Head and Neck Cancer

Home » Head and Neck Cancer » Oral Cavity Cancer

Questions to Ask Your Doctor About Your Cancer
(Free Handout)

Oral Cavity Cancer

The oral cavity includes the lip, the alveolar ridge (area immediately behind the top front teeth), the retromolar trigone (small area behind the wisdom teeth), the floor of the mouth (area under the tongue), the buccal mucosa (lining inside the lips and cheeks), the tongue, and the hard palate.

Approximately 30,000 new cases of oral cavity cancer occur each year. Studies show there is a strong link between smoking and alcohol consumption and disease development. Other factors include genetic susceptibility, diet (vitamin A deficiency), viruses (herpes simplex virus type 1), chronic irritants (e.g., poor dental hygiene), and syphilis. Pathologically, the most common tumor type found in the oral cavity is squamous cell carcinoma.

In the Unites States, cancer of the lip occurs in approximately 4000 people each year. Most cases occur on the lower lip and as many as 90% of cases occur in men. Risk factors include smoking (cigarettes and pipes) and sun exposure. Squamous cell carcinoma of the lip is the most common type, although basal cell carcinoma also can occur. The typical symptom is an ulcerative lesion or an exophytic (outward growing) growth on the lower lip.

Cancers of the alveolar ridge (area immediately behind the top front teeth) and retromolar trigone (small area behind the wisdom teeth) account for approximately 10% of all oral cancers, or about 4000 cases per year. Four times as many men are affected than women. Presenting symptoms usually include pain that is worsened by chewing. Other symptoms include loose teeth and intermittent bleeding. Nearly all of these cancers are squamous cell carcinomas.

Floor-of-the-mouth cancer usually develops around the age of 60. These cancers account for 10% to 15% of all oral cavity cancers - about 4000 to 6000 cases per year. They are approximately 3 times more common in men and typically present as infiltrating lesions that are very painful.

Cancers of the tongue occur in approximately 6000 individuals per year and account for about 15% of all oral cavity cancers. The average age at diagnosis is 60, and men are diagnosed three times more often than women. Tongue cancers, like most other oral cavity cancers, can be infiltrative or exophytic. In most cases, the primary presenting symptom is pain. Cancers of the tongue have a high risk of early lymph node involvement and spread to lymph nodes on both sides (bilateral) in as many as 25% of patients.

Tumors of the hard palate account for 5% of all oral cavity malignancies—about 1500 cases per year. They occur in men 8 times more often than in women. Squamous cell carcinoma of the hard palate accounts for about 50% of cases and tumors of the minor salivary glands (e.g., adenoid cystic, adenocarcinoma) account for the remaining cases.

Cancer of the buccal mucosa (lining inside the lips and cheeks) accounts for approximately 2500 cases per year. These cancers are often exophytic in nature. The presenting symptoms are usually pain, followed by bleeding and difficulty chewing.

Staging
See Staging for general staging rules. Oral cavity tumors are staged as follows:

TX	Primary tumor cannot be assessed
T0	No existence of primary tumor
Tis	Carcinoma in situ
T1	Tumor 2 cm or less in greatest dimension
T2	Tumor more than 2 cm but not more than 4 cm in greatest dimension.
T3	Tumor more than 4 cm in greatest dimension.
T4 (lip)	Tumor invades adjacent structures (e.g. through cortical bone, tongue, or skin of neck).
T4 (oral cavity)	Tumor invades adjacent structures (e.g. through cortical bone, into deep muscle of tongue, maxillary sinus, or skin).

Treatment

• Lip
  For early disease, either surgery or radiation is the mainstays. The choice of one over the other depends on the size and location of the disease. Given the infrequency of spread to the lymph nodes, elective treatment of the neck is not necessarily required. In advanced disease (Stages 3 and 4), a combination of surgery and postoperative radiation is often required.

• Alveolar Ridge and Retromolar Trigone
  In early disease (Stages 1 and 2) surgery or radiation alone with elective neck treatment (secondary to the tendency for regional nodal spread) is most often utilized. For advanced stages, multimodality therapy with surgery and postoperative radiation is often used.

• Floor of Mouth
  Treatment of early disease (Stage 1 and 2) involves surgical resection. However, either surgery or radiation as single modalities of therapy may be utilized. In early disease, the treatment of the neck is controversial; some opt for elective neck treatment in clinically negative necks, while others take a wait-and-see approach, with treatment reserved for those who show development of disease. For advanced disease (Stages 3 and 4), combined modality treatment with surgery and radiation is recommended. Elective treatment of the neck is required in all cases of advanced disease.

• Tongue
  Use of either surgery or radiation in early stage disease yields comparable outcomes. In advanced disease, as in other oral cavity cancers, combined modality therapy with surgery and radiation is utilized.

• Hard Palate
  For both early and advanced disease, surgery is used for primary therapy. Radiation has a role in advanced disease, depending upon the closeness or involvement of surgical margins by tumor, evidence of nerve involvement or the presence of lymph node metastases.

• Buccal Mucosa
  Small lesions (T1 or T2) can be handled equally well by either surgery or radiation. For patients with small lesions and clinically negative necks, observation can be performed rather than treatment of the neck. For more advanced lesions, treatment of the neck is advisable. In advanced cancers, treatment most often consists of surgery followed by postoperative radiation.

See oral cancer for more information.

© 1998-2008 Healthcommunities.com, Inc. All Rights Reserved.

Head and Neck Cancer Resources

	Questions to Ask Your Doctor About Your Cancer The more knowledge you have, the easier it is to make decisions about your cancer treatment. Print this free handout to take with you on your next office visit.	Advertising Disclaimer
	Join Our Head and Neck Cancer Forum Do you have a question, want to share medical advice, or just need to discuss your situation with someone else having a similar experience? The healthchannels forum is a resource for everyone to share and discuss their health and medical needs with others.
	Living with...Share your story Do you have a personal health story that you would like to share with others? As a source of free patient education, our goal is to provide our users with trustworthy information and support from others. That's why we've started our "Living with..." sections.
	Our "Living With..." support pages are a place to share experiences about living with a certain condition, disease, disorder, or illness and for loved ones of those dealing with health-related issues. Many people, especially when newly diagnosed, find comfort in knowing that others are having a similar experience. Help others by sharing your story. View stories already submitted. In honor of National Cancer Survivors Day on June 1, 2008, we asked you to share your stories about surviving cancer. Read the inspiring stories we received or share your survival story and help others in the fight against cancer.
Are you interested in becoming a nurse? Take this test. Advertising Disclaimer To quickly access health information from your website's browser, download Healthcommunities.com's healthchannels toolbar. Advertising Disclaimer