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Oral Cancers

Signs and Symptoms of Oral Cancer

For cancers in the mouth, you, your dentist or your general doctor can actually see or feel something abnormal in most cases. This is different from cancers in other parts of the head and neck, which can remain hidden for some time.

Symptoms to watch for include7, Ko YC, Huang YL, Lee CH, Chen MJ, Lin LM, Tsai CC. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. Nov 1995;24(10):450-453.8, SilvermanJr. S. Early diagnosis of oral cancer. Cancer. Oct 15 1988;62(8 Suppl):1796-1799.9Scully C, Porter S. ABC of oral health. Oral cancer. BMJ. Jul 8 2000;321(7253):97-100.:

  • Painful sores in the mouth: Most commonly, an oral cancer will start as a painful sore in the mouth. In some cases, a dentist or dental hygienist will see a sore in the mouth that you didn’t even realize was there. In general, a patch or sore in the mouth that doesn’t heal after a few weeks should be evaluated in more detail by a specialist.
  • A patch in the mouth: A red patch (erythroplakia) in the mouth that lasts for more than a few weeks is more likely to be cancer than a white patch.14 Koch WM, Choti MA, Civelek AC, Eisele DW, Saunders JR. Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 1998. 124:455-9. However, any lesion that doesn’t go away needs to be biopsied to determine whether it is cancer. The topic of white patches in the mouth (leukoplakia) and dysplasia (abnormal cells that are not cancer) can get complicated, and you should discuss this with a specialist.
  • Difficulty speaking: This is called dysarthria, and it can occur when a tumor changes the way your tongue moves.
  • Recurrent bleeding from the mouth: This can happen when the cancer makes a hole in some part of the mouth (this is called an ulcer) or if cancer cells are accidently rubbed off while brushing your teeth or eating certain foods.
  • Bad breath: In rare circumstances, when cancer cells start to become necrotic, the dead cells can lead to a bad smell from the mouth. This is called halitosis.
  • Loose teeth or dentures that don’t fit correctly: This happens if the tumor gets into the tooth sockets or the bones in which the teeth are rooted. This is of particular concern for oromandibular cancer.
  • Difficulty opening the mouth: This can happen if the cancer gets into any of the muscles that help to open and close the mouth. This is called trismus.
  • Numbness (for example in the lower teeth or lower lip/chin area): This means that the cancer cells have gotten into nerves that allow you to feel. The main nerve responsible for this when dealing with oral cancer runs just inside the lower jawbone, and a branch even runs in the middle of the jawbone and comes out under the skin of your chin.
  • Pain or difficulty swallowing: This can happen when tumors get large and either get in the way of eating or involve the muscles and nerves of swallowing.

In some cases, a dentist or oral surgeon will see something in the mouth, remove it and a week later get the report that it is a cancer.

If a lesion was removed and later found to be cancer: In this case, you should still see a specialist in head and neck cancers because it is important to review the pathology in detail to see if any more treatment is needed. Some questions to review are:

  • What type of cancer was it?
  • How big was it?
  • How deeply did it invade?
  • Was it completely removed with a rim of normal tissue around it? (This is known as having “clear margins.”)

In rare cases, the first sign of an oral cancer could be a lump in the neck.

  • A lump in the neck: This means that the tumor has spread to the lymph nodes in the neck. This is less common for oral cancers than other types of cancer in the head and neck because the primary cancer is usually the main problem.

But don’t jump to any conclusions. You could have one or more of these symptoms but NOT have an oral cancer. There are several non-cancerous causes of the same symptoms. That’s why you need to see a specialist.

References

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2 Bombeccari GP, Guzzi G, Tettamanti M, Giannì AB, Baj A, Pallotti F, Spadari F. Oral lichen planus and malignant transformation: a longitudinal cohort study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Sep;112(3):328-34.

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5 Petersen PE, Oral cancer prevention and control – The approach of the World Health Organization, Oral Oncol. 2008.

6 Ko YC, Huang YL, Lee CH, Chen MJ, Lin LM, Tsai CC. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. Nov 1995;24(10):450-453.

7 Ko YC, Huang YL, Lee CH, Chen MJ, Lin LM, Tsai CC. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. Nov 1995;24(10):450-453.

8 SilvermanJr. S. Early diagnosis of oral cancer. Cancer. Oct 15 1988;62(8 Suppl):1796-1799.

9 Scully C, Porter S. ABC of oral health. Oral cancer. BMJ. Jul 8 2000;321(7253):97-100.

10 Neville BW, Day TA. Oral cancer and precancerous lesions. CA: A cancer journal for clinicians. Jul-Aug 2002;52(4):195-215.

11 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

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13 Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, Petruzelli G, Gourin CG, Wong RJ, Ferris RL, El Naggar A, Ridge JA, Paniello RC, Owzar K, McCall L, Chepeha DB, Yarbrough WG, Myers JN. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol. 2010 Mar 10;28(8):1395-400.

14 Koch WM, Choti MA, Civelek AC, Eisele DW, Saunders JR. Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 1998. 124:455-9.

15 Shoaib T, Soutar DS, MacDonald DG, Camilleri IG, Dunaway DJ, GrayHW, McCurrach GM, Bessent RG, MacLeod TIF, Robertson AG. The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer.2001;91:2077-2083.

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21 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010.

22 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 9, 2016. To view the most recent and complete version of the guideline, go online to www.NCCN.org. The NCCN Guidelines are a work in progress that may be refined as often as new significant data becomes available. The NCCN Guidelines are a statement of consensus of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

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24 Pradhan SA, Rajpal RM. Marginal mandibulectomy in the management of squamous cancer of the oral cavity. Indian J Cancer.1987;24;167-171.

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27 Urist MM, O'Brien CJ, Soong SJ, Visscher DW, Maddox WA. Squamous cell carcinoma of the buccal mucosa: analysis of prognostic factors. Am J Surg. 1987 Oct;154(4):411-4.