Cancer of the gums: 9 things to know

Gum disease is far more common than any type of gum cancer. 

But how do you know if you have gingivitis, periodontitis or cancer?

We went to head and neck surgeon Ryan Goepfert, M.D. Here’s what he shared about how to distinguish gum cancer from other common conditions, as well as what causes it and when to seek help.

What does gum cancer look and feel like? How does it differ from gingivitis and periodontitis?

Gum cancer is usually something growing outward from the surface of the gums. It is often a mass and can be either red or white. It may also bleed. 

Gingivitis, on the other hand, is an early-stage infection of the gumline caused by the bacteria that live there naturally and create irritation. It can make your gums feel tender and swollen, or painful when they’re touched or flossed. It’s super common and caused by poor oral hygiene.

Periodontitis is a more advanced stage of gum disease. It’s a severe form of gingivitis that only develops if you have gingivitis for a really long time. If left untreated, it can eventually lead to other dental and jawbone problems. However, most gum disease should not cause loose teeth, numbness, or deep-seated pain. Those are all signs that something more serious is going on.

Does gum disease ever lead to gum cancer?

Not that we know of, though the data is unclear and is confounded by other factors. Among the risk factors common to both gum disease and gum cancer are smoking and chewing tobacco use. Nevertheless, some individuals with poor dental hygiene and without other known risk factors can develop gum cancer.

How common is gum cancer?

Gum cancer — or cancer of the alveolar ridge — was more common in the era of widespread chewing tobacco and cigarette use. But it is thankfully less common today. Oral cancers are most commonly found on the tongue, rather than the gums. Human papilloma virus, or HPV, does not cause cancer in the mouth, but is the main cause of upper throat (oropharynx) cancer in the United States.

What types of cancer do you see most often in the gums? 

Squamous cell carcinoma is far and away the most common, because the surface of the gums is made up almost entirely of squamous cells. Much rarer would be other cancers arising in the soft tissues of the gums and bone, including osteosarcomas, which start in the jawbone and grow outward, and mucosal melanomas, which can be dark in color.

What are the risk factors for gum cancer?

Tobacco use is the greatest risk factor in conjunction with alcohol use, and perhaps very poor dental hygiene. But it’s important to note that you don’t have to have a history of tobacco use to get this type of cancer.

Another possible risk factor is an ill-fitting dental appliance that rubs against the gums. Some people get callouses from those that can look like a mass and bleed. So, sometimes, it’s hard to distinguish between the two. However, as with poor dental hygiene, we really don’t know whether chronic trauma from dentures can cause gum cancer or not.

What are the first signs of gum cancer, and how is it usually diagnosed?

Most often, people will notice something weird in their mouths and then go to a dentist. The dentist may recognize it as gum cancer right away or send you to a specialist to confirm the diagnosis.

It’s a little rarer for a primary care physician to notice it, simply because they have so many other things to worry about. But sometimes, a dental hygienist will see something and alert the dentist. So, it’s a good idea to ask yours to check for signs of gum or oral cancer at your next teeth cleaning.

How is gum cancer typically treated?

The first step is almost always surgery. If a lesion is relatively small, we can cut it out. But if teeth are involved, we may need to remove them, too. And if something is growing into the jawbone, we start getting into much more complex surgeries that require reconstruction.

Sometimes, we might give a patient radiation therapy or chemotherapy after surgery. In every case, though, decisions about care should be made in a multidisciplinary setting.

What’s new in terms of the diagnosis and treatment of gum cancer?

People who have oral cancer syndromes like oral lichen planus or proliferative verrucous leukoplakia (PVL) can be really hard to treat because these conditions cause recurrent lesions that come back over and over again. And there’s a limit to how much surgery you can do in someone’s mouth.

Ann Gillenwater, M.D., is the leader of several clinical trials using photo-immunotherapy to treat cancers that have persisted or recurred despite other therapies.

Moran Amit, M.D., Ph.D., is also exploring whether immunotherapy delivered locally through an injection at the tumor site can yield a better response. Systemic immunotherapy (delivered through an IV) doesn’t seem to work in a lasting way; neither does chemotherapy. Radiation therapy works great to cure the cancer, but can destroy the jawbone in the process. That’s why we don’t use it as a primary treatment.

Anything else people should know about gum cancer?

The mouth wants to heal itself. So, if there’s an ulcer in your mouth that’s not getting better after 2 or 3 weeks and is not readily explained by having eaten something hot or cut yourself, see your dentist, primary care doctor, or an ENT. The vast majority of ulcers in your mouth are not cancer, but they should still be checked out.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.