Office of Cancer Control and Prevention

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Oral/Pharyngeal Cancer

What is it?

  • Oral and oropharyngeal cancer include cancer of the lip, tongue, floor of the mouth, palate, gingiva and alveolar mucosa, buccal mucosa, and oropharynx. Oral and oropharyngeal cancer is the sixth most common cancer among white males and the fourth most common among black males. Males are approximately twice as likely as females to be diagnosed with and to die from oral and oropharyngeal cancer. Males have traditionally had higher incidence rates than females in New Jersey and throughout the US, although in recent years, the gap has narrowed due at least in part, to the increasing number of women who began smoking over the past three decades

  • More than 90% of oral cancers are squamous cell carcinoma, arising in the lining tissue of the mouth and throat. About 5% are salivary gland malignancies, and smaller percentages are melanomas, sarcomas, and lymphomas. The primary focus of a cancer control program for oral and oropharyngeal cancers must, therefore, be on squamous cell carcinoma, the predominant type.

What puts me at risk?

The known risk factors for oral and oropharyngeal squamous cell carcinoma are long-term tobacco use, heavy alcohol use, infection with HPV, use of betel (areca) quid popular in Asian population, immunosuppression, and in the case of lip cancer, long-term sun exposure.

  • Use of tobacco. Inhaled, burnt tobacco can damage cells in the lining of the oral cavity and upper throat. Smokers are six times more likely than nonsmokers to develop oral or upper throat cancers. About 75% of people who develop these cancers admit to cigarette, pipe or cigar smoking. Smokeless tobacco use may also elevate the oral cancer risk.
  • Excessive alcohol consumption. Alcohol also can damage cells inside your mouth and upper throat. Most people diagnosed with oral and upper throat cancers are frequent drinkers of alcohol. The combination of heavy alcohol consumption and smoking tobacco products multiplies the risk.
  • Prolonged exposure to ultraviolet light. Too much ultraviolet light can damage the cells on your lips and increase your risk of lip cancer.
  • HPV. Recent studies suggest that some strains of the human papilloma virus, including types that cause most cervical cancers, may increase the risk for developing throat and mouth cancer.
  • Immunosuppression.  The immune system is the main defense against damaging changes in cells that can lead to cancer.  Suppression of the immune system, regardless of the cause, weakens the body’s resistance to cancer.
  • Signs and symptoms. In its early stages, mouth and throat cancer is usually painless and may look just like inflammations and irritations commonly seen in the mouth.  Any red or white patch, spot, sore, ulcer, lump or discoloration that that does not go away in two weeks should be evaluated by a dentist or physician.  In addition, sores that bleed, lumps that have increased in size, numbness or tingling of the gums or lips, difficulty swallowing and changes in the voice all require evaluation. 

    For more information, log onto:
    MayoClinic.com


Preventing Cancer

Other steps you can take to help prevent oral cancer or to prevent its progression include:

  • See your dentist twice a year for a check-up, especially if you are at high risk for oral cancer. .
  •  Ask your dentist for an oral cancer screening and make sure that every visible part of your mouth and throat is examined and that the dentist checks the lymph nodes in your neck.
  • Limit your exposure to the sun. Ultraviolet light damages the skin on your lips and increases your risk of cancer. When you are out in the sun, use sun protective lip balm and a wide-brimmed hat to protect your face, including your lips.
  • Some studies suggest that a balanced diet rich in fruit and green, leafy vegetables may have a protective effect.

    For more information on preventing cancer, log onto:
    MayoClinic.com


Screening for Early Detection

  • Oral Exam – Ask for an oral cancer screening. Screening for oral cancer may be done during a physical exam by the dentist or physician. The areas of the mouth that are inspected for early detection are: the floor of the mouth, the front and sides of the tongue, and the soft palate. During the exam, the physician or dentist will pull out your tongue, sometimes with gauze wrapped around it, and feel under the tongue, inside the cheeks, and your neck.

    For more information on oral cancer screening, log onto :
    Mayo Foundation for Medical Education and Research
    National Cancer Institute – Oral Cancer Screening

Treatment Options

  • Surgery -The type of surgery you may need depends on the size and location of the tumor. For tumors that have invaded nearby tissues, surgery is more extensive. Sometimes surgeons need to remove bone from the jaw or roof of the mouth. To treat a cancer of your tongue or the upper part of your throat, your surgeon may need to remove tissues that you use to swallow and in some cases your voice box (larynx). If the cancer has spread beyond your mouth, your surgeon also may need to remove lymph nodes in your neck.

  • Radiation therapy- Radiation therapy uses X-rays to kill cancer cells. This approach also may be used along with surgery to destroy small amounts of cancer cells that couldn't be removed during surgery.  These treatments also affect the normal tissues near the tumor and may result in dry mouth, loss of teeth, skin changes and loss of hair follicles.  The side effects of radiation and other cancer treatments must be discussed in detail with your physician and with the dentist who will care for you after the treatment is done.

  • Chemotherapy- With chemotherapy, drugs are used to destroy cancer cells. You take these drugs either through your veins (intravenously) or orally. The type of drugs and the length of treatment depend on the size, type, and location of the tumor. Chemotherapy may also be used before surgery in order to shrink a tumor. Or, in the case of a large and invasive tumor, chemotherapy may be used in combination with radiation therapy and in place of surgery.

  • Reconstructive surgery- The goal of reconstructive surgery is to improve your appearance and to help you adjust to difficulties you may have chewing, swallowing, speaking or breathing. Sometimes you will need grafts of skin or other tissue from other parts of your body to rebuild areas in your mouth, throat or jaw. If you have had extensive surgery in your neck, you may also undergo surgery to create a hole in your neck (tracheostomy) to help you breathe more easily. If muscles you need for swallowing have been removed, you'll need surgery to create a hole in your abdomen (gastrostomy) in order to receive food directly into your stomach through a feeding tube.

  • Rehabilitation- Adjusting to life after your surgery may mean working with a speech therapist and dietitian. A speech therapist can help you overcome problems with speech and eating. If you have lost the ability to speak, you can learn to speak by forcing air up through your esophagus (esophageal speech). Artificial devices also are available to help you speak or speak more loudly. A dietitian can help you choose foods that are suitable for you if you've lost some of your ability to chew and swallow. In addition, you may benefit from sessions with a physical therapist and occupational therapist to help you make adjustments in your personal and work routines.

    For more information about treatment options, log onto:
    MayoClinic.com

    For information on finding a doctor or treatment facility, log onto: http://www.cancer.gov/cancertopics/factsheet/Therapy/doctor-facility


    Clinical Trials

Coping with Cancer

    Palliative Care

    • Palliative care is a coordinated, inter-disciplinary approach to healthcare that enhances the quality of life of patients with cancer and other illnesses. It targets the physical and psychological symptoms and spiritual needs of patients from the time of diagnosis to end-of-life care in all settings.

    For more information on Palliative Care , log onto:
    The World Oncology Network
    StopPain.org
    New Jersey Hospice and Palliative Care Organization

    Children Coping with Parents with Oral & Oropharyngeal Cancer

    • Learn more about all different types of cancers.
    • Questions that children might have dealing with cancer.
    • Books to help children understand more about certain cancers.
    • Stories from other children.
    • Camps and foundations.

    For more information, log onto:
    CancerSourceKids


Statistics

Comprehensive Cancer Control Plan
New Jersey State Cancer Registry

More Information