into cancer.
  • Bleeding in the mouth or lips.
  • Numbness of the lower lip and chin.
  • An unexpected change in voice.
  • Loose teeth.
  • Changes in mouth shape that affect dentures or mouthguards being able to fit properly in the mouth.
  • Unexplained difficulty or pain when chewing, swallowing or moving the tongue or jaw.
  • Swelling of the jaw.
  • An unexplained sore throat or feeling that something is caught in the throat that won’t go away.
  • Lump in your neck.
  • An earache that will not go away.

Diagnosing Lip & Oral Cavity Cancers

If you have symptoms that suggest oral cancer, your doctor or dentist will perform a physical exam of the lips and oral cavity to check your mouth and throat for red or white patches, lumps, swelling, or other problems. A physical exam includes looking carefully at the roof of your mouth, back of your throat, and insides of your cheeks and lips. The floor of your mouth and lymph nodes in your neck will also be checked.

If your doctor finds something that is concerning, they might do a biopsy, which is the removal of a small piece of tissue to look for cancer cells. Usually, a biopsy is done with local anesthesia. A biopsy is the only sure way to know if the abnormal area is cancerous.

If your biopsy comes back positive for cancerous cells, your doctor may elect to have one or more tests done to further diagnose and stage the disease. A few of those methods that are also used in the lip and oral cancer diagnosis and staging process are:

  • X-rays: An X-ray of your entire mouth can show whether cancer has spread to the jaw. Images of your chest and lungs can show whether cancer has spread to these areas.
    • Barium swallow: Involves the patient drinking a liquid that contains barium (a metallic compound), which coats and outlines the esophagus, allowing it to show-up in x-rays, and then series x-rays are taken.
  • CT scan: An X-ray machine linked to a computer takes a series of detailed pictures of your body. You may receive an injection of dye to help the tissues show more clearly. Tumors in your mouth, throat, neck, lungs, or elsewhere in the body can show up on the CT scan.
  • MRI: A powerful magnet linked to a computer is used to make detailed pictures of your body. An MRI can show whether oral cancer has spread.
  • Endoscopy: The doctor uses a thin, lighted tube (endoscope) to check your throat, windpipe, and lungs. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of cancer.
  • PET scan: You receive an injection of a small amount of radioactive sugar. The radioactive sugar gives off signals that the PET scanner picks up. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter in the picture because they take up sugar faster than normal cells do. A PET scan shows whether oral cancer may have spread.
  • Exfoliative cytology: A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, mouth, or throat. The cells are viewed under a microscope to find out if they are abnormal.
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

Lip & Oral Cavity Cancers Staging

If oral cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Many of the tests listed in the diagnosis section are performed to determine if the cancer has spread and to where.

Doctors describe the stage of the cancer based on the size of the tumor, whether it has invaded nearby tissues, and whether it has spread to the lymph nodes or other tissues.

For oral cancers, stages 1 and 2 are combined and classified as “early cancer”. Stages 3 and 4 are classified as “advanced cancer.” Below are the details of each class.

  • Early Cancer Lip or Oral Cancers – Stage 1 or 2 oral cancer is usually a small tumor (smaller than a walnut), and no cancer cells are found in the lymph nodes.
  • Advanced Cancer Lip or Oral Cancers – Stage 3 or 4 oral cancer is usually a large tumor (as big as a lime). The cancer may have invaded nearby tissues or spread to lymph nodes or other parts of the body.

When oral cancer spreads, cancer cells may be found in the lymph nodes in the neck or in other tissues of the neck. Cancer cells can also spread to the lungs, liver, bones, and other parts of the body. When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells as the primary (original) tumor. For example, if oral cancer spreads to the lungs, the cancer cells in the lungs are actually oral cancer cells. The disease is called metastatic oral cancer, not lung cancer. It’s treated as oral cancer, not lung cancer. Doctors sometimes call the new tumor “distant” or metastatic disease.

Treatment Options for Lip & Oral Cancer

People with early oral cancer may be treated with surgery and/or radiation therapy. People with advanced oral cancer may need a combination of treatments since the cancer is likely in the lymph system throughout the body. The choice of cancer treatment regimens depends mainly on your general health, where in your mouth or throat the cancer began, the size of the tumor, and whether the cancer has spread.

Surgery

Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer and often included at some point during the oral cancer treatment process. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. You may have surgery alone or in combination with other therapies.

Surgery to remove a small tumor in your mouth may not cause any lasting problems. For a larger tumor, however, the surgeon may have to remove part of the palate, tongue, or jaw, and this may change the patient’s ability to chew, swallow, or talk. Also, this may change the look or structure of the face. A patient may have reconstructive or plastic surgery to rebuild any bones or tissues that were removed from the mouth.

Also, surgery may cause tissues in the face to swell. This swelling usually goes away within a few weeks; however, removing lymph nodes can result in swelling that lasts a longer time.

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells and can be used to treat the area where the patient is affected by oral cancer. This type of treatment focuses on treating the specific area(s) where the cancer was found. Radiation therapy is an option used for small tumors, for people who can’t have surgery, before surgery to shrink the tumor, or after surgery to destroy cancer cells that may remain in the area.

  • External radiation therapy – Focusing a beam of radiation from a machine outside the body is the most common way to give radiation for lip and oral cancer. This is known as external beam radiation therapy. Some cancer treatment centers offer IMRT, which uses a computer to more closely target the oral tumor to lessen the damage to healthy tissue. You may go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks. Each treatment takes only a few minutes.
  • Brachytherapy – Brachytherapy, also known as internal radiation or interstitial radiation, is radiation that is delivered directly into or near the cancer.The radiation comes from radioactive material in seeds, wires, or tubes put directly in the mouth or throat tissue. Because external radiation approaches are now very precise, treating lip and oral cancer with brachytherapy is not very common. If this method is used, patients may need to stay in the hospital for several days. Usually, the radioactive material is removed before you go home.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. The chemotherapy drugs that treat oral cancer are usually given through a vein (intravenous), and the drugs enter the bloodstream and travel throughout your body. You may receive chemotherapy in an outpatient setting at a cancer center like ours.

Some patients may need a treatment regimen that includes both chemotherapy and radiation therapies. For some patients, the two treatments may be alternated throughout the week. For others, it may be necessary to complete one regimen completely before starting the next.

Chemotherapy and radiation therapy can cause some of the same side effects — including painful mouth and gums, dry mouth, infection, and changes in taste. Some anticancer drugs can cause bleeding in the mouth and a deep pain that feels like a toothache. Other chemo drugs may cause diarrhea, kidney damage, and numbness and tingling in the hands and feet.

Chemotherapy can also affect the blood-producing cells of the bone marrow, leading to low blood cell counts. Some side effects that may result from this could include:

  • Higher risk of infections (due to low white blood cell counts)
  • Bruising or bleeding more easily (due to low blood platelet counts)
  • Fatigue (due to low red blood cell counts)

While some side effects can be permanent, most improve once treatment has stopped. There are ways to prevent or treat many of the side effects of chemo, so speak with your doctor if you are experiencing any side effects.

Targeted Therapy

Some people with oral cancer receive a type of drug known as targeted therapy. Cetuximab (Erbitux) was the first targeted therapy approved for oral cancer. Cetuximab binds to oral cancer cells and interferes with cancer cell growth and the spread of cancer. You may receive cetuximab through a vein once a week for several weeks at the doctor’s office. It may be given along with radiation therapy or chemotherapy.

Sources:

https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/treating/chemotherapy.html
https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/treating/radiation-therapy.html