Oral cancer: What you should know

Each year more than 30,000 people are diagnosed with oral cancer. This type of tumor can occur on the tongue, lips, gums, cheek, palate or floor of the mouth. When caught early, oral cancer is highly treatable, so it’s important to know what to look for.

Ann Gillenwater, M.D., director of MD Anderson’s Oral Cancer Prevention Clinic, recently answered a few questions to help patients and families facing oral cancer, as well as those worried about oral cancer symptoms.

Here’s what she had to say.

What are common oral cancer symptoms and precursors?

Common symptoms of oral cancer include a sore in the mouth that doesn’t heal, loose teeth, difficulty chewing, swallowing or moving the jaw, persistent bad breath, a lump or red patch in the mouth and unexplained weight loss.

Some oral cancers begin as precancerous lesions, which need to be closely monitored. The most common type is leukoplakia, which is a white area or spot in the mouth. The other types are:

• erythroplakia, a red, raised area or spot that can bleed if scraped
• erythroleukoplakia, a spot with both red and white areas in the mouth.

Are certain people more likely to develop oral cancer?

Yes. Those more likely to develop oral cancer include tobacco users and people who drink alcohol in excess, as well as those with:

• immunosuppression
• lichen planus
• graft vs. host disease
• leukoplakia
• erythroplakia
• erythroleukoplakia
• fanconi anemia 

Many of my patients ask me if their oral cancer came from the human papillomavirus (HPV), and the answer is almost always no. That’s a common misconception. It’s extremely rare for HPV cancers to occur in the mouth, although it does commonly occur in the throat, which leads to this confusion.  

What can people do to lower their risk of oral cancer?

I tell my patients to not drink alcohol in excess and to stop smoking. It’s also important to maintain a healthy diet that consists of fruits, vegetables, lean meats and unprocessed foods. Routine dental care and good dental hygiene also are essential. Dentists often recognize precancerous lesions during routine dental check-ups.  

How are oral cancer and oral precancerous lesions typically treated?

We tailor the treatment plans to fit each patient, but surgery is often required to remove oral cancers. We use minimally invasive surgical techniques to preserve as much healthy tissue as possible.

Surgery is sometimes followed by radiation therapy and chemotherapy. At MD Anderson, we offer two radiation therapies that minimize damage to healthy tissues surrounding the tumor: proton therapy and intensity-modulated radiotherapy (IMRT).

What treatment options are typically offered to patients experiencing an oral cancer recurrence?

The first line of treatment is surgery, followed by radiation therapy.

What side effects do oral cancer patients typically experience after treatment?

Many patients with early oral cancers have minimal side effects. But surgery can often affect the speech and swallowing functioning of those with advanced oral cancers. Radiation can cause dry mouth for both groups.

Our plastic surgeons and dental oncologists can reconstruct portions of the mouth that have been surgically removed. Our speech pathologists also work closely with the patients to help restore their speech and swallowing.

What new oral cancer research is being done at MD Anderson?

For patients with no history of tobacco or alcohol use, we evaluate their lifestyle habits to try to determine what caused this disease. I work closely with engineers at Rice University to advance our diagnostic screening tools and better understand how likely oral lesions are to become cancer.

We also have a clinical trial for advanced oral cancer that uses genomic biomarkers to identify those individuals most likely to respond to chemotherapy. In addition, we will soon open a chemopreventive study investigating a new immunotherapy drug to prevent high-risk patients from developing oral cancer.

What’s your advice for patients who’ve just been diagnosed with oral cancer or oral precancerous lesions?

Be sure to choose a doctor experienced in oral cancer at a facility that offers a full spectrum of treatment options. It also doesn’t hurt to get a second opinion. 

If you have precancerous lesions, they should be examined and monitored by a doctor experienced in oral cancer. At our Oral Cancer Prevention Clinic, we are testing advanced diagnostic tools that give quantitative measurements of lesions, which non-invasively indicate a lesion’s chance of having a high-grade pre-cancer or cancer. 

Finally, whether you have oral cancer or precancerous lesions, my number one rule is to stay positive and remember that many patients do quite well.