Oral Pathology & Cancers

Oral Cancer: Introduction 

What is cancer?

Cancer is when cells in the body change and grow out of control. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not need them any longer. Cancer is made up of abnormal cells that grow even though your body doesn’t need them. In most types of cancer, the abnormal cells grow to form a lump or mass called a tumor.

What is oral cancer?

Oral cancer is cancer that starts in the mouth or throat. Oral cancer is fairly common and very curable if found and treated at an early stage. A doctor or dentist usually finds oral cancer in its early stages because the mouth can be easily examined. 

Illustration of the Oral Cavitiy
Anatomy of the Mouth (Oral Cavity); Click to Enlarge

Understanding the mouth and throat

The mouth is also called the oral cavity. It includes many parts:

  • The lips

  • The lining inside the lips and cheeks (buccal mucosa)

  • The front two-thirds of the tongue (oral tongue)

  • The gums and teeth

  • The bottom of the mouth (floor)

  • The bony top of the mouth (hard palate)

  • The area behind the wisdom teeth (retromolar trigone)

The back of the tongue (base of the tongue), the back of the roof of the mouth (soft palate), and the tonsils are not considered part of the oral cavity. Instead, they are considered part of the region called the throat (oropharynx).

Every part of the mouth has an important function. For example, the lips are very important for speaking. The tongue is also very important for speaking, as well as for swallowing. The gums help protect the teeth and keep them healthy. Salivary glands in the mouth make saliva to keep the mouth wet and to help digest food.

Cancers of the oral cavity can cause eating and speaking problems, and can sometimes hinder normal breathing.

Types of oral cancer

More than 90% of all oral cavity tumors are squamous cell carcinoma. Squamous cells make up the lining of the oral cavity (the mucosa). As cancer in the mouth's lining grows, it can spread deeper into the mouth's nearby tissues.

Verrucous carcinoma is another type of oral cancer. It's considered a type of squamous cell carcinoma, but this low-grade cancer rarely spreads to distant sites (metastasizes). It accounts for less than 5% of all diagnosed oral cancer.

Other much less common types of oral cancer include salivary gland tumors, including adenoid cystic carcinoma, adenocarcinoma, and other types of salivary gland cancer.

Talk with your healthcare provider

If you have questions about oral cancer, talk with your healthcare provider. He or she can help you understand more about this cancer. 

 Oral Cancer: Treatment Questions 

Talking with healthcare providers about cancer can be overwhelming. It can be hard to take in all of the information. It helps to be prepared. Make a list of questions and bring them to your appointments. Write the answers down in a notebook. Make sure you ask how the treatment will change your daily life, including your diet, and how you will look and feel after treatment. Ask how successful the treatment is expected to be, and what the risks and possible side effects are.

You may also want to ask a friend or family member to go with you. He or she can take notes and write down the answers, and also ask questions you may not think of. You can also ask your healthcare provider if you can record the conversation.

Below are some questions to ask during your appointments.

Deciding on a treatment

  • What kind of oral cancer do I have? Where is it?

  • What is the stage of my cancer?

  • Has the cancer spread from where it started?

  • What treatments do you think are best for me and why?

  • Will I have trouble swallowing, eating, or speaking after treatment? Will I lose teeth?

  • Will I look different?

  • What is the success rate of this treatment for my type and stage of oral cancer?

  • What is the life expectancy for someone with my stage of cancer receiving this treatment?

  • How do I go about getting a second opinion? 

  • Are there any clinical trials I should look into?

 Getting ready for treatment

  • How long is the treatment period?

  • How long will each treatment take?

  • Who will give me the treatment?

  • Where do I have to go for the treatment?

  • Does someone need to go with me to the treatments?

  • Will the treatment affect how I look or how I use my mouth? If so, what can be done to help?

  • During treatment, will I be able to go to work and be around my family?

  • Should I change my diet? What foods will I not be able to eat?

  • Should I try to quit smoking?

  • Should I stop drinking alcohol?

  • Can I take my other medicines during the treatment period?

  • How will I feel after the treatment?

Coping during treatment

  • What side effects can I expect?

  • How long will side effects last?

  • What can I do to ease the side effects?

  • Are there side effects that I need to call you about?

  • How do I reach you after hours and on weekends?

  • What can I do to ease the side effects?

  • Are there support groups nearby that I can talk to? 

After treatment

  • How will I feel after the treatment?

  • What type of follow-up will I need after treatment?

  • How will we know if treatment worked?

Oral Cancer: Prevention

How can oral cancer be prevented? 

The best way to protect yourself from oral cancer is to know what makes you more likely to get it. These are called risk factors. You can’t affect some risk factors, but others you can.

The primary risk factors for oral cancer are:

  • Using tobacco in any form

  • Drinking alcohol in large amounts over a long period of time

The risk for oral cancer is higher in people who use both tobacco and alcohol. 

Making lifestyle changes

To help prevent oral cancer, the most important lifestyle changes are:                                                                       

  • Quitting use of all types of tobacco

  • Avoiding other people's smoke (secondhand smoke)

  • Limiting or not drinking alcohol

Other lifestyle changes that can help prevent oral cancer include:                                                                       

  • Protecting yourself from UV light exposure. People who spend a lot of time in the sun have a greater risk for lip cancer. Protect your lips with sunscreen or lip balm with an SPF of 30.

  • Preventing HPV infection. Limit your risk for oral human papillomavirus (HPV) infection. The risk for HPV is higher in people who have oral sex and multiple sex partners.

  • Eating well. People who don’t eat a lot of fruits and vegetables may have a greater risk for oral and throat cancers. It's important to eat a healthy diet.

  • Having dentures fitted properly. Dentures that rub the inside of the cheeks or the tongue can cause irritation that changes the cells of the mouth. This may contribute to an increased risk for cancer over time. All denture wearers should remove and clean their dentures every night and have them regularly checked by a dentist. Everyone should get regular dental care. 

Talk with your healthcare provider 

If you’re at risk for oral cancer, your healthcare provider can suggest resources to help. Making changes can be hard, but you don’t have to make them alone. Your healthcare provider can help you find a counselor or self-help group in your area. You’ll connect with other people who have been able to make these changes. Ask them for ideas about what worked for them.

Your healthcare provider can also screen you for oral cancer. This can help find oral cancer in its early stages, when it’s easiest to treat. 

Monthly Self-Exams

At Marshall Health, we recommend monthly self-exams, which is consistent with the recommendations of the American Association of Oral and Maxillofacial Surgeons. You need a bright light and mirror. Then follow these simple steps:

  1. Remove any dentures. 
  2. Look and feel inside your lips and the front of your gums.