Lip and Oral Cavity Cancer

Lip and oral cavity cancer is a disease that begins in the lips or mouth, and while it affects thousands of Americans each year, many cases can be prevented through lifestyle changes and early detection can significantly improve survival rates.

Table of contents

• What is Lip and Oral Cavity Cancer?
• Parts of the Oral Cavity
• Risk Factors
• Signs and Symptoms
• Diagnosis and Testing
• Treatment Options
• Outlook and Survival
• Prevention

What is Lip and Oral Cavity Cancer?

Lip and oral cavity cancer is a disease that starts in the lips or mouth. The oral cavity refers to your mouth and includes all the pink areas you can see when you open wide and look in a mirror^[1]. This type of cancer is part of a larger group called head and neck cancers^[1].

Most lip and oral cavity cancers begin in squamous cells, which are thin, flat cells that line the inside of the lips and oral cavity. When viewed under a microscope, these cells look like fish scales^[3]. Cancers that start in squamous cells are called squamous cell carcinomas. As the cancer grows, these abnormal cells may spread into deeper tissue^[1].

Squamous cell carcinoma often develops in areas of leukoplakia, which are white patches of cells that do not rub off^[1]. These white patches, along with red patches called erythroplakia, can be warning signs that should not be ignored.

Parts of the Oral Cavity

• Front two-thirds of the tongue
• Gingiva (gums)
• Buccal mucosa (the lining of the inside of the cheeks)
• Floor (bottom) of the mouth under the tongue
• Hard palate (the roof of the mouth)
• Retromolar trigone (the small area behind the wisdom teeth)
• Lips

Understanding which parts of your mouth are included in the oral cavity helps you know where this cancer can develop^[1]. Most lip and oral cavity cancers can form on the lips or tongue, but they may also occur on the gums, inside the cheeks, the floor or roof of the mouth, or the small area behind the wisdom teeth^[4].

Risk Factors

Lip and oral cavity cancer happens when certain changes occur in how cells in your lips and mouth function, especially how they grow and divide. While experts don’t know exactly what causes these cancers, they have identified several risk factors that increase your chances of developing the disease^[1].

A risk factor is anything that increases the chance of getting a disease. Some risk factors can be changed, while others, like age or genetics, cannot. However, having one or more risk factors does not mean you will definitely get lip and oral cavity cancer. Many people with risk factors never develop the disease^[1].

The most important risk factors for lip and oral cavity cancer include:

• Using tobacco products of any kind, including cigarettes, cigars, pipes, chewing tobacco, snuff, or water pipes. About 90% of oral cancer patients are tobacco users^[1][23].
• Heavy alcohol use, which means more than three drinks on any day or more than seven drinks per week for women, or more than four drinks on any day or more than 14 drinks per week for men^[7]. About one in three oral cancer cases is linked to excessive alcohol consumption^[23].
• Combined tobacco and alcohol use, which increases your risk up to 30 times compared to people who don’t use either^[12].
• Exposure to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time, especially for lip cancer^[1].
• Being male. Men are about 2.3 times more likely to develop this cancer than women, and men over age 50 face the greatest risk^[3][7].
• Having human papillomavirus (HPV), a sexually transmitted infection^[2].
• Having a family history of oral cancer^[3].
• Having fair skin, which increases risk particularly for lip cancer^[12].

It’s important to note that about 25% of people who develop oral cancer don’t smoke or have other known risk factors^[3]. This means that even if you’ve never smoked and drink only occasionally, you should still be aware of the signs and symptoms of this disease.

Signs and Symptoms

Lip and oral cavity cancer often appears as a growth or sore that doesn’t go away^[4]. In its early stages, oral cancer may look like a common mouth problem, such as a mouth sore. The key difference is that cancer-related changes don’t go away on their own. A cold sore, for example, typically heals within about 10 days, but lip cancer lesions persist^[12].

Common signs and symptoms include:

• A sore on the lip or in the mouth that bleeds easily and doesn’t heal within two weeks^[3]
• A lump, thickening, or swelling on the lips, gums, or other areas inside the mouth^[4][7]
• White, red, or mixed red and white patches on the gums, tongue, or lining of the mouth^[3][7]
• Bleeding, pain, or numbness in the lip or mouth^[4]
• Areas in your mouth that bleed for no obvious reason^[3]
• Loose teeth or changes in how dentures fit in your mouth^[4][7]
• Difficulty or pain when chewing, swallowing, or moving the tongue or jaw^[4][7]
• A change in voice or hoarseness^[4]
• A sore throat or feeling that something is caught in the throat^[4]
• Swelling of the jaw^[7]
• Ear pain without hearing loss^[3]
• Unexplained weight loss^[4]

These symptoms can be caused by lip and oral cavity cancer or by other, less serious conditions. However, if you have any of these symptoms and they don’t go away within two weeks, you should contact your doctor or dentist right away^[4]. Sometimes lip and oral cavity cancer may not cause any symptoms at all and is found during a regular dental exam^[4].

Diagnosis and Testing

If your doctor or dentist suspects you might have lip and oral cavity cancer, they will perform several tests to confirm the diagnosis and determine if the cancer has spread. Often, dentists or dermatologists spot lip cancer during routine exams^[12].

Tests that examine the mouth and throat are used to diagnose and stage lip and oral cavity cancer^[1]. These may include:

• Physical exam: Your healthcare provider will examine your lip, mouth, face, and neck to look for signs of cancer. A doctor or dentist will feel the entire inside of your mouth with a gloved finger and examine your oral cavity with a small long-handled mirror and lights^[4]. They will also check your neck for swollen lymph nodes and ask about your medical history and habits, such as whether you smoke^[4][12].
• Biopsy: During a biopsy, your doctor removes a small sample of tissue from the affected area and sends it to a laboratory for testing. A specialist called a pathologist examines the tissue under a microscope to determine whether cancer is present, what type it is, and how aggressive the cancer cells are^[10][12]. In most cases, biopsies can be performed in the office, but sometimes a more thorough evaluation is done in an operating room under general anesthesia^[4].

If the biopsy confirms cancer, your doctor may order additional tests to determine if the cancer has spread beyond your lips or mouth. These imaging tests may include:

• Endoscopy: A brief procedure performed under local anesthesia using a flexible scope to check the extent of any abnormality in the oral cavity^[4]
• Computed tomography (CT or CAT) scan: An imaging test that creates detailed pictures of your mouth, throat, and neck to see if cancer has spread to surrounding lymph nodes^[4][10]
• Magnetic resonance imaging (MRI) scan: Another type of imaging test that uses magnets and radio waves to create detailed pictures of soft tissues^[4][10]
• Positron emission tomography (PET) scan: A test to determine if cancer has spread to other organs, such as the lungs^[4][10]

The stage of the cancer is determined based on these test results. A lower stage, such as stage 1, indicates a smaller cancer confined to one area. The highest stage indicates a more severe cancer that may have spread to other parts of the body^[4].

Treatment Options

Treatment for lip and oral cavity cancer depends on several factors, including the stage and location of the cancer, as well as your overall health. Early cancers (stage I and stage II) are highly curable, while more advanced cancers may require a combination of treatments^[9].

The main treatment options include:

Surgery

Surgery to remove the tumor is a common treatment for oral cancer and is often included at some point during the treatment process^[17]. The surgeon removes the cancer and a margin of healthy tissue that surrounds it. For small tumors, surgery may not cause any lasting problems. However, for larger tumors, the surgeon may need to remove part of the tongue, palate, or jaw, which can affect your ability to chew, swallow, or talk, and may change the appearance of your face^[10][17].

After removing a large tumor, you may need reconstructive or plastic surgery to rebuild bones or tissues and repair the lip to allow for normal eating, drinking, and speaking^[10]. Surgery may also involve removing cancerous lymph nodes in the neck^[4][10].

Radiation Therapy

Radiation therapy uses powerful energy beams, such as X-rays, to kill cancer cells^[10]. It can be used alone for small tumors, before surgery to shrink the tumor, or after surgery to destroy any remaining cancer cells^[17].

There are two main types of radiation therapy:

• External radiation therapy: A machine outside the body delivers radiation beams to the tumor. This is the most common approach. You may go to the hospital or clinic once or twice a day, generally five days a week for several weeks^[17].
• Brachytherapy (internal radiation): Radioactive material in seeds, wires, or tubes is placed directly into or near the cancer. This method is not very common for treating lip and oral cancer anymore because external radiation approaches are now very precise^[17].

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. The drugs are usually given through a vein (intravenous), enter the bloodstream, and travel throughout your body^[17]. Chemotherapy is often combined with radiation therapy for more advanced cancers^[17].

Targeted Therapy

Targeted therapy is a treatment option that uses drugs designed to attack specific features of cancer cells^[17]. This approach may be used for certain types of oral cancer.

The choice of treatment depends on the anticipated functional and cosmetic results, as well as the availability of specialists with the required expertise^[9]. Most patients with stage III or stage IV tumors are candidates for treatment by a combination of surgery and radiation therapy^[9].

Outlook and Survival

Certain factors affect your chance of recovery and treatment options^[1]. Early cancers of the lip and oral cavity are highly curable by surgery or radiation therapy^[9]. When diagnosed and treated early, oral cancer has a high survival rate^[12].

Approximately 63% of people with oral cavity cancer are alive five years after diagnosis^[3]. However, survival rates depend on when the cancer is found. The five-year survival rate is 67% if the cancer spreads locally and 40% if it spreads to distant parts of the body^[20].

Unfortunately, about 66% of Americans discover they have oral cancer in its late stages, which is why early detection is extremely important^[23]. For oral cancer, most recurrences happen within the first two years of treatment. If someone reaches five years after treatment with no sign of cancer, the chance of it coming back is very low^[18].

Several factors can affect your outlook. A positive surgical margin (cancer cells found at the edge of removed tissue) or a tumor depth of more than 5 millimeters significantly increases the risk of the cancer coming back^[9]. The depth of the tumor and whether cancer has spread to lymph nodes also affect prognosis^[9].

Prevention

Many cases of lip and oral cavity cancer can be prevented through lifestyle changes and healthy habits. Here are important steps you can take to reduce your risk:

Avoid Tobacco

The most important thing you can do to prevent oral cancer is not to use any tobacco products^[18][23]. This includes avoiding cigarettes, cigars, pipes, chewing tobacco, snuff, and water pipes. If you currently use tobacco, talk to your doctor about help with quitting.

Limit Alcohol Consumption

It’s important not to drink too much alcohol or to abstain from alcohol altogether^[18]. If you do drink, do so in moderation: no more than two drinks a day for men and one drink a day for women^[1].

Protect Your Lips from the Sun

Limit sun exposure and use sunscreen on your lips as well as your face^[4][20]. Avoid spending long periods in the sun without UV protection, and stay away from tanning beds.

Eat a Healthy Diet

A simple thing everyone can do to decrease the risk of oral cancer is increase fruit and vegetable consumption^[18]. Eating a balanced diet with plenty of fruits and vegetables supports overall health and may help prevent cancer.

Maintain Good Oral Hygiene

Develop and maintain good oral care habits. A person’s risk for oral cancer goes up if they have periodontal disease (gum disease) or missing teeth^[23]. Brush your teeth twice a day for two minutes or more, brush your tongue every time you brush your teeth, and floss daily^[23].

Get Regular Screenings

Visit your dentist regularly, as dangerous spots or sores in the mouth can be very tiny and difficult to see on your own^[4]. The American Cancer Society recommends oral cancer screening every three years for people over 20 and every year for those over 40^[4].

Every month, examine your lips, gums, and cheeks carefully. Call your doctor if you notice changes in appearance, such as red or white patches or lesions in your mouth, especially if they are painful or bleed, or if you find lumps or enlarged lymph nodes in your neck^[4].

Exercise and Reduce Stress

It’s very important to try to reduce stress and to exercise on a regular basis^[18]. These healthy lifestyle habits support your overall wellbeing and may help lower your cancer risk.

Remember that preventing oral cancer is much better than treating it. By making these healthy choices and staying alert to changes in your mouth, you can significantly reduce your risk of developing this disease.