Cancer of the hard palate: 8 things to know

The palate — or roof of the mouth — consists of two sections. The soft area toward the back of the mouth is considered a part of the throat. The hard, bony part closer to the front is considered a part of the oral cavity.

Cancer of the hard palate isn’t very common. Only about 54,000 cases are diagnosed each year worldwide.

To learn more about this rare cancer — including how it is diagnosed and treated — we spoke with head and neck tumor surgeon Ehab Hanna, M.D. Here’s what he shared.

What types of cancer are typically found in the hard palate?

• Squamous cell carcinoma: This is the most common type of hard palate cancer. It accounts for about 90% of all cases diagnosed each year. It is associated with excessive tobacco and alcohol use, as well as poor dental hygiene.
• Adenoid cystic carcinoma: This is a type of salivary gland tumor. It usually starts in the tiny little salivary glands located in the roof of the mouth. We don’t really know what causes adenoid cystic carcinoma, but it’s often associated with a DNA mutation. 
• Mucosal melanoma: We don’t see this type of cancer too often, as it’s extremely rare in the hard palate. I’d say fewer than 100 cases are diagnosed in the United States each year. 

How unusual are hard palate cancers in general?

They’re not very common. Only about 900,000 head and neck cancers are diagnosed worldwide each year. Of those, about 30% are in the oral cavity. And of those, only about 20% are cancers of the hard palate.

What are the symptoms of hard palate cancer?

The most common symptoms are:

• an ulcer that won’t heal
• a bump on the roof of the mouth
• a rough white patch that’s new and won’t go away

Mucosal melanoma, which is rare in that location, is usually dark like a mole. But these are hard to see unless people are actively looking inside their mouths with a flashlight and a mirror. That’s where oral cancer screenings come in. 

Most dentists perform oral cancer screenings as a part of their patients’ checkups. So, if you’re already getting your teeth cleaned twice a year, chances are any oral cancers will be caught early, when they’re easiest to treat. 

How are hard palate cancers diagnosed? 

A biopsy is always the first step in diagnosing hard palate cancers. These are usually followed by a CT scan or an MRI. We may also run a small camera up inside a patient’s nose or sinuses so we can determine the full extent of their cancer before deciding on a treatment plan.

How is hard palate cancer typically treated? 

It depends on how advanced the disease is, of course, but it usually starts with surgery. Early-stage tumors can sometimes be completely removed this way, so surgery may be all that’s needed. With more advanced tumors, you’ll likely need that plus radiation, and possibly chemotherapy and/or immunotherapy.

What are the latest advances in the diagnosis and treatment of hard palate cancer?

Molecular markers allow us to make more accurate diagnoses, so we’ve gotten a lot better at identifying even the rarest hard palate cancers now. That’s the key to getting patients the right treatment.

Proton therapy lets us target tumors more precisely while avoiding healthy tissues. We’re also exploring treatment options with immunotherapy and targeted therapy. 

But the biggest advances in treatment are related to reconstruction. When you remove the roof of the mouth either partially or totally, you’re taking out the natural barrier that exists between the oral cavity and the nasal passage and/or sinuses. Without that barrier, patients can neither eat nor talk.

We have two ways to correct this:

1. Prosthetics are the quickest and easiest way to solve the problem. An obturator is a custom-made device designed to cover the hole left behind in the hard palate by tumor-removal surgery. It looks a bit like a denture but has a dome-shaped structure that fits snugly into the defect and clips onto the remaining teeth. The first one is usually fabricated by our prosthodontics experts during surgery, but patients often get new ones as their healing progresses.
2. Reconstructive surgery is a fairly complicated procedure, so it’s important to have a very experienced doctor performing it. When the surgeon goes to remove the tumor, he or she will determine the most appropriate site to pull donor material from — usually the patient’s thigh or arm — and then transfer that tissue to the roof of the mouth. If teeth are involved, the surgeon may also need to harvest bone, which may serve to facilitate dental implants.

But whether we’re talking about tissue replacement or prosthetics, our techniques have evolved to return patients to a very normal level of functioning after surgery. 

Other than tobacco and alcohol use, are there any other risk factors for hard palate cancer?

Chewing betel nuts is associated with a higher risk of developing it. But that’s a more common habit in India and Southeast Asia. It’s not as big of a factor here in the U.S.

Anything else you want people to know about hard palate cancers?

I don’t want everyone with a canker sore to be concerned about cancer. Most oral ulcers are not cancer and will heal just fine on their own. But any abnormal mass or ulcer on the roof of your mouth that doesn’t go away within two weeks should be evaluated by a specialist.

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