Oral cancer includes cancer of the lips, tongue, mouth, gums, salivary glands and oropharynx (throat). The National Cancer Institute estimated that there would be about 54,000 new cases of oral cancer diagnosed in 2022 in the United States. Of these, men are diagnosed two times more frequently than women.

Oral cancer: Risk factors

The main risk factors associated with oral cancer are smoking — cigarettes, cigars, pipe and smokeless tobacco — and alcohol consumption. The five-year survival rate for patients with oral cancer has not significantly improved over the past three decades, with the mean survival of approximately 55%. This poor survival rate is attributed to the late diagnosis in the majority of patients.

Oral cancer: Symptoms

• The majority of patients are referred after a diagnosis by their dentist or dental hygienist.
• The symptoms of oral cancer are usually a nonhealing, often painless ulcer that has been present for more than two weeks. The ulcer easily bleeds on contact and is sometimes neglected because it is associated with a trauma caused by tongue biting or denture irritation.
• Oral cancer may first appear as white or red patches in the mouth. As the cancer increases in size, it may become painful and even cause pain to be felt in the ears.
• Patients may also lose weight over this time period if chewing or swallowing becomes too uncomfortable.

Oral cancer: Diagnosis

The diagnosis is made by performing an incisional biopsy to get a small sample of the lesion and submitting it to the pathologist for review.

Patients receive an injection with local anesthesia before the biopsy is performed. The patient may experience slight discomfort after the procedure, which is usually relieved with over-the-counter pain medication.

After the biopsy, the workup consists of a complete head and neck physical exam and a CT scan of the neck to determine if the cancer has spread to the lymph nodes. A chest X-ray is also obtained along with blood work.

Oral cancer: Treatments

Surgery

The most common treatment for oral cancer is surgery. Surgery involves the removal of the cancer in the mouth, as well as a neck dissection (removal of lymphatic tissues of the neck along with their associated fat). A neck dissection is performed for one of two reasons:

• The presence of a lump in the neck is suspicious for cancer (therapeutic neck dissection)
• The surgeon needs to look for possible hidden neck disease (exploratory neck dissection)

Surgery alone may be sufficient treatment; however, patients may be referred for radiation therapy or chemotherapy to ensure the cancer is eradicated. The typical hospitalization for these surgeries may be as short as a couple of days.

Post-surgery reconstruction

One of the major advances in the care of oral cancer patients has been in the area of reconstruction. The gold standard at most major cancer centers is the reconstruction of complex defects with microvascular reconstructive techniques.

Microvascular free flaps involve the transfer of distant skin, muscle and/or bone with their own blood vessels to reconstruct (recreate) the missing structures. This is a specialized and technically sophisticated surgery that allows patients to have improved function and a post-surgery appearance that may not be significantly changed from before the surgery.