February 3, 2010

Oral Cancer 101

All parts of the mouth can get cancer. This includes the throat, lips, tongue, and every other part of the mouth.

Oral cancer comes in two forms: oral cavity cancer and oropharyngeal cancer. The first spreads from the mouth, and the second from the throat.

Of all the signs of oral cancer, the most typical are a bleeding sore or sores that will not heal and pain in the mouth that does not stop. As well as these symptoms, the following may be early signs of mouth cancer:

  • A red or white patch in any area of the mouth
  • A lump in the cheek
  • An area of the mouth that has grown encrusted
  • Problems with tongue movement, swallowing, or chewing

Dentists are trained to detect these early signs of mouth cancer, which makes regular dental exams all the more crucial.

Determining the Stage of Oral Cancer

If a dentist can’t identify the source of any of the symptoms listed above, she may refer the patient to a throat, nose, or ear specialist. The specialist may in turn call for a biopsy, which is the extraction (under local or general anesthesia) of a small bit of tissue by a pathologist, who then examines it to see if cancer cells are present.

If the pathologist does find cancer cells, a doctor will then employ an x-ray, CT scan, MRI, endoscopy, and/or PET scan to determine the stage of the cancer based on tumor size and degree of isolation. In stages I and II (early oral cancer), the tumor is typically less than the size of a walnut and the cancer cells will not have spread to the lymph nodes. In stages III and IV (advanced oral cancer), the tumor may be as large as a lime and the cancer cells will have spread to surrounding tissue, possibly including the lymph nodes and other areas.

Oral Cancer Treatments

Once the stage of the oral cancer has been determined, four treatments are possible: surgery, radiation therapy, chemotherapy, and targeted therapy. The nature of surgery depends upon the degree of advancement of the mouth cancer.

Smaller tumors involve less invasive surgeries, which may have minimal lasting effects. However, larger and more advanced tumors may require the surgeon to remove parts of the tongue or jaw, which can permanently affect the patient’s appearance and ability to speak, chew, or swallow.

As fatigue and pain are common post-surgery symptoms, patients should discuss post-surgery pain management strategies with their doctors. Treatment that involves the use of high-energy rays to destroy cancer cells is known as radiation therapy. This may or may not be employed in conjunction with surgery.

In higher doses, radiation therapy often entails a number of side effects, including dry mouth, fatigue, and weight loss. Management strategies for these side effects should be discussed between patient and doctor prior to radiation therapy.

Treatment that involves the use of anti-cancer drugs (usually administered intravenously) to destroy cancer cells is known as chemotherapy, and is often accompanied by radiation therapy and may produce many of the same side effects.

Though it targets cancer cells, chemotherapy often inadvertently damages blood cells also, as well as cells in the hair roots and the digestive tract. This can lead to fatigue, hair loss, nausea, and loss of appetite.

A fourth and final oral cancer treatment is targeted therapy, which uses a drug that binds to mouth cancer cells and stunts their growth. Targeted therapy may be used with radiation therapy and chemotherapy.

It is important for patients beginning oral cancer treatment not only to consult their doctor regarding the range of treatments and their side effects, but also to seek out a second opinion, perhaps from a surgeon or medical oncologist, about the original diagnosis.