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Lip and Oral Cavity Cancer

Description

What is cancer of the lip and oral cavity?

Cancer of the lip and oral cavity is a disease in which cancer (malignant) cells are found in the tissues of the lip or mouth. The oral cavity includes the front two thirds of the tongue, the upper and lower gums (the gingiva), the lining of the inside of the cheeks and lips (the buccal mucosa), the bottom (floor) of the mouth under the tongue, the bony top of the mouth (the hard palate), and the small area behind the wisdom teeth (the retromolar trigone).

Cancers of the head and neck are most often found in people who are over the age of 45. Cancer of the lip is more common in men than in women, and is more likely to develop in people with light-colored skin who have been in the sun a lot. Cancer of the oral cavity is more common in people who chew tobacco or smoke pipes.

A doctor should be seen if a person finds a lump in the lip, mouth, or gums, finds a sore in the mouth that doesn?t heal, or has bleeding or pain in the mouth. Another sign of a cancer of the mouth or gums is when dentures no longer fit well. Often lip and oral cavity cancers are found by dentists when examining the teeth.

If there are symptoms, a doctor will examine the mouth using a mirror and lights. The doctor may order x-rays of the mouth. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. The patient will be given a substance to take feeling away from the area for a short time (a local anesthetic) so no pain is felt. The doctor will also feel the throat for lumps.

The chance of recovery (prognosis) depends on where the cancer is in the lip or mouth, whether the cancer is just in the lip or mouth or has spread to other tissues (the stage), and the patient?s general state of health.

Stage Explanation

Stage of cancer of the lip and oral cavity

Once cancer of the lip and oral cavity is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for cancer of the lip and oral cavity:

Stage I

The cancer is no more than 2 centimeters (about 1 inch) and has not spread to lymph nodes in the area (lymph nodes are small bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells).

Stage II

The cancer is more than 2 centimeters, but less than 4 centimeters (less than 2 inches), and has not spread to lymph nodes in the area.

Stage III

Either of the following may be true:

  1. The cancer is more than 4 centimeters.

  2. The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimeters (just over one inch).

Stage IV

Any of the following may be true:

  1. The cancer has spread to tissues around the lip and oral cavity. The lymph nodes in the area may or may not contain cancer.

  2. The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches).

  3. The cancer has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lip and oral cavity or in another part of the body.

Treatment Option Overview

How cancer of the lip and oral cavity is treated

There are treatments for all patients with cancer of the lip and oral cavity. Two kinds of treatment are used:

  • Surgery (taking out the cancer)

  • Radiation therapy (using high-dosex-rays or other high-energy rays to kill cancer cells)

Chemotherapy (using drugs to kill cancer cells) is being tested in clinical trials.

Surgery is a common treatment of cancer of the lip and oral cavity. The doctor may remove the cancer and some of the healthy tissue around the cancer. The doctor may also remove the lymph nodes in the neck (lymph node dissection).

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors.Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes or needles in the area where the cancer cells are found (internal radiation therapy). If smoking is stopped before radiation therapy is started, the patient has a better chance of surviving longer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

If the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given chemotherapy after surgery to kill any cancer cells that are left. Chemotherapy given after an operation to a person who has no cancer cells that can be seen is called adjuvant chemotherapy. Chemotherapy given before surgery to try and shrink the cancer so it can be removed is called neoadjuvant chemotherapy.

Hyperthermia is a new treatment being tested in certain patients. It uses a special machine to heat the body for a certain period of time to kill cancer cells. Because cancer cells are often more sensitive to heat than normal cells, the cancer cells die and the cancer shrinks.

Because the lips and mouth are needed to eat and talk, a patient may need special help adjusting to the side effects of the cancer and its treatment. The doctor will consult with several kinds of doctors who can help determine the best treatment for the patient. Trained medical staff can also help a patient recover from treatment and adjust to new ways of eating and talking. A patient may need plastic surgery or help learning to eat and speak if a large part of the lip or mouth is taken out.

Treatment by stage

Treatment of cancer of the lip and oral cavity depends on where the cancer is, the stage of the disease, and the patient?s age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for patients with cancer of the lip and oral cavity. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I Lip and Oral Cavity Cancer

Treatment depends on where the cancer is in the lip or mouth.

Lip cancer

If the cancer is in the lip, treatment may be one of the following:

  1. Surgery.

  2. Radiation therapy.

Tongue cancer

If the cancer is in the tongue, treatment may be one of the following:

  1. Surgery.

  2. Surgery followed by radiation therapy to the neck.

  3. Radiation therapy to the mouth and the neck.

Buccal mucosa cancer

If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:

  1. Surgery.

  2. Radiation therapy.

Floor of the mouth cancer

If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:

  1. Surgery.

  2. Radiation therapy.

Lower gum cancer

If the cancer is in the lower gums (gingiva), treatment may be one of the following:

  1. Surgery.

  2. Radiation therapy.

Retromolar trigone cancer

If the cancer is in the small area behind the wisdom teeth, (retromolar trigone), treatment may be one of the following:

  1. Surgery to remove part of the jawbone.

  2. Radiation therapy followed (if needed) by surgery.

Upper gums and hard palate cancer

If the cancer is in the upper gums (gingiva) or the top bony part of the mouth (hard palate), treatment may be one of the following:

  1. Surgery.

  2. Surgery followed by radiation therapy.

Stage II Lip and Oral Cavity Cancer

Treatment depends on where the cancer is in the lip or mouth.

Lip cancer

If the cancer is in the lip, treatment may be one of the following:

  1. Surgery.

  2. External and/or internal radiation therapy.

Tongue cancer

If the cancer is in the tongue, treatment may be one of the following:

  1. Radiation therapy.

  2. Surgery and radiation therapy.

Buccal mucosa cancer

If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:

  1. Radiation therapy.

  2. Surgery.

  3. Surgery plus radiation therapy.

Floor of the mouth cancer

If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:

  1. Surgery.

  2. Radiation therapy.

  3. Surgery followed by internal or external radiation therapy.

Lower gum cancer

If the cancer is in the lower gums (gingiva), treatment may be one of the following:

  1. Surgery.

  2. Radiation therapy.

Retromolar trigone cancer

If the cancer is in the small space behind the wisdom teeth (retromolar trigone), treatment may be one of the following:

  1. Surgery to remove part of the jawbone.

  2. Radiation therapy followed (if needed) by surgery.

Upper gum or hard palate cancer

If the cancer is in the upper gums or the top bony part of the mouth (hard palate), treatment will probably be surgery followed by radiation therapy.

Stage III Lip and Oral Cavity Cancer

Treatment depends on where the cancer is in the lip or mouth. In addition to the treatments listed below, a patient will probably have radiation therapy to the neck with or without surgery to remove lymph nodes in the neck (lymph node dissection).

Lip cancer

If the cancer is in the lip, treatment may be one of the following:

  1. Surgery to remove the cancer plus internal or external radiation therapy.

  2. Radiation therapy.

  3. A clinical trial of chemotherapy followed by surgery or radiation therapy.

  4. A clinical trial of surgery followed by chemotherapy.

  5. A clinical trial of surgery, radiation therapy, and chemotherapy.

  6. A clinical trial of a new radiation therapy technique (superfractionated).

Tongue cancer

If the cancer is in the tongue, treatment may be one of the following:

  1. External radiation therapy with or without internal radiation therapy.

  2. Surgery followed by radiation therapy.

Buccal mucosa cancer

If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:

  1. Surgery to remove the cancer and the tissue around it.

  2. Radiation therapy.

  3. Surgery plus radiation therapy.

  4. A clinical trial of chemotherapy followed by surgery or radiation therapy.

  5. A clinical trial of surgery followed by chemotherapy.

  6. A clinical trial of surgery, radiation therapy, and chemotherapy.

Floor of the mouth cancer

If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:

  1. Surgery to remove the cancer and lymph nodes in the neck. Part of the jawbone may also be removed if necessary.

  2. External radiation therapy with or without internal radiation therapy.

  3. A clinical trial of chemotherapy followed by surgery or radiation therapy.

  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Lower gum cancer

If the cancer is in the lower gums (gingiva), treatment will probably be radiation therapy given before or after surgery to remove the cancer.

Retromolar trigone cancer

If the cancer is in the small space behind the wisdom teeth (retromolar trigone), treatment may be one of the following:

  1. Surgery followed by radiation therapy.

  2. A clinical trial of chemotherapy followed by surgery or radiation therapy.

  3. A clinical trial of surgery followed by chemotherapy.

  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Upper gum or hard palate cancer

If the cancer is in the top part of the gums (gingiva) or the top bony part of the mouth (the hard palate), treatment may be one of the following:

  1. Radiation therapy.

  2. Surgery plus radiation therapy.

For all stage III lip and oral cavity cancers, clinical trials are testing chemotherapy combined with radiation therapy.

Stage IV Lip and Oral Cavity Cancer

Treatment depends on where the cancer is in the lip or mouth. In addition to the treatments listed below, a patient will probably have radiation therapy to the neck with or without surgery to remove lymph nodes in the neck (lymph node dissection).

Lip cancer

If the cancer is in the lip, treatment may be one of the following:

  1. Surgery to remove the cancer plus internal or external radiation therapy.

  2. A clinical trial of radiation therapy.

  3. A clinical trial of chemotherapy combined with radiation therapy.

  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Tongue cancer

If the cancer is in the tongue, treatment may be one of the following:

  1. Surgery to remove the tongue and the voice box (larynx) below it followed by radiation therapy.

  2. Radiation therapy to relieve symptoms.

  3. A clinical trial of chemotherapy combined with radiation therapy.

  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Buccal mucosa cancer

If the cancer is in the lining of the inside of the cheeks and lips (buccal mucosa), treatment may be one of the following:

  1. Surgery to remove the cancer and the tissue around it.

  2. Radiation therapy.

  3. Surgery plus radiation therapy.

  4. A clinical trial of chemotherapy combined with radiation therapy.

  5. A clinical trial of fractionated (smaller doses) radiation therapy.

Floor of the mouth cancer

If the cancer is in the bottom (floor) of the mouth, treatment may be one of the following:

  1. Surgery to remove the cancer followed by radiation therapy.

  2. Radiation therapy followed by surgery.

  3. A clinical trial of chemotherapy combined with radiation therapy.

  4. A clinical trial of fractionated (smaller doses) radiation therapy.

Lower gum cancer

If the cancer is in the lower gums (gingiva), treatment may be one of the following:

  1. Surgery, radiation therapy, or both.

  2. A clinical trial of chemotherapy combined with radiation therapy.

  3. A clinical trial of fractionated (smaller doses) radiation therapy.

Retromolar trigone cancer

If the cancer is in the small space behind the wisdom teeth (retromolar trigone), treatment may be one of the following:

  1. Surgery followed by radiation therapy.

  2. A clinical trial of chemotherapy combined with radiation therapy.

  3. A clinical trial of fractionated (smaller doses) radiation therapy.

Upper gum or hard palate cancer

If the cancer is in the top part of the gums (gingiva) or the top bony part of the mouth, treatment may be one of the following:

  1. Surgery plus radiation therapy.

  2. A clinical trial of chemotherapy combined with radiation therapy.

  3. A clinical trial of fractionated (smaller doses) radiation therapy.

Recurrent Lip and Oral Cavity Cancer

Treatment depends on the type of treatment the patient had before. If radiation therapy was given, the patient may have surgery when the cancer comes back. If surgery was used, the patient may have more surgery, radiation therapy, or both. Patients may want to consider taking part in a clinical trial of new chemotherapydrugs, chemotherapy plus additional radiation therapy, or hyperthermia.

Changes to This Summary (07/19/2005)

The PDQcancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary and links to the NCI Dictionary of Cancer Terms were added..

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Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

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