Oral Cancer
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Cancer of the lip and oral cavity is a disease in
which cancer (malignant) cells are found in the tissues of the lip or mouth.
The oral cavity includes the front two thirds of the tongue, the upper and
lower gums (the gingiva), the lining of the inside of the cheeks and lips (the
buccal mucosa), the bottom (floor) of the mouth under the tongue, the bony
top of the mouth (the hard palate), and the small area behind the wisdom teeth
(the retromolar trigone).
Cancers of the head and neck are most often found
in people who are over the age of 45. Cancer of the lip is more common in men
than in women, and is more likely to develop in people with light-colored skin
who have been in the sun a lot. Cancer of the oral cavity is more common in
people who chew tobacco or smoke pipes.
A doctor should be seen if a person finds a lump in
the lip, mouth, or gums, finds a sore in the mouth that doesnft heal, or has
bleeding or pain in the mouth. Another sign of a cancer of the mouth or gums
is when dentures no longer fit well. Often lip and oral cavity cancers are
found by dentists when examining the teeth.
If there are symptoms, a doctor will examine the mouth
using a mirror and lights. The doctor may order x-rays of the mouth. If tissue
that is not normal is found, the doctor will need to cut out a small piece
and look at it under the microscope to see if there are any cancer cells. This
is called a biopsy. The patient will be given a substance to take feeling away
from the area for a short time (a local anesthetic) so no pain is felt. The
doctor will also feel the throat for lumps.
The chance of recovery (prognosis) depends on where
the cancer is in the lip or mouth, whether the cancer is just in the lip or
mouth or has spread to other tissues (the stage), and the patientfs general
state of health.
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Stage of cancer of the lip and oral cavity
Once cancer of the lip and oral cavity is found, more tests will be done to find
out if cancer cells have spread to other parts of the body. This is called
staging. A doctor needs to know the stage of the disease to plan treatment.
The following stages are used for cancer of the lip and oral cavity:
The cancer is no more than 2 centimeters (about
1 inch) and has not spread to lymph nodes in the area (lymph nodes are small
bean-shaped structures that are found throughout the body; they produce and
store infection-fighting cells).
The cancer is more than 2 centimeters, but less
than 4 centimeters (less than 2 inches), and has not spread to lymph nodes
in the area.
Either of the following may be true:
- The cancer is more than 4 centimeters.
- The cancer is any size but has spread to only one lymph node on the same side
of the neck as the cancer. The lymph node that contains cancer measures no
more than 3 centimeters (just over one inch).
Any of the following may be true:
- The cancer has spread to tissues around the lip and oral cavity.
The lymph nodes in the area may or may not contain cancer.
- The cancer is any size and has spread to more than one lymph node on the same
side of the neck as the cancer, to lymph nodes on one or both sides of the
neck, or to any lymph node that measures more than 6 centimeters (over 2
inches).
- The cancer has spread to other parts of the body.
Recurrent disease means that the cancer has come
back (recurred) after it has been treated. It may come back in the lip and
oral cavity or in another part of the body.
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How cancer of the lip and oral cavity is treated
There are treatments for all patients with cancer
of the lip and oral cavity. Two kinds of treatment are used:
- Surgery (taking out the cancer)
- Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer
cells)
Chemotherapy (using drugs to kill cancer cells)
is being tested in clinical trials.
Surgery is a common treatment of cancer of the lip
and oral cavity. The doctor may remove the cancer and some of the healthy tissue
around the cancer. The doctor may also remove the lymph nodes in the neck (lymph
node dissection).
Radiation therapy uses high-energy x-rays to kill
cancer cells and shrink tumors. Radiation may come from a machine outside the
body (external radiation therapy) or from putting materials that produce radiation
(radioisotopes) through thin plastic tubes or needles in the area where the
cancer cells are found (internal radiation therapy). If smoking is stopped
before radiation therapy is started, the patient has a better chance of surviving
longer.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy
may be taken by pill, or it may be put into the body by a needle in a vein
or muscle. Chemotherapy is called a systemic treatment because the drug enters
the bloodstream, travels through the body, and can kill cancer cells throughout
the body.
If the doctor removes all the cancer that can be
seen at the time of the operation, the patient may be given chemotherapy after
surgery to kill any cancer cells that are left. Chemotherapy given after an
operation to a person who has no cancer cells that can be seen is called adjuvant
chemotherapy. Chemotherapy given before surgery to try and shrink the cancer
so it can be removed is called neoadjuvant chemotherapy.
Hyperthermia is a new treatment being tested in
certain patients. It uses a special machine to heat the body for a certain
period of time to kill cancer cells. Because cancer cells are often more sensitive
to heat than normal cells, the cancer cells die and the cancer shrinks.
Because the lips and mouth are needed to eat and
talk, a patient may need special help adjusting to the side effects of the
cancer and its treatment. The doctor will consult with several kinds of doctors
who can help determine the best treatment for the patient. Trained medical
staff can also help a patient recover from treatment and adjust to new ways
of eating and talking. A patient may need plastic surgery or help learning
to eat and speak if a large part of the lip or mouth is taken out.
Treatment of cancer of the lip and oral cavity depends
on where the cancer is, the stage of the disease, and the patientfs age and
overall health.
Standard treatment may be considered because of
its effectiveness in patients in past studies, or participation in a clinical
trial may be considered. Not all patients are cured with standard therapy and
some standard treatments may have more side effects than are desired. For these
reasons, clinical trials are designed to find better ways to treat cancer patients
and are based on the most up-to-date information. Clinical trials are ongoing
in many parts of the country for patients with cancer of the lip and oral cavity.
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Treatment depends on where the cancer is in the
lip or mouth.
If the cancer is in the lip, treatment may be one
of the following:
- Surgery.
- Radiation therapy.
If the cancer is in the tongue, treatment may be
one of the following:
- Surgery.
- Surgery followed by radiation therapy to the neck.
- Radiation therapy to the mouth and the neck.
If the cancer is in the lining of the inside of
the cheeks and lips (buccal mucosa), treatment may be one of the following:
- Surgery.
- Radiation therapy.
If the cancer is in the bottom (floor) of the mouth,
treatment may be one of the following:
- Surgery.
- Radiation therapy.
If the cancer is in the lower gums (gingiva), treatment
may be one of the following:
- Surgery.
- Radiation therapy.
If the cancer is in the small area behind the wisdom
teeth, (retromolar trigone), treatment may be one of the following:
- Surgery to remove part of the jawbone.
- Radiation therapy followed (if needed) by surgery.
If the cancer is in the upper gums (gingiva) or
the top bony part of the mouth (hard palate), treatment may be one of the following:
- Surgery.
- Surgery followed by radiation therapy.
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Treatment depends on where the cancer is in the
lip or mouth.
If the cancer is in the lip, treatment may be one
of the following:
- Surgery.
- External and/or internal radiation therapy.
If the cancer is in the tongue, treatment may be
one of the following:
- Radiation therapy.
- Surgery and radiation therapy.
If the cancer is in the lining of the inside of
the cheeks and lips (buccal mucosa), treatment may be one of the following:
- Radiation therapy.
- Surgery.
- Surgery plus radiation therapy.
If the cancer is in the bottom (floor) of the mouth,
treatment may be one of the following:
- Surgery.
- Radiation therapy.
- Surgery followed by internal or external radiation therapy.
If the cancer is in the lower gums (gingiva), treatment
may be one of the following:
- Surgery.
- Radiation therapy.
If the cancer is in the small space behind the wisdom
teeth (retromolar trigone), treatment may be one of the following:
- Surgery to remove part of the jawbone.
- Radiation therapy followed (if needed) by surgery.
If the cancer is in the upper gums or the top bony
part of the mouth (hard palate), treatment will probably be surgery followed
by radiation therapy.
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Treatment depends on where the cancer is in the lip or mouth. In addition to
the treatments listed below, a patient will probably have radiation therapy
to the neck with or without surgery to remove lymph nodes in the neck (lymph
node dissection).
If the cancer is in the lip,
treatment may be one of the following:
- Surgery to remove the cancer plus internal or external radiation
therapy.
- Radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of surgery followed by chemotherapy.
- A clinical trial of surgery, radiation therapy, and chemotherapy.
- A clinical trial of a new radiation therapy technique (superfractionated).
If the cancer is in
the tongue, treatment may be one of the following:
- External beam with or without internal radiation therapy.
- Surgery followed by radiation therapy.
If the
cancer is in the lining of the inside of the cheeks and lips (buccal mucosa),
treatment may be one of the following:
- Surgery to remove the cancer and the tissue around it.
- Radiation therapy.
- Surgery plus radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of surgery followed by chemotherapy.
- A clinical trial of surgery, radiation therapy, and chemotherapy.
If
the cancer is in the bottom (floor) of the mouth, treatment may be one of the
following:
- Surgery to remove the cancer and lymph nodes in the neck. Part of
the jawbone may also be removed if necessary.
- External beam therapy with or without internal radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer
is in the lower gums (gingiva), treatment will probably be radiation therapy
given before or after surgery to remove the cancer.
If
the cancer is in the small space behind the wisdom teeth (retromolar trigone),
treatment may be one of the following:
- Surgery followed by radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of surgery followed by chemotherapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
If
the cancer is in the top part of the gums (gingiva) or the top bony part of
the mouth (the hard palate), treatment may be one of the following:
- Radiation therapy.
- Surgery plus radiation therapy.
For all stage III lip and oral cavity cancers,
clinical trials are testing chemotherapy combined with radiation therapy.
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Treatment depends on where the cancer is in the
lip or mouth. In addition to the treatments listed below, a patient will probably
have radiation therapy to the neck with or without surgery to remove lymph
nodes in the neck (lymph node dissection).
If the cancer is in the lip, treatment may be
one of the following:
- Surgery to remove the cancer plus internal or external radiation
therapy.
- A clinical trial of radiation therapy.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the tongue, treatment may
be one of the following:
- Surgery to remove the tongue and the voicebox (larynx) below it
followed by radiation therapy.
- Radiation therapy to relieve symptoms.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the lining of the inside of
the cheeks and lips (buccal mucosa), treatment may be one of the following:
- Surgery to remove the cancer and the tissue around it.
- Radiation therapy.
- Surgery plus radiation therapy.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the bottom (floor) of the
mouth, treatment may be one of the following:
- Surgery to remove the cancer followed by radiation therapy.
- Radiation therapy followed by surgery.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the lower gums (gingiva),
treatment may be one of the following:
- Surgery, radiation therapy, or both.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the small space behind the
wisdom teeth (retromolar trigone), treatment may be one of the following:
- Surgery followed by radiation therapy.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
If the cancer is in the top part of the gums (gingiva)
or the top bony part of the mouth, treatment may be one of the following:
- Surgery plus radiation therapy.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
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Treatment depends on the type of treatment the
patient had before. If radiation therapy was given, the patient may have surgery
when the cancer comes back. If surgery was used, the patient may have more
surgery, radiation therapy, or both. Patients may want to consider taking part
in a clinical trial of new chemotherapy drugs, chemotherapy plus additional
radiation therapy, or hyperthermia.
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