Oral and Oropharyngeal Cancer

OVERVIEW

Head and neck cancers account for about 3 percent of all cancers in the United States. Of head and neck cancers, oral and oropharyngeal cancers are two of the most common types. In 2007, the American Cancer Society estimates that 31,000 men and women will be diagnosed with oral and oropharyngeal cancer in the United States. The disease is twice as likely to occur in men than women because men are more likely to use tobacco and alcohol for a long time and in large enough doses to cause cancer. Since the 1980s, with the adult smoking rate decreasing, the incidence rate and deaths from oral and oropharyngeal cancer are also decreasing. With early detection and treatment when the cancer is localized, there is a five-year survival rate of 82 percent. The five-year survival rate for all stages combined is 59 percent.

Oral cancer begins in the mouth (also called the oral cavity), including the lips, the lining of the lips and cheeks, the teeth and gums, the front two-thirds of the tongue, the floor of the mouth, the hard palate (roof of the mouth), and the areas behind the wisdom teeth. Oropharyngeal cancer begins in the oropharynx, the area just behind the mouth where the oral cavity stops. It includes the back of the mouth, the soft palate, the tonsillar area, and the pharyngeal wall (back wall of the throat).

John Theurer Cancer Center's Division of Head and Neck Oncology comprises board-certified otolaryngologists who are highly skilled in the diagnosis, treatment, and management of all types of cancers that affect the head and neck. The head and neck cancer team brings together experts in otolaryngology (ear, nose, and throat medicine), plastic and reconstructive surgery, medical oncology, maxillofacial surgery, dentistry, radiation oncology, radiology, and nursing. This specialized approach to treating head and neck cancers provides patients with the exact type of services they need to battle the disease and its physical, emotional, and social side effects.

DIAGNOSTIC SERVICES - OROPHARYNGEAL CANCER

Your doctor may use several different approaches to diagnose oral and oropharyngeal cancer. The Cancer Center offers:

  • nasopharyngoscopy, pharyngoscopy, and laryngoscopy (tests involving fiberoptic scopes and mirrors to view the structures)
  • panendoscopy (a test involving fiberoptic scopes to view the larynx, hypopharynx, esophagus, trachea, and bronchi)
  • tissue and cell samples (including exfoliative cytology, which involves scraping lesions from the area; biopsies; and fine needle aspiration)
  • CT scan
  • MRI
  • panorex (rotating X-rays of the upper and lower jawbones)
  • chest X-rays (to see if the cancer has spread to the lungs)
  • barium swallow
  • radionuclide bone scan (to see if the cancer has spread to the bones)

RISK FACTORS

By far, the greatest risk factor for oral and oropharyngeal cancer is the use of tobacco. Ninety percent of patients diagnosed with these cancers use tobacco. Smokers are six times more likely than non-smokers to be diagnosed with one of these cancers. The habitual use of alcohol is another leading risk factor; 75 to 80 percent of those diagnosed drink alcohol frequently. Men are twice as likely to be diagnosed than women because men are more likely to use tobacco and alcohol for a long time and at large enough doses to cause cancer. Other risk factors include:

  • ultraviolet light or sun exposure (30 percent of patients with cancer of the lips have outdoor jobs)
  • vitamin A deficiency
  • human papillomavirus (HPV) infection (may contribute to 20 to 30 percent of oral cancer cases)
  • taking immunosuppressant drugs to treat immune system disease or to prevent organ rejection after transplantation
  • long-term irritation to the lining of the mouth from poorly fitting dentures
  • Plummer-Vinson syndrome, a rare iron deficiency

SYMPTOMS

The most common symptoms for oral and oropharyngeal cancers are:

  • a sore in the mouth that does not heal
  • persistent pain in the mouth
  • a lump or thickening in the cheek
  • a persistent white or red patch on the gum, tongue, tonsil, or lining of the mouth
  • a sore throat that doesn't go away
  • difficulty chewing or swallowing or moving the jaw or tongue
  • numbness of the tongue or other area of the mouth
  • swelling of the jaw that causes dentures to fit poorly or become uncomfortable
  • loosening of the teeth or pain around the teeth or jaw
  • voice changes
  • a lump or mass in the neck
  • weight loss

TREATMENT SERVICES

The main treatment for oral and oropharyngeal cancers is surgery, which may be combined with radiation therapy and/or chemotherapy for optimal treatment.

Surgery

The main treatment for oral and oropharyngeal cancers is surgery. There are a number of surgical options based on the type of tumor, where it is located, its size, whether and where it has spread, and the patient's general health. Surgical options include:

  • primary tumor resection (removal of the tumor and surrounding tissue)
  • full or partial mandible resection (removal of the tumor, surrounding tissue, and possibly a portion of the jawbone)
  • maxillectomy (removal of the tumor and the roof of the mouth)
  • Mohs surgery (removal of lip cancer tumors in slices)
  • laryngectomy (removal of the voice box if a tumor of the tongue or oropharynx is at risk of causing problems with swallowing and allowing food to go into the lungs)
  • neck dissection (removal of lymph nodes in the neck, if the cancer has spread to them)
  • pedicle or free flap reconstruction (a type of reconstructive surgery using skin grafts from the chest or back to repair defects in the mouth, throat, or neck caused by removal of large tumors)
  • tracheostomy (a permanent opening made through the neck into the windpipe, into which a tube is inserted to enable breathing, if a tumor is blocking the trachea)
  • gastrostomy tube (a feeding tube placed into the stomach if the cancer doesn't permit the patient to swallow)
  • dental extractions and implants (to facilitate radiation therapy or if the jawbone is removed due to cancer)

Radiation Therapy

Three-dimensional conformal radiation therapy is the most common type of radiation therapy used to treat oral and oropharyngeal cancers. High-dose-rate brachytherapy (the insertion of small rice-like tubes containing radiation into the tumor) may be used in combination with three-dimensional conformal radiation therapy.

Chemotherapy

Chemotherapy may be used at the time of radiation therapy or before surgery to help shrink tumors.