Oral and Oropharyngeal Cancer

Overview

Cancer begins when cells become abnormal and multiply without control or order. These cells form a growth of tissue, called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous). Cancerous cells can invade nearby tissue and sometimes spread to other parts of the body through the bloodstream and the body’s lymphatic system.

In the head and neck region, two of the most common types of cancer are cancer of the oral cavity (mouth and tongue) and cancer of the oropharynx (the middle of the throat from the tonsils to the tip of the voice box). The oral cavity and oropharynx, along with other parts of the head and neck, contribute to the ability to chew, swallow, breathe, and talk.
The oral cavity includes the lips, buccal mucosa (lining of the lips and cheeks), gingiva (upper and lower gums), front two-thirds of the tongue, floor of the mouth under the tongue, hard palate (roof of the mouth), and the retromolar trigone (small area behind the wisdom teeth).
The oropharynx begins where the oral cavity stops. It includes the soft palate at the back of the mouth, the part of the throat behind the mouth, the tonsils, and the base of the tongue.

Two factors greatly increase the risk of oral and oropharyngeal cancer:

Tobacco use. Use of tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single largest risk factor for head and neck cancer. Pipe smoking is particularly linked to cancer in the part of the lips that contact the pipe stem. Chewing tobacco or snuff is associated with a 50% increase in risk of cancers of the cheeks, gums, and inner surface of the lips where the tobacco has the most contact.

Alcohol. Frequent and heavy consumption of alcohol increases the risk of head and neck cancer.
Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Using alcohol and tobacco together increases this risk even more. Recent studies have suggested that people who have used marijuana may be at higher than average risk for head and neck cancer. Second-hand smoke may also increase a person’s risk of head and neck cancer.

Other factors can raise a person’s risk of oral and oropharyngeal cancer include:

Prolonged sun exposure. Prolonged sun exposure is linked to cancer in the lip area.

Human papillomavirus (HPV). Research indicates that infection with this virus is a risk factor for oral and oropharyngeal cancer. In fact, HPV-related oropharyngeal cancer in the tonsils and the base of the tongue have become more frequent in recent years. HPV is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers

Gender. Men are more likely to develop oral and oropharyngeal cancer than women.

Fair skin. Fair skin is linked to a higher risk of lip cancer.

Age. People over 45 are at increased risk for oral cancer, although this type of cancer can develop in people of any age.

Oral hygiene. People with poor oral hygiene/dental care may have an increased risk of oral cavity cancer. Poor dental health or ongoing irritation from poorly fitting dentures, especially in people who use alcohol and tobacco products, may contribute to the promotion of oral and oropharyngeal cancer.

Poor diet/nutrition. A diet low in fruits and vegetables, a vitamin A deficiency, and chewing betel nuts (a nut containing a mild stimulant that is popular in Asia) increase the risk of oral and oropharyngeal cancer.

Weakened immune system. People with a weakened immune system have a higher risk of oral and oropharyngeal cancer.

Symptoms

Often, a dentist is the first person to find this type of cancer during a routine examination. People with oral and oropharyngeal cancer may experience the following symptoms. Sometimes, people with oral and oropharyngeal cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.

• Sore in the mouth or on the lip that does not heal (the most common symptom)
• Red or white patch on the gums, tongue, tonsil, or lining of the mouth
• Lump on the lip, mouth, neck, or throat or a feeling of thickening in the cheek
• Persistent sore throat or feeling that something is caught in the throat
• Hoarseness or change in voice

Treatment

The treatment of oral and oropharyngeal cancer depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health.
This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information.

Surgery

It is important that a person seek the opinion of different members of the multidisciplinary team prior to deciding on a specific treatment. Even though surgery is the fastest way to eliminate cancerous tissues, other treatment methods do exist and may be equally effective in treating the cancer. People are encouraged to ask about other treatment options.