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Lip and Oral Cavity Cancer Treatment

Lip and oral cavity cancer is a disease in which malignant (cancer) cells form in the lips or mouth.

Most lip and oral cavity cancers start in squamous cells, the thin, flat cells lining the inside of 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 may develop in areas of leukoplakia (white patches of cells that do not rub off).

Lip and oral cavity cancer is a type of head and neck cancer.

  • 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, bony area behind the wisdom teeth).

Tobacco and alcohol use can affect the risk of lip and oral cavity cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for lip and oral cavity cancer include the following:

  • Using tobacco products.
  • Heavy alcohol use.
  • Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
  • Being male.

Signs of lip and oral cavity cancer include a sore or lump on the lips or in the mouth.

These and other signs and symptoms may be caused by lip and oral cavity cancer or by other conditions. Check with your doctor if you have any of the following:

  • 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, 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 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 medical 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 is inserted through an incision (cut) in the skin or opening in the body, such as the nose or mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. If any concerning lesion is found, cells taken from the patches are also checked under the microscope for signs of cancer.
  • 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. Your dentist may have performed this test.
  • 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. 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.
  • Barium swallow: A series of x-rays of the upper aerodigestive tract beginning at the mouth and ending at 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 to identify any problems with swallowing. 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 radioactive 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.
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

Stages of Lip and Oral Cavity Cancer

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.

There are three ways that cancer spreads in the body. Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas or adjacent tissues.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body, and lodges in lymph nodes.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in the lymph nodes.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if laryngeal cancer spreads to the lung, the cancer cells in the lung are actually laryngeal cancer cells. The disease is metastatic laryngeal cancer, not lung cancer.

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.
Stage I

In stage I, cancer has formed. The tumor is 2 centimeters or smaller and the deepest point of tumor invasion is 5 millimeters or less.

Stage II

In stage II, the tumor:

  • is 2 centimeters or smaller and the deepest point of tumor invasion is greater than 5 millimeters; or
  • is larger than 2 centimeters but not larger than 4 centimeters and the deepest point of tumor invasion is 10 millimeters or less.

Stage III

In stage III, the tumor:

  • is larger than 2 centimeters but not larger than 4 centimeter sand the deepest point of tumor invasion is greater than 10 millimeters; or
  • is larger than 4 centimeters and the deepest point of tumo rinvasion is 10 millimeters or less; or
  • has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor.

Stage IV

Stage IV is the most advanced stage.

Treatment Options Overview

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 coordinated by a head and neck surgeon, 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 help adjusting to the side effects of the cancer and its treatment. The surgeon may refer you the patient to other health professionals with special training in the treatment of patients with head and neck cancer. These include the following:

  • Head and neck surgeon and head and neck microvascular reconstructive surgeon
  • Radiation oncologist
  • Medical oncologist
  • Dentist
  • Speech therapist
  • Dietitian
  • Psychologist
  • Rehabilitation specialist

Two types of standard treatment are used:

Surgery 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, like the jaw bone.
  • 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.
  • Reconstructive 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.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation or chemotherapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. 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. External and internal radiation therapy are used to treat lip and oral cavity cancer.

Radiation therapy may work better in patients who have stopped smoking 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.

Certain factors affect chance of recovery and treatment options.

  • Prognosis (chance of recovery) depends on the following:
  • The stage of the cancer
  • The location and size of the tumor.
  • The grade of the tumor.
  • The patient's age, gender, and general health, including whether the patient is anemic, malnourished or still using tobacco.

Treatment options depend on the following:

  • The stage of the disease.
  • The location and size of the tumor.
  • Keeping the patient's ability to talk, eat, and breathe as normal as possible.
  • Whether the cancer has come back (recurred).
  • 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 drugs to reduce the risk of a second head and neck cancer. Information about ongoing clinical trials is available from the NCI website.

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