Oral cancer can form in any part of the mouth. Most oral cancers begin in the flat cells that cover the surfaces of your mouth, tongue, and lips. Anyone can get oral cancer, but the risk is higher if you are male, use tobacco, drink lots of alcohol, have HPV, or have a history of head or neck cancer. Frequent sun exposure is also a risk factor for lip cancer.

Symptoms of oral cancer include

• White or red patches in your mouth
• A mouth sore that won't heal
• Bleeding in your mouth
• Loose teeth
• Problems or pain with swallowing
• A lump in your neck
• An earache

Tests to diagnose oral cancer include a physical exam, endoscopy, biopsy, and imaging tests. Oral cancer treatments may include surgery, radiation therapy, and chemotherapy. Some patients have a combination of treatments.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for lip and oral cavity cancer include the following:

• Using tobacco products.
• Heavy alcohol use.
• Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
• Being male.

Signs of lip and oral cavity cancer include a sore or lump on the lips or in the mouth.

These and other signs and symptoms may be caused by lip and oral cavity cancer or by other conditions. Check with your doctor if you have any of the following:

• A sore on the lip or in the mouth that does not heal.
• A lump or thickening on the lips or gums or in the mouth.
• A white or red patch on the gums, tongue, or lining of the mouth.
• Bleeding, pain, or numbness in the lip or mouth.
• Change in voice.
• Loose teeth or dentures that no longer fit well.
• Trouble chewing or swallowing or moving the tongue or jaw.
• Swelling of jaw.
• Sore throat or feeling that something is caught in the throat.

Lip and oral cavity cancer may not have any symptoms and is sometimes found during a regular dental exam.

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

The following tests and procedures may be used:

• Physical exam of the lips and oral cavity: An exam to check the lips and oral cavity for abnormal areas. 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. 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 history of the patient’s health habits and past illnesses and medical and dental treatments will also be taken.
• Endoscopy : A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
• Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist. If leukoplakia is found, cells taken from the patches are also checked under the microscope for signs of cancer.
• Exfoliative cytology : A procedure to collect cells from the lip or oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, mouth, or throat. The cells are viewed under a microscope to find out if they are abnormal.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. 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, 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

Computed tomography (CT) scan of the head and neck. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.

• Barium swallow : A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken. This procedure is also called an upper GI series.
• 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.
• Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

Certain factors affect prognosis (chance of recovery) and treatment options.

Prognosis (chance of recovery) depends on the following:

• The stage of the cancer.
• Where the tumor is in the lip or oral cavity.
• Whether the cancer has spread to blood vessels.

For patients who smoke, the chance of recovery is better if they stop smoking before beginning radiation therapy.

Treatment options depend on the following:

• The stage of the cancer.
• The size of the tumor and where it is in the lip or oral cavity.
• Whether the patient's appearance and ability to talk and eat can stay the same.
• The patient's age and general health.

Patients who have had lip and oral cavity cancer have an increased risk of developing a second cancer in the head or neck. Frequent and careful follow-up is important.

KEY POINTS

• After lip and oral cavity cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lip and oral cavity or to other parts of the body.
• There are three ways that cancer spreads in the body.
• Cancer may spread from where it began to other parts of the body.
• The following stages are used for lip and oral cavity cancer:
  • Stage 0 (Carcinoma in Situ)
  • Stage I
  • Stage II
  • Stage III
  • Stage IV

After lip and oral cavity cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lip and oral cavity or to other parts of the body.

The process used to find out if cancer has spread within the lip and oral cavity or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose lip and oral cavity cancer are also used to stage the disease.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if lip cancer spreads to the lung, the cancer cells in the lung are actually lip cancer cells. The disease is metastatic lip cancer, not lung cancer.

The following stages are used for lip and oral cavity cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).

Stage I

In stage I, cancer has formed. The tumor is 2 centimeters or smaller and the deepest point of tumor invasion is 5 millimeters or less.

Tumor sizes are often measured in millimeters (mm) or centimeters. Common items that can be used to show tumor size in mm include: a sharp pencil point (1 mm), a new crayon point (2 mm), a pencil-top eraser (5 mm), a pea (10 mm), a peanut (20 mm), and a lime (50 mm).

Stage II

In stage II, the tumor:

• is 2 centimeters or smaller and the deepest point of tumor invasion is greater than 5 millimeters; or
• is larger than 2 centimeters but not larger than 4 centimeters and the deepest point of tumor invasion is 10 millimeters or less.

Stage III

In stage III, the tumor:

• is larger than 2 centimeters but not larger than 4 centimeters and the deepest point of tumor invasion is greater than 10 millimeters; or
• is larger than 4 centimeters and the deepest point of tumor invasion is 10 millimeters or less; or
• has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC.

• In stage IVA, the tumor:
  • is larger than 4 centimeters and the deepest point of tumor invasion is greater than 10 millimeters; or cancer has spread to the outer surface of the upper or lower jawbone, into the maxillary sinus, or to the skin of the face. The cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor; or
  • is any size or cancer has spread to the outer surface of the upper or lower jawbone, into the maxillary sinus, or to the skin of the face. Cancer has spread:
    • to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
    • to one lymph node that is larger than 3 centimeters but not larger than 6 centimeters, on the same side of the neck as the primary tumor; or
    • to multiple lymph nodes that are not larger than 6 centimeters, on the same side of the neck as the primary tumor; or
    • to multiple lymph nodes that are not larger than 6 centimeters, on the opposite side of the neck as the primary tumor or on both sides of the neck.
• In stage IVB, the tumor:
  • has spread to one lymph node that is larger than 6 centimeters; or
  • has spread to one lymph node that is larger than 3 centimeters, on the same side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
  • has spread to one lymph node of any size on the opposite side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
  • has spread to multiple lymph nodes anywhere in the neck, and cancer has spread through the outside covering of any lymph node into nearby connective tissue; or
  • has spread further into the muscles or bones needed for chewing, or to the part of the sphenoid bone behind the upper jaw, and/or to the carotid artery near the base of the skull. Cancer may have also spread to one or more lymph nodes of any size, anywhere in the neck.
• In stage IVC, the tumor:
  • has spread beyond the lip or oral cavity to other parts of the body, such as the lung, liver, or bone.

Lip and oral cavity cancer can recur (come back) after it has been treated.

The cancer may come back in the lip or mouth or in other parts of the body.

KEY POINTS

• There are different types of treatment for patients with lip and oral cavity cancer.
• Patients with lip and oral cavity cancer should have their treatment planned by a team of doctors who are expert in treating head and neck cancer.
• Two types of standard treatment are used:
  • Surgery
  • Radiation therapy
• New types of treatment are being tested in clinical trials.
  • Chemotherapy
  • Hyperfractionated radiation therapy
  • Hyperthermia therapy
• Treatment for lip and 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 patients with lip and oral cavity cancer.

Different types of treatment are available for patients with lip and 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. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Patients with lip and oral cavity cancer should have their treatment planned by a team of doctors who are expert in treating head and neck cancer.

Treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. Because the lips and oral cavity are important for breathing, eating, and talking, patients may need special help adjusting to the side effects of the cancer and its treatment. The medical oncologist may refer the patient to other health professionals with special training in the treatment of patients with head and neck cancer. These include the following:

• Head and neck surgeon.
• Radiation oncologist.
• Dentist.
• Speech therapist.
• Dietitian.
• Psychologist.
• Rehabilitation specialist.
• Plastic surgeon.

Two types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is a common treatment for all stages of lip and oral cavity cancer. Surgery may include the following:

• Wide local excision: Removal of the cancer and some of the healthy tissue around it. If cancer has spread into bone, surgery may include removal of the involved bone tissue.
• Neck dissection: Removal of lymph nodes and other tissues in the neck. This is done when cancer may have spread from the lip and oral cavity.
• Plastic surgery: An operation that restores or improves the appearance of parts of the body. Dental implants, a skin graft, or other plastic surgery may be needed to repair parts of the mouth, throat, or neck after removal of large tumors.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

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. There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.

External-beam radiation therapy of the head and neck. A machine is used to aim high-energy radiation at the cancer. The machine can rotate around the patient, delivering radiation from many different angles to provide highly conformal treatment. A mesh mask helps keep the patient’s head and neck from moving during treatment. Small ink marks are put on the mask. The ink marks are used to line up the radiation machine in the same position before each treatment.

• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy are used to treat lip and oral cavity cancer.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. It is also important for patients to have a dental exam before radiation therapy begins, so that existing problems can be treated.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells 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). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavitysuch as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Hyperfractionated radiation therapy

Hyperfractionated radiation therapy is radiation treatment in which the total dose of radiation is divided into small doses and the treatments are given more than once a day.

Hyperthermia therapy

Hyperthermia therapy is a treatment in which body tissue is heated above normal temperature to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation and certain anticancer drugs.

Treatment for lip and oral cavity cancer may cause side effects.

For information about side effects caused by 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 or to find out the stage of the cancer may be repeated. Some tests will be repeated in order 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 condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment of stage I lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

• Surgery (wide local excision).
• Internal radiation therapy with or without external radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

• Surgery (wide local excision).
• Internal radiation therapy with or without external radiation therapy.
• Radiation therapy to lymph nodes in the neck.

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

• Surgery (wide local excision) for tumors smaller than 1 centimeter, with or without internal and/or external radiation therapy.
• Surgery (wide local excision with skin graft) or radiation therapy for larger tumors.

Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

• Surgery (wide local excision) for tumors smaller than ½ centimeter.
• Surgery (wide local excision) or radiation therapy for larger tumors.

Lower gingiva

If cancer is in the lower gingiva (gums), treatment may include the following:

• Surgery (wide local excision, which may include removing part of the jawbone, and skin graft).
• Radiation therapy with or without surgery.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

• Surgery (wide local excision, which may include removing part of the jawbone.)
• Radiation therapy with or without surgery.

Upper gingiva or hard palate

If cancer is in the upper gingiva (gums) or the hard palate (the roof of the mouth), treatment is usually surgery(wide local excision) with or without radiation therapy.

Stage II Lip and Oral Cavity Cancer

Treatment of stage II lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

• Surgery (wide local excision).
• External radiation therapy and/or internal radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

• Radiation therapy and/or surgery (wide local excision).
• Internal radiation therapy with surgery (neck dissection).

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

• Radiation therapy for tumors that are 3 centimeters or smaller.
• Surgery (wide local excision) and/or radiation therapy for larger tumors.

Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

• Surgery (wide local excision).
• Radiation therapy.
• Surgery (wide local excision) followed by external radiation therapy, with or without internal radiation therapy, for large tumors.

Lower gingiva

If cancer is in the lower gingiva (gums), treatment may include the following:

• Surgery (wide local excision, which may include removing part of the jawbone, and a skin graft).
• Radiation therapy alone or after surgery.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

• Surgery (wide local excision, which includes removing part of the jawbone).
• Radiation therapy with or without surgery.

Upper gingiva or hard palate

If cancer is in the upper gingiva (gums) or the hard palate (the roof of the mouth), treatment may include the following:

• Surgery (wide local excision) with or without radiation therapy.
• Radiation therapy alone.

Stage III Lip and Oral Cavity Cancer

Treatment of stage III lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

• Surgery and external radiation therapy with or without internal radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of hyperfractionated radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

• External radiation therapy with or without internal radiation therapy.
• Surgery (wide local excision) followed by radiation therapy.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of hyperfractionated radiation therapy.

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

• Surgery (wide local excision) with or without radiation therapy.
• Radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of hyperfractionated radiation therapy.

Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

• Surgery (wide local excision, which may include removing part of the jawbone, with or without neck dissection).
• External radiation therapy with or without internal radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of hyperfractionated radiation therapy.

Lower gingiva

If cancer is in the lower gingiva (gums), treatment may include the following:

• Surgery (wide local excision) with or without radiation therapy. Radiation may be given before or after surgery.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of hyperfractionated radiation therapy.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

• Surgery to remove the tumor, lymph nodes, and part of the jawbone, with or without radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of hyperfractionated radiation therapy.

Upper gingiva

If cancer is in the upper gingiva (gums), treatment may include the following:

• Radiation therapy.
• Surgery (wide local excision) and radiation therapy.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of hyperfractionated radiation therapy.

Hard palate

If cancer is in the hard palate (the roof of the mouth), treatment may include the following:

Radiation therapy.

• Surgery (wide local excision) with or without radiation therapy.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of hyperfractionated radiation therapy.

Lymph nodes

For cancer that may have spread to lymph nodes, treatment may include the following:

• Radiation therapy and/or surgery (neck dissection).
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of hyperfractionated radiation therapy.

Stage IV Lip and Oral Cavity Cancer

Treatment of stage IV lip and oral cavity cancer depends on where cancer is found in the lip and oral cavity.

Lip

If cancer is in the lip, treatment may include the following:

• Surgery and external radiation therapy with or without internal radiation therapy.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of hyperfractionated radiation therapy.

Front of the tongue

If cancer is in the front of the tongue, treatment may include the following:

• Surgery to remove the tongue and sometimes the larynx (voice box) with or without radiation therapy.
• Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of hyperfractionated radiation therapy.

Buccal mucosa

If cancer is in the buccal mucosa (the lining of the inside of the cheeks), treatment may include the following:

• Surgery (wide local excision) and/or radiation therapy.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of hyperfractionated radiation therapy.

Floor of the mouth

If cancer is in the floor (bottom) of the mouth, treatment may include the following:

• Surgery before or after radiation therapy.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of hyperfractionated radiation therapy.

Lower gingiva

If cancer is in the lower gingiva (gums), treatment may include the following:

• Surgery and/or radiation therapy.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of hyperfractionated radiation therapy.

Retromolar trigone

If cancer is in the retromolar trigone (the small area behind the wisdom teeth), treatment may include the following:

• Surgery to remove the tumor, lymph nodes, and part of the jawbone, followed by radiation therapy.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of hyperfractionated radiation therapy.

Upper gingiva or hard palate

If cancer is in the upper gingiva (gums) or hard palate (the roof of the mouth), treatment may include the following:

• Surgery with radiation therapy.
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of hyperfractionated radiation therapy.

Lymph nodes

For cancer that may have spread to lymph nodes, treatment may include the following:

• Radiation therapy and/or surgery (neck dissection).
• A clinical trial of chemotherapy and radiation therapy.
• A clinical trial of chemotherapy before or after surgery.
• A clinical trial of hyperfractionated radiation therapy.

Treatment Options for Recurrent Lip and Oral Cavity Cancer

Treatment of recurrent lip and oral cavity cancer may include the following:

• Surgery, if radiation therapy was used before.
• Surgery and/or radiation therapy, if surgery was used before.
• A clinical trial of chemotherapy with or without radiation therapy.
• A clinical trial of hyperthermia therapy.

What is screening?

Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

Scientists are trying to better understand which people are more likely to get certain types of cancer. They also study the things we do and the things around us to see if they cause cancer. This information helps doctors recommend who should be screened for cancer, which screening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

General Information About Oral Cavity and Nasopharyngeal Cancers

KEY POINTS

• Oral cavity and nasopharyngeal cancers are diseases in which malignant (cancer) cells form in the mouth and throat.
• The number of new cases of oral cavity and nasopharyngeal cancers and the number of deaths from these cancers vary by sex and geographic region.
• Different factors increase or decrease the risk of oral cavity and nasopharyngeal cancers.

Oral cavity and nasopharyngeal cancers are diseases in which malignant (cancer) cells form in the mouth and throat.

Oral cavity cancer usually forms in the squamous cells (thin, flat cells lining the inside of the oral cavity).

Oral cavity cancer forms in any of these tissues of the oral cavity:

• The lips.
• 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 front of the roof of the mouth).
• The retromolar trigone (the small area behind the wisdom teeth).

Pharyngeal cancer forms in the tissues of the pharynx (throat), including the nasopharynx, oropharynx, and hypopharynx. This summary covers nasopharyngeal cancer, which forms in the tissue of the nasopharynx (the upper part of the throat behind the nose).

The number of new cases of oral cavity and nasopharyngeal cancers and the number of deaths from these cancers vary by sex and geographic region.

From 2008 to 2017, the number of new cases of oral cavity cancer slightly increased.

Oral cavity cancer is more common in men than in women. Although oral cavity cancer may occur in adults of any age, it occurs most often in those aged 75 to 84 years.

France, Brazil, and parts of Asia have much higher rates of oral cavity cancer than most other countries.

Nasopharyngeal cancer is rare in the United States. It is more common in parts of Asia, the Arctic region, North Africa, and the Middle East.

Different factors increase or decrease the risk of oral cavity and nasopharyngeal cancers.

Anything that increases your chance of getting a disease is called a risk factor. Anything that decreases your chance of getting a disease is called a protective factor.

Being infected with Epstein-Barr virus (EBV) increases the risk of nasopharyngeal cancer.

For more information about risk factors and protective factors for oral cavity cancer, see the PDQ summaries on Oral Cavity, Oropharyngeal, Hypopharyngeal, and Laryngeal Cancers Prevention and Lip and Oral Cavity Cancer Treatment (Adult).

Oral Cavity and Nasopharyngeal Cancers Screening

KEY POINTS

• Tests are used to screen for different types of cancer when a person does not have symptoms.
• There are no standard or routine screening tests for oral cavity and nasopharyngeal cancers.
• Screening tests for oral cavity and nasopharyngeal cancers are being studied in clinical trials.

Tests are used to screen for different types of cancer when a person does not have symptoms.

Scientists study screening tests to find those with the fewest harms and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) helps a person live longer or decreases a person's chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.

There are no standard or routine screening tests for oral cavity and nasopharyngeal cancers.

No studies have shown that screening for oral cavity cancer and nasopharyngeal cancer would lower the risk of dying from these diseases.

A dentist or medical doctor may check the oral cavity during a routine check-up. The exam will include looking for lesions, including areas of leukoplakia (an abnormal white patch of cells) and erythroplakia (an abnormal red patch of cells). Leukoplakia and erythroplakia lesions on the mucous membranes may become cancerous.

If lesions are seen in the mouth, the following procedures may be used to find abnormal tissue that might become oral cavity cancer:

• Toluidine blue stain: A procedure in which lesions in the mouth are coated with a blue dye. Areas that stain darker are more likely to be cancer or become cancer.
• Fluorescence staining: A procedure in which lesions in the mouth are viewed using a special light. After the patient uses a fluorescent mouth rinse, normal tissue looks different from abnormal tissue when seen under the light.
• Exfoliative cytology: A procedure to collect cells from the oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, or mouth. The cells are viewed under a microscope to find out if they are abnormal.
• Brush biopsy: The removal of cells using a brush that is designed to collect cells from all layers of a lesion. The cells are viewed under a microscope to find out if they are abnormal.

More than half of oral cancers have already spread to lymph nodes or other areas by the time they are found.

Epstein-Barr virus (EBV) has been linked to nasopharyngeal cancer. Screening for nasopharyngeal cancer using the EBV antibody test or EBV DNA test has been studied. These are laboratory tests used to check the blood for EBV antibodies or EBV DNA. If EBV antibodies or DNA are found in the blood more tests may be done to check for nasopharyngeal cancer. No studies have shown that screening would decrease the risk of dying from this disease.

Screening tests for oral cavity and nasopharyngeal cancers are being studied in clinical trials.

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.

Risks of Oral Cavity and Nasopharyngeal Cancers Screening

KEY POINTS

• Screening tests have risks.
• The risks of screening for oral cavity and nasopharyngeal cancers include the following:
  • Finding these cancers may not improve health or help a person live longer.
  • False-negative test results can occur.
  • False-positive test results can occur.
  • Misdiagnosis can occur.

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

The risks of screening for oral cavity and nasopharyngeal cancers include the following:

Finding these cancers may not improve health or help a person live longer.

Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. Finding these cancers is called overdiagnosis. It is not known if treatment of oral cavity cancer or nasopharyngeal cancer would help you live longer than if no treatment were given, and treatments for cancer, such as surgery and radiation therapy, may have serious side effects.

False-negative test results can occur.

Screening test results may appear to be normal even though oral cavity cancer or nasopharyngeal cancer is present. A person who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if there are symptoms.

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests and procedures (such as biopsy), which also have risks.

Misdiagnosis can occur.

A biopsy is needed to diagnose oral cavity and nasopharyngeal cancers. Cells or tissues are removed from the oral cavity or nasopharynx and viewed under a microscope by a pathologist to check for signs of cancer. When the cells are cancer and the pathologist reports them as not being cancer, the cancer is misdiagnosed. Cancer is also misdiagnosed when the cells are not cancer and the pathologist reports there is cancer. When cancer is misdiagnosed, treatment that is needed may not be given or treatment may be given that is not needed.