Recently, you've noticed a pale lump inside your mouth that doesn't seem to be healing. It's not like anything you've seen before. What you may have encountered is an early sign of oral or throat (oropharyngeal) cancer.
The American Cancer Society estimates more than 30,000 new cases of oral and throat cancer occur annually in the United States. Oral cancer includes cancer of your lips, mouth, tongue, gums and salivary glands. Throat cancer involves cancer of the part of your throat just behind your mouth. It's estimated that more than 7,000 Americans die of oral and throat cancers annually.
Periodic self-examination of your mouth is the best way to detect the early signs of oral and throat cancer. And, when detected early, oral cancer is almost always successfully treated. Unfortunately, many oral and throat cancers are far advanced by the time a doctor is made aware of the situation. This is because oral and throat cancers are usually painless in their early stages or have minor symptoms similar to other health problems, such as a toothache.
An early indication of oral and throat cancer is one or more changes in the way the soft tissues of your mouth usually look or feel. Signs and symptoms may include:
Most oral cancers arise on the lips, tongue or on the floor of the mouth. They also may occur inside your cheeks, on your gums or on the roof of your mouth.
Oral and throat cancer appears to occur as a result of damage to the DNA in the cells in your mouth and throat. Using tobacco and excessive alcohol consumption can damage these tissues. The combination of smoking or chewing tobacco and excessive drinking creates a much higher risk of oral and throat cancer. Excessive exposure to ultraviolet light also can cause damage. Damage to cells may cause them to malfunction and mutate into cancer cells.
A variety of factors that you can control increase your risk of oral cancer. These include:
Use of tobacco. Tobacco can damage cells in the lining of the oral cavity and upper throat. Smokers are much more likely to develop oral or upper throat cancers than nonsmokers are. About 90 percent of people who develop these cancers use some form of tobacco. Tobacco use is more prevalent among men, so oral cancer is more common in men than in women.
People who use smokeless or chewing tobacco are at even higher risk of cancers of the cheek and inner surface of the lips. Aside from oral and throat cancers, using smokeless tobacco can cause other serious health problems, including other cancers, gum disease and possibly cardiovascular disease.
See your doctor if you:
Any of the above factors may indicate oral cancer. If you have any of these signs and symptoms that last more than two weeks, see your doctor. The earlier you seek medical advice, the better your chances of successful treatment.
Diagnosis initially involves you and your dentist or doctor discussing the history of your signs and symptoms and your doctor performing an examination of your mouth. To determine whether abnormal-appearing areas within your mouth are cancerous, your doctor will need to take a small tissue sample (biopsy) to be examined in the laboratory.
Almost all oral and throat cancers are of the squamous cell type (squamous cell cancer or carcinoma). Squamous cells are firm and flat, and they form the lining of the oral cavity and upper throat as well as the surface of your skin. Squamous cell cancer begins with abnormal cells located only on the surface. As it progresses, the malignant cells invade deeper layers of the oral cavity and upper throat and may spread to your lymph nodes as well as to other parts of your body.
For your doctor to determine if the oral or throat cancer has spread, and if so how far it has spread, you'll need to undergo imaging procedures, which may include:
Many oral and throat cancers aren't detected until they're far advanced. When detected early, squamous cell cancer can often be successfully treated.
Doctors use surgery and radiation therapy to treat oral and throat cancer in the earliest stages. For cancer in more advanced stages, doctors use surgery combined with radiation therapy or radiation therapy combined with chemotherapy.
Your treatment plan should be developed for you specifically based on multiple factors by an integrated team of doctors including surgeons, cancer specialists (oncologists) and oncologists who specialize in treating cancer with radiation (radiation oncologists). Treatment options include:
Surgery. The type of surgery you may need depends on the size and location of the tumor. Doctors can surgically remove tumors that haven't grown into nearby tissues with relatively few side effects. However, if the tumor has invaded nearby tissues, the operation is more extensive.
Sometimes surgeons need to remove bone tissue from the jaw or the roof of the mouth. To treat a cancer of your tongue or the upper part of your throat, your surgeon may need to remove tissues that you use to swallow and in some cases your voice box (larynx). If the cancer has spread beyond your mouth, your surgeon may also need to remove lymph nodes in your neck.
You may not have any major side effects from surgery to remove a small tumor from your mouth. However, extensive surgery may require major adjustments in the way you chew, swallow, breathe and speak. You may need a prosthetic device in your mouth to replace removed portions of your teeth, gums and jaw. In more advanced cases, you may need to use tubes for feeding and breathing and an artificial voice aid for speaking.
Recovery and rehabilitation
Following removal of an extensive tumor, reconstructive surgery or speech pathology may enhance your recovery and rehabilitation.
Reconstructive surgery. The goal of reconstructive surgery is to improve your appearance and to help you adjust to difficulties you may have with chewing, swallowing, speaking or breathing.
Sometimes you'll need grafts of skin or tissue from other parts of your body to rebuild areas in your mouth, throat or jaw. You may also need to have a dental prosthesis implanted to replace a part of your jaw removed during surgery. If you've had extensive surgery in your neck, you may also undergo surgery to create a hole in your neck (tracheostomy) to help you breathe more easily. If muscles you need for swallowing have been removed, you'll need surgery to create a hole in your abdomen (gastrostomy) in order to receive food directly into your stomach through a feeding tube.
Rehabilitation. Adjusting to life after surgery may mean working with a speech therapist and dietitian. A speech therapist can help you overcome problems with speech and swallowing. If you've lost the ability to speak, you can learn to speak by forcing air up through your esophagus (esophageal speech). Artificial devices also are available to help you speak or speak more loudly.
A dietitian can help you choose foods that are suitable for you if you've lost some of your ability to chew and swallow. In addition, you may benefit from sessions with a physical therapist and occupational therapist to help you make adjustments in your personal life and work life.
Tobacco and alcohol are by far the most important risk factors for oral and throat cancer. You can greatly reduce your risk by not smoking and limiting the amount of alcohol you drink. Other steps you can take to help prevent oral and throat cancer or its progression include:
A diagnosis of cancer can be extremely challenging. Remember that no matter what your concerns or prognosis, you're not alone. Here are some strategies and resources that may make dealing with cancer easier:
Know what to expect. Find out everything you can about your cancer — the type, stage, your treatment options and their side effects. The more you know, the more active you can be in your own care.
In addition to talking with your doctor, look for information in your local library and on the Internet. The National Cancer Institute (NCI) will answer questions from the public. You can reach NCI at 800-4-CANCER, or 800-422-6237. Or contact the American Cancer Society at 800-ACS-2345, or 800-227-2345.
Maintain a strong support system. Having a support system can help you cope with any issues, pain and anxieties that might occur. Although friends and family can be your best allies, they may sometimes have trouble dealing with your illness.
If so, the concern and understanding of a formal support group or others coping with cancer can be especially helpful. Although support groups aren't for everyone, they can be a good source for practical information. You may also find you develop deep and lasting bonds with people who are going through the same things you are.
July 14, 2006