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Table of Contents General Information About Lip and Oral Cavity Cancer
Stages of Lip and Oral Cavity Cancer
Recurrent Lip and Oral Cavity Cancer
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Recurrent Lip and Oral Cavity Cancer
Get More Information From NCI
Changes to This Summary (09/20/2007)
About PDQ
General Information About Lip and Oral Cavity Cancer
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Lip and oral cavity cancer is a disease in which malignant
(cancer) cells form in the lips or mouth.
The oral cavity includes the following:
- The front two thirds of the
tongue.
- The gingiva (gums).
- The buccal mucosa (the lining of
the inside of the cheeks).
- The floor (bottom) of the mouth under the tongue.
- The hard palate (the roof of the mouth).
- The retromolar trigone (the
small area behind the wisdom teeth).
Most lip and oral cavity cancers start in squamous cells,
the thin, flat cells that line the lips and oral cavity. These are called squamous cell carcinomas. Cancer cells may spread into deeper tissue as the cancer grows. Squamous cell carcinoma usually develops in areas of leukoplakia (white patches of cells that do not rub off).
Tobacco and alcohol use can affect the risk of
developing lip and oral cavity cancer.
Risk factors for lip and
oral cavity cancer include the
following:
Possible signs of lip and oral cavity cancer include a sore or
lump on the lips or in the mouth.
These and other symptoms may be caused by lip and oral cavity
cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the
following problems occur:
- A sore on the lip or in the mouth that does not
heal.
- A lump or thickening on the lips or gums or in the mouth.
- A white or red patch on the gums, tongue, tonsils, or lining of the mouth.
- Bleeding, pain, or numbness in the lip or mouth.
- Change in voice.
- Loose teeth or dentures that no longer fit well.
- Trouble chewing or swallowing or moving the tongue or jaw.
- Swelling of jaw.
- Sore throat or feeling that something is caught in the throat.
Lip and oral cavity cancer may not have any symptoms and is sometimes found during a regular dental exam.
Tests that examine the mouth and throat are used to detect
(find), diagnose, and stage lip and oral cavity cancer.
The following tests and procedures may be used:
- Physical exam of the lips and oral cavity: An exam to check the lips and oral cavity for abnormal areas. The doctor or dentist will feel the entire inside of the mouth with a gloved finger and examine the oral cavity with a small
long-handled mirror and lights. This will include checking the insides of the cheeks and lips; the gums; the roof and floor of the mouth; and the top, bottom, and sides of the tongue. The neck will be felt for swollen lymph nodes. A history of the patient’s health habits and past illnesses and medical and dental treatments will also be taken.
- Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope (a thin, lighted tube) is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. Tissue samples and lymph nodes may be taken for biopsy.
- X-rays of the head, neck, and chest: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. If leukoplakia is found, cells taken from the patches are also checked under the microscope for signs of cancer.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Exfoliative cytology: A procedure to collect cells from the lip or oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, mouth, or throat. The cells are viewed under a microscope to find out if they are abnormal.
- Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken. This procedure is also called an upper GI series.
- PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Certain factors affect prognosis (chance
of recovery) and treatment options.
Prognosis (chance of recovery) depends on the following:
- The stage of the cancer.
- Where the tumor is in the lip or oral cavity.
- Whether the cancer has spread to blood vessels.
For patients who smoke, the chance of recovery is better if they stop smoking before beginning radiation therapy.
Treatment options depend on the following:
- The stage of the cancer.
- The size of the tumor and where it is in the lip or oral cavity.
- Whether the patient's appearance and ability to talk and eat can stay the same.
- The patient's age and general health.
Patients who have had lip and oral cavity cancer have an increased risk of developing a second
cancer in the head or neck. Frequent and
careful follow-up is important. Clinical trials are studying the use of retinoid drugs to reduce the risk of a second head and neck cancer. Information about ongoing clinical trials is available from the NCI Web site 1.
Stages of Lip and Oral Cavity Cancer
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After lip and oral cavity cancer has been diagnosed, tests are
done to find out if cancer cells have spread within the lip and oral cavity or
to other parts of the body.
The process used to find out if cancer has spread within the lip and oral cavity or
to other parts of the body is called staging. The information gathered from the staging
process determines the stage of the
disease. It is important to know the stage in order to plan treatment.
The results of the tests used to diagnose lip and oral cavity cancer are also used to stage the disease. (See the General Information 2 section.)
The following stages are used for lip and oral cavity
cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
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| Pea, peanut, walnut, and lime show tumor sizes. |
Stage I
In stage I, cancer has formed and the tumor is 2 centimeters or smaller. Cancer has not spread to the lymph
nodes.
Stage II
In stage II, the tumor is
larger than 2 centimeters but not larger than 4 centimeters, and cancer has not spread
to the lymph
nodes.
Stage III
In stage III, the tumor:
- may be any size and has spread to a single lymph node that is 3 centimeters or smaller, on the same side of the neck as the cancer; or
- is larger than 4 centimeters.
Stage IV
Stage IV is divided
into stages IVA, IVB, and IVC as follows:
- In stage IVA, the tumor:
- has spread to nearby tissues in the lip and oral cavity; or
- is any size and may have spread to nearby tissues in the lip and oral cavity. Cancer has spread to 1 or more lymph
nodes on one or both sides of the neck, and the involved lymph nodes are 6 centimeters or smaller.
- In stage IVB, the tumor:
- may be any size and has spread to one or more lymph
nodes that are larger than 6 centimeters; or
- has spread to the muscles or bones in the oral cavity, or to the base of the skull and/or the carotid artery. Cancer may have spread to one or more lymph nodes on one or both sides of the neck.
- In stage IVC, the tumor has spread beyond the lip and oral cavity to other parts of the body. The tumor may be any size and may have spread to the lymph
nodes.
Recurrent Lip and Oral Cavity Cancer
Recurrent lip and oral
cavity cancer is cancer that has
recurred (come back) after it has been treated. The
cancer may come back in the lip or mouth or in other parts of the body. Treatment Option Overview
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There are different types of treatment for patients with lip
and oral cavity cancer.
Different types of treatment are available for patients with lip
and oral cavity cancer. Some
treatments are standard (the currently used treatment), and some are being
tested in clinical trials. Before
starting treatment, patients may want to think about taking part in a clinical
trial. A treatment clinical trial is a research study meant to help improve
current treatments or obtain information on new treatments for patients with
cancer. When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Web site 1. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Patients with lip and oral cavity cancer should have their
treatment planned by a team of doctors who are expert in treating head and neck
cancer.
Treatment will be overseen by a medical oncologist, a doctor who specializes in
treating people with cancer. Because the lips and oral cavity are important for
breathing, eating, and talking, patients may need special help adjusting to the side effects of the cancer and its treatment. The medical oncologist may refer
the patient to other health professionals with special training in the treatment of patients
with head and neck cancer. These include the following:
Two types of standard treatment are used:
Surgery
Surgery (removing the cancer in an operation) is a common
treatment for all stages of lip and
oral cavity cancer. Surgery may include the following:
- Wide local excision: Removal of the cancer and some of the healthy tissue around it. If cancer has spread into bone, surgery may include removal of the involved bone tissue.
- Neck dissection: Removal of lymph nodes and other tissues
in the neck. This is done when cancer may have spread from the lip and oral cavity.
- Plastic surgery: An operation that restores or improves the appearance of parts of the body. Dental implants, a skin graft, or other plastic surgery may be needed to repair parts of the mouth, throat, or neck after removal of large tumors.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
For patients who smoke, radiation therapy works better when smoking is stopped before beginning treatment. It is also important for patients to have a dental exam before radiation therapy begins, so that existing problems can be treated.
New types of treatment are being tested in clinical
trials. These include the following:
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hyperfractionated radiation therapy
Hyperfractionated radiation therapy is radiation treatment in which each day's total dose of radiation is divided into two or more smaller doses, usually given hours apart, instead of giving it all at once. This is also called superfractionated radiation therapy.
Hyperthermia therapy
Hyperthermia therapy is a
treatment in which body tissue is heated above normal temperature to damage and
kill cancer cells or to make cancer cells more sensitive to the effects of
radiation and certain anticancer drugs.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site 1.
Treatment Options by Stage
Stage I Lip and Oral Cavity Cancer
Treatment of stage I lip and oral
cavity cancer depends on where cancer is found in the lip and oral cavity.
Lip
If cancer is in the lip, treatment may include the
following:
Front of the tongue
If cancer is in the front of the tongue, treatment may include the
following:
Buccal mucosa
If cancer is in the buccal mucosa (the lining of the inside of the
cheeks), treatment may include the following:
Floor of the mouth
If cancer is in the floor (bottom) of the mouth, treatment may
include the following:
Lower gingiva
If cancer is in the lower gingiva (gums), treatment may include the
following:
Retromolar trigone
If cancer is in the retromolar trigone (the small area behind the
wisdom teeth), treatment may include the following:
Upper gingiva or hard palate
If cancer is in the upper gingiva (gums) or the hard palate (the
roof of the mouth), treatment is usually surgery (wide local excision) with or without radiation therapy.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I lip and oral cavity cancer 3.
Stage II Lip and Oral Cavity Cancer
Treatment of stage II lip and oral
cavity cancer depends on where cancer is found in the lip and oral cavity.
Lip
If cancer is in the lip, treatment may include the
following:
Front of the tongue
If cancer is in the front of the tongue, treatment may include the
following:
Buccal mucosa
If cancer is in the buccal mucosa (the lining of the inside of the
cheeks), treatment may include the following:
Floor of the mouth
If cancer is in the floor (bottom) of the mouth, treatment may
include the following:
Lower gingiva
If cancer is in the lower gingiva (gums), treatment may include the
following:
Retromolar trigone
If cancer is in the retromolar trigone (the small area behind the
wisdom teeth), treatment may include the following:
Upper gingiva or hard palate
If cancer is in the upper gingiva (gums) or the hard palate (the
roof of the mouth), treatment may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II lip and oral cavity cancer 4.
Stage III Lip and Oral Cavity Cancer
Treatment of stage III lip and oral
cavity cancer depends on where cancer is found in the lip and oral cavity.
Lip
If cancer is in the lip, treatment may include the following:
Front of the tongue
If cancer is in the front of the tongue, treatment may include the
following:
Buccal mucosa
If cancer is in the buccal mucosa (the lining of the inside of the
cheeks), treatment may include the following:
Floor of the mouth
If cancer is in the floor (bottom) of the mouth, treatment may
include the following:
Lower gingiva
If cancer is in the lower gingiva (gums), treatment may
include the following:
Retromolar trigone
If cancer is in the retromolar trigone (the small area behind the
wisdom teeth), treatment may include the following:
Upper gingiva
If cancer is in the upper gingiva (gums), treatment may include the
following:
Hard palate
If cancer is in the hard palate (the
roof of the mouth), treatment may include the
following:
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