Oral Cavity Cancer (Tongue and Mouth)
Oral Cavity Cancer (Tongue and Mouth) Overview
Oral cavity cancer (also called oral cancer or cancer of the mouth) develops when a tumor forms in the oral cavity, which includes the following structures:
- Front two-thirds of the tongue
- Roof or floor of the mouth
- Lining of the cheeks and/or lips
These tumors arise when cells inside the oral cavity mutate abnormally in a process called oncogenesis. Nearly all oral cancers are squamous cell carcinomas—also known as squamous cell cancers. These cancer cells are thin and flat and form in the lining of the mouth. Oral cavity cancer is a type of head and neck cancer. It is a life-threatening and life-altering disease that often necessitates a “new normal” for patients who are diagnosed. Cancer within the mouth can spread rapidly and, as with other cancers, early detection improves the effects of treatment. If caught quickly, oral cancer responds well to treatment. Cancer of the mouth accounts for about 3% of all cancers diagnosed annually, or approximately 54,000 cases per year. Oral cancer can be diagnosed by a physician or dentist. Many dentists screen for oral cancer of the tongue or mouth during an annual dental exam by examining your mouth, tongue, lips, and neck.
Anatomy of the Oral Cavity
Your oral cavity is comprised of your mouth, including the following:
- Tongue (front two-thirds)
- Roof of your mouth (hard palate)
- Floor of your mouth (under your tongue)
- Buccal mucosa (cheek and lip lining)
- Retromolar trigone (the small area of tissue behind your wisdom teeth)
Oral Cavity Cancer Symptoms
Symptoms of cancer of the mouth may include:
- Visible red or white patches in the mouth, or on your tongue or gums
- Mouth sore that doesn’t heal
- Unusual bleeding, swelling, or pain in the mouth
- Loose teeth
- Pain or difficulty swallowing that does not go away while chewing, and/or speaking
- Difficulty moving your tongue and jaw
- Lump in your neck
- Earache or ear pain that won’t go away
- Numbness of your tongue or in your mouth
Oral cancer symptoms can be different for everybody, and many of the symptoms above are shared with less-serious diseases and illnesses. If you are worried that you might have oral cancer, it is important to make an appointment with your doctor as soon as possible.
Oral Cavity Cancer Treatments
Oral cancer can be treated by surgery, radiation therapy, and/or chemotherapy. Most often, cancer of the mouth is treated with a combination of these treatments. For most oral cavity cancers, a patient will undergo surgery first, followed by radiation and/or chemotherapy, depending on a tumor’s characteristics. Treatment is based on the size and type of the tumor, where the oral cancer of the tongue or mouth originated, and whether the cancer has metastasized. Patients with oral cavity cancer are often treated by head and neck surgeons; ear, nose, and throat doctors; oncologists; and radiation oncologists.
Surgery is usually the first line of treatment for oral cancer. The best chance for a good outcome, and/or a complete cure, is when all of the following are true:
- You are healthy enough to undergo surgery
- The surgery is performed within 30 days of diagnosis
- The cancer can be fully removed
The scope of surgical intervention is dependent upon the size, location, and spread of the cancer. Surgery for oral cancer can be complex. Treatment involves removing the tumor, along with a cuff of normal tissue (called the margin) to maximize the likelihood that all cancer is removed. Lymph nodes that may be at risk of developing metastatic growths are also removed in an operation called a neck dissection. Types of oral cavity cancer surgery include:
- Glossectomy to remove a part of, or all of, the tongue
- Laryngectomy to remove all of, or a portion of, your voice box (larynx)
- Oral cavity composite resection, where a portion of the jaw is removed with other soft tissues of the oral cavity like the tongue or floor of mouth
The next phase of surgery involves reconstructive surgery to help restore form and function of the mouth and surrounding structures. The primary purpose of reconstructive surgery is to prevent saliva leakage by assembling structures of the oral cavity in a way where saliva remains in the mouth. The secondary focus is to restore function. As the anatomy of the head and neck are critical to a person’s ability to breathe, speak, and swallow, reconstruction to help restore these functions is critical. For example, the tip of your tongue is important for speech as it interacts with your teeth, mouth, and lips to create sound and form words. If a tumor on the tongue is removed, surgeons will try to spare as much of the tongue as possible so patients can speak and swallow. The final goal of head and neck reconstruction is to restore these functions and attempt to optimize cosmesis, to preserve and restore one’s outward physical appearance.
After surgery, radiation therapy or chemotherapy—or a combination of the two—is often the next step for patients whose tumor has aggressive features on final analysis. All tumors are reviewed after surgery by a pathologist, who examines the tissue under a microscope to determine the overall size of the tumor, margin status, number of lymph nodes involved, and presence of aggressive features like:
- Perineural invasion (tumor crawling along nerves)
- Lymphovascular invasion (tumor growing into lymphatic channels or blood vessels)
- Extra nodal extension (whether tumor in any lymph nodes has broken through the lymphnode capsule)
This final pathology report determines the stage of the tumor and whether radiation therapy or chemotherapy will be beneficial.
Radiation therapy describes the use of radiation – or beams of intensely focused, high-energy X-rays, gamma rays, electron beams, or protons – to destroy the cancer cells and treat cancers of the mouth. One of the most common forms of cancer treatment, radiation is generally administered through external beam radiation therapy (EBRT) or intensity modulated radiation therapy (IMRT). Radiation therapy does not physically remove a tumor or lesion. Rather, it damages the DNA of a tumor’s cells, thereby reducing or eliminating its ability to continue growing.
Chemotherapy is the use of medicine to treat cancer and prevent tumor growth by destroying rapidly reproducing cancer cells in your body. It can be administered by infusion, injection, or by mouth. It is often used if a cancer has metastasized, or spread. Chemotherapy is also used to lessen the likelihood that cancer will return, and it can also ease cancer symptoms by reducing the stress tumors place on nearby structures and organs.
It is a treatment often used in combination with other therapies, including radiation and surgery. While chemotherapy has proven to be an effective treatment for cancer, it can also destroy healthy cells, creating side effects that can seriously impact your quality of life.
Common Questions About Oral Cancer
What are risk factors for cancers of the mouth?
Risk factors for mouth cancer include a history of tobacco or heavy alcohol use (more than eight drinks per week for women, and more than 15 drinks per week for men); a history of head or neck cancer; radiation exposure; and previous use of paan (betel quid) in the mouth. Oral cavity cancer is more prevalent in individuals over the age of 40, and occurs more frequently in men.
What tests determine if I have oral cavity cancer of my mouth or tongue?
Tests to diagnose cancers of the mouth include a physical exam looking for a lump in the neck or mouth; nasal endoscopy to look at the sinuses, throat, and back of the neck; and medical imaging. If your doctor finds a suspicious lesion, you may need a laryngoscopy. This is an exam done under anesthesia to biopsy and examine the voice box, vocal cords, and throat. Biopsies for oral cavity cancers can also sometimes be completed in the office under local anesthetic.
Is oral cavity cancer treatable?
Yes, oral cavity cancers are treatable. They can be treated with surgery, radiation therapy, chemotherapy, or with a combination of these therapies. How these tumors are treated depends on patient-specific factors, such as overall health, medical history, and size and spread of the cancer.
Generally speaking, oral cavity cancers are more successfully treated when caught in the earlier stages of development.
How quickly does oral cancer spread?
The speed of mouth cancer spread varies from tumor to tumor. Most oral cavity cancers tend to spread locally and regionally, within the lymph nodes of the neck. It’s recommended that patients begin treatment within four to six weeks of initial diagnosis.
What are the stages of oral cancer?
- Stage 0 Oral Cavity Cancer: This is the earliest stage of mouth cancer. Stage 0 indicates pre-cancerous/abnormal cells in the oral cavity that could evolve into Stage I oral cancer.
- Stage I Oral Cavity Cancer: Stage I is an early phase of oral cavity cancer where a tumor is no larger than 2 centimeters and has not spread to the lymph nodes.
- Stage II Oral Cavity Cancer: Stage II mouth cancer describes a tumor is larger than 2 centimeters but smaller than 4 centimeters. As with Stage I, this stage of cancer also has not spread to the lymph nodes.
- Stage III Oral Cavity Cancer: Stage III oral cancer describes a tumor larger than 4 centimeters that may or may not have spread to the lymph nodes.
- Stage IV Oral Cavity Cancer: Stage IV oral cancer tumors can be any size, with the disease having spread to other parts of the body, including areas of the body outside of the head and neck; other parts of the oral cavity (such as the lips, tongue, or jaw); or to a lymph node on one or both sides of the neck.
What is the survival rate for cancer of the mouth?
On average, national and international data suggest that the five-year overall survival rate for mouth
cancer is 50% to 60%.
Can oral cavity cancer be cured?
Yes, oral cancer can be cured. After a patient has completed cancer treatment, a patient’s medical team will continue to monitor for signs of the cancer returning. After five years of treatment, if there are no signs of cancer, physicians will consider a patient cured.
Can oral cancer return?
Yes, oral cavity cancers can be aggressive, as they are often caused by years (or decades) of exposure to substances like tobacco and alcohol. Other conditions that accompany heavy use of these substances can compromise a patient’s health in other areas of the body, like the lungs or heart. As such, a risk of recurrence can be high, but this risk is dependent upon the original tumor and patient’s overall health.
What are the side effects of surgical treatment for oral cancer?
Surgery requires the removal of the entirety of the tumor and a cuff of normal tissue. Surgery also requires access to the tumor. As such, the side effects of surgery can vary widely. Chemotherapy and radiation therapy on top of surgery can also result in long-term side effects. Patients can often expect a “new normal” post-surgery.
Treatment goals include:
- Removing all of the cancer
- Restoring separation between the mouth and deep structures of the neck to prevent saliva from bathing critical structures like the carotid artery
- Enabling breathing, speech, and swallowing
- Optimizing one’s outward physical appearance post-surgery.
Additionally, every patient who is undergoing a major head and neck cancer operation has a low risk of long-term tracheostomy or feeding tube dependence.
What types of mouth cancer are there?
More than 90% of head and neck cancers are oral squamous cell cancers. This type of cancer is detailed above. Other types of cancers in the oral cavity include salivary gland cancers, lymphomas, and mucosal melanomas.
Salivary Gland Cancers: Oral cavity cancers can develop in the minor salivary glands, located in the mouth on each side of your face. The most common type of salivary gland cancer is mucoepidermoid carcinoma. Other types of cancers of the salivary glands include adenoid cystic carcinoma, acinic cell carcinoma, carcinoma ex pleomorphic adenoma, polymorphous adenocarcinoma, adenocarcinomas, and secretory carcinoma.
Lymphomas: Lymphoma is a cancer of the lymphatic system, including the lymph nodes and vessels in the mouth. Oral lymphomas are a rare, but serious, type of oral cavity cancer.
Mucosal Melanomas: Generally, mucosal melanomas originate in the nose or sinuses, but very rarely, they develop in the mucous membranes inside of the mouth. Mucosal melanomas in the oral cavity are an extremely rare, but aggressive, type of cancer.
Information and Resources for Oral Cavity (Tongue and Mouth) Cancer
- Moustafa Mourad, Thomas Jetmore, Ameya A. Jategaonkar, Sami Moubayed, Erin Moshier, Mark L. Urken, Epidemiological Trends of Head and Neck Cancer in the United States: A SEER Population Study, J Oral Maxillofac Surg. 2017 Dec;75(12):2562-2572. doi: 10.1016/j.joms.2017.05.008. Epub 2017 May 22. PMID: 28618252.
- Ameya A. Jategaonkar, Vivian F. Kaul, Eric Lee, Eric M. Genden, Surgery of the Palatomaxillary Structure, SEmin Plast Surg. 2020 May 34(2):71-76. doi: 10.1055/s-0040-1709430. Epub 2020 May 6. PMID: 32390773.
- American Cancer Society. Oral Cavity and Oropharyngeal Cancer Stages. March 23, 2021.
- National Institute of Dental and Craniofacial Research. Oral Cancer 5-Year Survival Rates by Race, Gender, and Stage of Diagnosis. April 2023.
- National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Oral Cavity and Pharynx Cancer. 2022.