Oral cancer is any malignant (cancerous) growth found in the mouth or lips. These cancers typically begin on the tongue or bottom of the mouth, and are the most common head and neck cancer. Because of their location, they are highly treatable if caught early.

Risk Factors

We don’t always know why oral cancer develops. There are certain risk factors, though:

  • Age (older than 40)
  • Gender (males have a higher risk)
  • History of smoking or heavy alcohol use
  • Family history of head and neck cancer
  • Too much sun exposure on the lips

Human Papillomavirus (HPV), Sex, and Oral Cancer

Infections from some strains of the sexually transmitted human papillomavirus (HPV) can cause cancer on the back of the tongue (oral cancer) or the tonsils (oropharyngeal cancer). Please keep in mind that:

  • There is no cure for HPV, but most people with infections from the particularly troublesome strains do not develop cancer.
  • While the HPV vaccine cannot help patients already diagnosed with oral or oropharyngeal cancer, it can help prevent the diseases. Parents are encouraged to vaccinate their children at age 11 or 12, though men and women can get the shots as late as 26.
  • Oral and oropharyngeal cancers are tested for HPV, and those that are positive often respond well to treatment.
  • We are particularly knowledgeable about HPV-related head and neck cancers—one of our pathologists developed the vaccine and continues to research the diseases. That helps us appreciate the nuances of these cancers and the best treatment approach.

Symptoms

Symptoms of oral cancer may include:

  • White or red patches in your mouth
  • Mouth sores that will not heal
  • Bleeding in the mouth or tongue
  • Mouth or lip numbness
  • Pain while chewing or swallowing
  • A lump in your neck
  • Swelling or lump in your mouth
  • Persistent earaches
  • Constant coughing
  • Persistent sore throat or hoarse voice
  • Loose teeth or dentures that no longer fit

Other condition can also cause these symptoms, so it’s important to see a doctor right away. Keep in mind that oral cancers caused by HPV infection are often harder to detect than tobacco-related cancers because the symptoms are often subtle and painless.

Diagnosis

To make a diagnosis, our doctors:

  • Take a full medical history
  • Perform a complete head and neck exam
  • Possibly remove a small amount of the tumor during a biopsy, for further study
  • Potentially run lab and imaging tests, including:
    • X-ray
    • MRI
    • CT (CAT) scan
    • PET scan
    • Panendoscopy: direct laryngoscopy (look at voice box), esophagoscopy (esophagus) and bronchoscopy (bronchial tubes and lungs)

These exams and tests help the doctor determine:

  • The type of cancer and its stage
  • How aggressive it is
  • Whether it has spread
  • How best to treat it

Treatment

Treatment options for oral cancer depend on:

  • The cancer’s stage
  • The tumor’s size and location
  • The possible impact on your appearance and ability to talk and eat
  • Your age and overall health

Early-stage oral tumors usually get treated with surgery or radiation, or a combination of the two (sometimes lymph nodes also need radiation). Removing smaller tumors from the back of the tongue is often done with a minimally invasive approach, through robotic-assisted surgery. Learn more about our head and neck surgery, or our robot surgery.

More advanced cancers may receive a similar approach, or we may recommend a clinical trial, including chemotherapy before or after surgery or chemotherapy with radiation. We also have clinical trials for targeted therapy.

Reconstruction and Rehab

For some spots, like the lining of the cheeks, the gums, or behind the wisdom teeth, we may need to remove and then rebuild part of the jawbone. Larger tumors in the cheek linings might require a skin graft repair. For tumors removed from the tongue, we can rebuild the organ with other skin, then offer speech therapy.

Follow-Up Care

Patients who have had oral cancer are at risk of developing a second head or neck cancer, and our doctors also want to catch any original cancer that might return. After treatment, they will ask you to come in for regular checkups, as frequently as once a month for the first year.