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Oral Cancer Signs and Symptoms

US News & World Report - Health logo US News & World Report - Health 6/13/2019 Michael O. Schroeder
a man talking on a cell phone: Man feeling toothache and holding his jaw with negative expression. Man wearing casual clothing. Focus on foreground (man) Horizontal composition. Image developed from Raw format. © (Getty Images) Man feeling toothache and holding his jaw with negative expression. Man wearing casual clothing. Focus on foreground (man) Horizontal composition. Image developed from Raw format.

Often the first sign is a sore in the mouth that just won’t heal. Frequently it’s a raised white or red patch, or lesion, that may be on the tongue, the floor of the mouth or the cheek.

“Typically lesions that don’t disappear after two or three weeks probably warrant further investigation,” says Dr. Jose Zevallos, chief of the division of head and neck surgery at Siteman Cancer Center at Barnes-Jewish Hospital in St. Louis. “And they can evolve over time.”

While something like a cold sore would be expected to come and go, a sore in the mouth that persists could be a sign of a far more serious issue: oral cavity, or mouth, cancer. So it’s worth seeing a dentist or a primary care doctor for a closer evaluation. Dentists are often the first to diagnose oral cancer, perhaps while seeing patients for routine visits or addressing other common issues like cavities and gum disease.

According to the American Cancer Society, about 53,000 people this year will get oral cavity or oropharyngeal cancer – both of which are often lumped together as simply oral cancer. Annually, about 10,860 people die from these cancers. Oropharyngeal cancer involves malignancies that start in the oropharynx, which includes the soft palate (the back, muscular part of the roof of the mouth), the back one-third of the tongue and the side and back walls of the throat, the ACS notes.

As with other types of cancer – and with no routine screening guidelines for oral cancer – it’s key to heed any possible signs and symptoms of oral cancer. Early detection is “critically important for oral cavity and other head and neck cancers,” Zevallos stresses.

Of course, the earlier the cancer is caught, the better the outcomes and survival rates tend to be. “But also importantly, the smaller the tumor, the earlier the stage, the earlier it’s caught, the less invasive a surgery becomes to cure it,” Zevallos points out. He adds that oral cavity cancer is primarily treated surgically, and the larger the tumor, the greater the need for reconstruction. “If a tumor is caught early, then a surgeon can avoid removing more critical structures that will affect swallowing and speech in the long run,” he says.

Possible signs and symptoms of oral cavity or oropharyngeal cancer include:

  • Sores in the mouth or lips that won’t heal.
  • White or red patches anywhere in the mouth, gums, tongue or tonsils.
  • Persistent pain in the mouth, around the teeth or the jaw.
  • Bleeding in the mouth.
  • A lump in the cheek.
  • Jaw swelling. For denture wearers, this may affect fit.
  • Loosening of teeth.
  • A lump in the neck.
  • Voice changes.

Pay attention to the lack of symmetry with symptoms, too. Experiencing pain or burning in a specific part of your mouth, for example, can be a telltale sign of oral cavity cancer. “If you’re eating spicy foods, your whole mouth might burn, but it wouldn’t be a specific pinpoint area in your mouth or on your tongue, like for example on the left side of my tongue,” notes Dr. Jennifer Cracchiolo, a head and neck surgeon who has oral cavity cancer as one of her areas of focus at Memorial Sloan Kettering Cancer Center.

But when that burning or pain is asymmetrical, occurring in a part of the mouth, rather than uniformly, that warrants a closer look by a dental or medical provider. “If you feel an abnormality or if one side of your tongue or your cheek feels different than the other side, have it evaluated,” echoes John Comisi, an associate professor of restorative dentistry in the College of Dental Medicine at the Medical University of South Carolina. He reiterates that routine dental hygiene and exam visits are recommended twice a year – or more frequently for some who have problems like gum disease or a high rate of cavities.

Also, “there can be tumors of the gums – specifically the gingiva around the teeth; and, for example, again if asymmetrically there’s bleeding in a certain area,” Cracchiolo adds, “then that may trigger you to see a dentist earlier to have them take a look at it, and then potentially an oral surgeon or a head and neck surgeon if needed.”

Preventing and Treating Oral Cancer

Risk factors for oral cancer include:

Tobacco use and alcohol consumption – particularly drinking in excess – significantly increase the risk of developing mouth cancer. In the U.S., smoking and drinking are the leading causes of oral cavity cancer.

“In terms of prevention, for oral cavity cancer, the most important thing that one can do is not smoke,” Zevallos says. Often, clinicians point out, people both smoke and drink in excess – which further raises their risk. “The risk of oral cavity and other head and neck cancer increases exponentially in patients who smoke and drink heavily,” Zevallos says.

HPV, the most common sexually transmitted infection – which can cause cervical cancer, along with a range of other cancers – is a significant risk factor for oropharyngeal cancer.

According to the ACS, oral cancers are twice as common in men as they are in women, possibly because of higher tobacco and alcohol use in the past. Advancing age, too, puts a person at higher risk for oral cancer, which tends to take longer to develop. UV exposure can also raise the risk of developing cancer of the lip.

In addition, certain diseases ranging from genetic syndromes like Fanconi anemia to autoimmune conditions like Lichen planus that occurs primarily in middle-aged adults may also increase one’s risk for developing oral cancer.

So even if you don’t smoke or drink, it’s important to be vigilant and get evaluated right away for any possible signs of oral cancer. “Along with a clinical exam of the mouth and throat, some dentists and doctors may use special dyes and/or lights to look for abnormal areas, especially if you are at higher risk for these cancers,” according to the ACS. “If an abnormal area is spotted, tests may also be used to help decide if they might be cancers (and need to be biopsied) or to choose the best spot to take tissue from for a biopsy.”

Some people have dysplasia or the presence of abnormal cells in the mouth, which appears as leukoplakia or erythroplakia, a white or red patch, respectively. While these may be harmless, they can also sometimes precede cancer. For this reason a clinician may closely monitor the patch, while advising the patient to take other steps to reduce their risk for developing oral cavity cancer – and recommend further evaluation if the lesion changes in appearance. “We recommend things like no tobacco use, no alcohol use, no mouthwash with alcohol and biopsy with change,” Cracchiolo says.

For those who are diagnosed with oral cavity cancer, the primary treatment is surgery. The scope of the procedure depends on the cancer’s growth and the extent to which it’s spread into healthy surrounding tissues.

In addition, some patients may undergo radiation or chemotherapy. For cancer that’s detected early, however, often less needs to be done to treat it successfully. “Many patients, if it’s caught early – going back to the importance of early detection,” Cracchiolo says, “can have surgery without any additional treatment.”

Gallery: Ways Your Home Could Be Giving You Cancer (Provided by The Remedy)


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