Oral cavity cancer is a disease in which malignant (cancer) cells form in the tissues of the mouth.

The oral cavity includes the following:

• The front two thirds of the tongue.
• The gingiva (gums).
• The buccal mucosa (the lining of the inside of the cheeks).
• The floor (bottom) of the mouth under the tongue.
• The hard palate (the roof of the mouth).
• The retromolar trigone (the small area behind the wisdom teeth).

Most tumors in the oral cavity are benign (not cancer).

Oral cavity cancer in children is very rare. More than 90% of tumors in the mouths of children are benign. When oral cavity cancer occurs, the most common types are lymphoma and sarcoma. Squamous cell carcinoma (cancer that forms in the thin, flat cells lining the inside of the mouth) is rare in children.

Both benign and malignant oral cavity tumors can affect eating or speaking and need treatment.

Being infected with the human papillomavirus (HPV) may increase the risk of oral cavity cancer.

Anything that increases your chance of getting a disease is called a risk factor. Not every child with one or more of these risk factors will develop oral cavity cancer, and it will develop in some children who don't have any known risk factors. Talk with your child's doctor if you think your child may be at risk.

Risk factors for oral cavity cancer in children and adolescents include the following:

• Being infected with HPV.
• Having certain genetic conditions, such as Fanconi anemia, dyskeratosis congenita, connexin gene mutations, epidermolysis bullosa, or xeroderma pigmentosum.
• Having chronic graft-versus-host disease.

Signs and symptoms of oral cavity cancer include a sore that does not heal.

These and other signs and symptoms may be caused by oral cavity cancer or by other conditions.

Check with your child's doctor if your child has any of the following:

• A sore in the mouth that does not heal.
• A lump or thickening in the mouth.
• A white or red patch on the gums, tongue, or lining of the mouth.
• Bleeding or pain in the mouth.

Tests that examine the mouth and throat are used to diagnose oral cavity cancer.

In addition to asking about your child's personal and family health history and doing a physical exam, your child's doctor may perform the following tests and procedures.

• Oral exam: An exam to check the oral cavity for abnormal areas. This exam may be done while under anesthesia. The medical doctor or dentist will feel the entire inside of the mouth with a gloved finger and examine the oral cavity with a small long-handled mirror and lights or a fiberoptic device. This will include checking the insides of the cheeks and lips; the gums; the roof and floor of the mouth; and the top, bottom, and sides of the tongue. The neck will be felt for swollen lymph nodes. A dental exam may also be done.
• X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of the inside of the body.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas of the body, such as the head and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the head or neck, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
  • Fine-needle aspiration biopsy: The removal of tissue or fluid using a thin needle.
  • Incisional biopsy: The removal of part of a lump or a sample of tissue that doesn’t look normal.

There is no standard staging system for childhood oral cavity cancer.

The process used to find out if cancer has spread from the oral cavity to nearby areas or to other parts of the body is called staging. There is no standard staging system for childhood oral cavity cancer. The results of the tests and procedures done to diagnose oral cavity cancer are used to help make decisions about treatment.

Sometimes childhood oral cavity cancer recurs (comes back) after treatment.

Treatment Option Overview

KEY POINTS

• There are different types of treatment for children with oral cavity cancer.
• Children with oral cavity cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.
• Three types of standard treatment are used:
  • Surgery
  • Chemotherapy
  • Radiation therapy
• New types of treatment are being tested in clinical trials.
  • Targeted therapy
• Treatment for childhood oral cavity cancer may cause side effects.
• Patients may want to think about taking part in a clinical trial.
• Patients can enter clinical trials before, during, or after starting their cancer treatment.
• Follow-up tests may be needed.

There are different types of treatment for children with oral cavity cancer.

Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

Children with oral cavity cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:

• Pediatrician.
• Pediatric surgeon.
• Radiation oncologist.
• Pathologist.
• Pediatric ear, nose, and throat specialist.
• Pediatric nurse specialist.
• Social worker.
• Rehabilitation specialist.
• Psychologist.
• Child-life specialist.

Three types of standard treatment are used:

Surgery

Surgery is the most common treatment for benign oral cavity tumors and oral cavity cancer in children.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapy is being studied for the treatment of childhood oral cavity cancer that has recurred (come back).

Treatment for childhood oral cavity cancer may cause side effects.

For information about side effects that begin during treatment for cancer, see our Side Effects page.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment of Benign Childhood Oral Cavity Tumors

Treatment of a newly diagnosed benign (not cancer) oral cavity tumor in children may include the following:

• Surgery to remove the tumor.

Treatment of Childhood Oral Cavity Cancer

Treatment of newly diagnosed malignant oral cavity tumor in children may include the following:

• Surgery to remove the tumor.
• Chemotherapy.
• Radiation therapy.

Treatment of Recurrent Childhood Oral Cavity Cancer

Treatment of recurrent oral cavity cancer in children may include the following:

• A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.