Oral cancer includes cancer of the lips, tongue, mouth, gums, salivary glands and
oropharynx. The National Cancer Institute estimates that there will be approximately
35,000 new cases of oral cancer diagnosed in the United States in 2007. Of these,
men are diagnosed two times more frequently than women.
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 percent. This
poor survival rate is attributed to the late diagnosis in the majority of patients.
Evaluation and Diagnosis
The majority of patients present after diagnosis by their dentist or dental hygienist.
The symptoms of oral cancer are usually a nonhealing, often nonpainful 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.
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.
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)
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 typical hospitalization for these surgeries may be as short as a couple of days
for patients who don't need microvascular reconstruction, or as long as a week for
those who require microvascular reconstruction.
The UF Health Cancer Center – Jacksonville offers the following services related
to oral cancer: