Lip and Oral Cavity Cancer
[Back to top]
Description
[Back to top]
What is cancer of the lip and oral cavity?
Cancer of the lip and oral cavity is a disease in which cancer (malignant)
cells are found in the tissues of the lip or mouth. The oral cavity includes
the front two thirds of the tongue, the upper and lower gums (the gingiva), the
lining of the inside of the cheeks and lips (the buccal mucosa), the bottom
(floor) of the mouth under the tongue, the bony top of the mouth (the hard
palate), and the small area behind the wisdom teeth (the retromolar trigone).
Cancers of the head and neck are most often found in people who are over the
age of 45. Cancer of the lip is more common in men than in women, and is more
likely to develop in people with light-colored skin who have been in the sun a
lot. Cancer of the oral cavity is more common in people who chew tobacco or
smoke pipes.
A doctor should be seen if a person finds a lump in the lip, mouth, or gums,
finds a sore in the mouth that doesn’t heal, or has bleeding or pain in the
mouth. Another sign of a cancer of the mouth or gums is when dentures no
longer fit well. Often lip and oral cavity cancers are found by dentists when
examining the teeth.
If there are symptoms, a doctor will examine the mouth using a mirror and
lights. The doctor may order x-rays of the mouth. If tissue that is not
normal is found, the doctor will need to cut out a small piece and look at it
under the microscope to see if there are any cancer cells. This is called a
biopsy. The patient will be given a substance to take feeling away from the
area for a short time (a local anesthetic) so no pain is felt. The doctor will
also feel the throat for lumps.
The chance of recovery (prognosis) depends on where the cancer is in the lip or
mouth, whether the cancer is just in the lip or mouth or has spread to other
tissues (the stage), and the patient’s general state of health.
[Back to top]
Stage Explanation
[Back to top]
Stage of cancer of the lip and oral cavity
Once cancer of the lip and oral cavity is found, more tests will be done to
find out if cancer cells have spread to other parts of the body. This is
called staging. A doctor needs to know the stage of the disease to plan
treatment. The following stages are used for cancer of the lip and oral
cavity:
[Back to top]
Stage I
The cancer is no more than 2 centimeters (about 1 inch) and has not spread to
lymph nodes in the area (lymph nodes are small bean-shaped structures that are
found throughout the body; they produce and store infection-fighting cells).
[Back to top]
Stage II
The cancer is more than 2 centimeters, but less than 4 centimeters (less than 2
inches), and has not spread to lymph nodes in the area.
[Back to top]
Stage III
Either of the following may be true:
- The cancer is more than 4 centimeters.
- The cancer is any size but has spread to only one lymph node on the same side
of the neck as the cancer. The lymph node that contains cancer measures no
more than 3 centimeters (just over one inch).
[Back to top]
Stage IV
Any of the following may be true:
- The cancer has spread to tissues around the lip and oral cavity. The lymph
nodes in the area may or may not contain cancer.
- The cancer is any size and has spread to more than one lymph node on the same
side of the neck as the cancer, to lymph nodes on one or both sides of the
neck, or to any lymph node that measures more than 6 centimeters (over 2
inches).
- The cancer has spread to other parts of the body.
[Back to top]
Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may come back in the lip and oral cavity or in another part
of the body.
[Back to top]
Treatment Option Overview
[Back to top]
How cancer of the lip and oral cavity is treated
There are treatments for all patients with cancer of the lip and oral cavity.
Two kinds of treatment are used:
- Surgery (taking out the cancer)
- Radiation therapy (using high-dose x-rays or other high-energy rays to kill
cancer cells)
Chemotherapy (using drugs to kill cancer cells) is being tested in clinical
trials.
Surgery is a common treatment of cancer of the lip and oral cavity. The doctor
may remove the cancer and some of the healthy tissue around the cancer. The
doctor may also remove the lymph nodes in the neck (lymph node dissection).
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink
tumors. Radiation may come from a machine outside the body (external radiation
therapy) or from putting materials that produce radiation (radioisotopes)
through thin plastic tubes or needles in the area where the cancer cells are
found (internal radiation therapy). If smoking is stopped before radiation
therapy is started, the patient has a better chance of surviving longer.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by
pill, or it may be put into the body by a needle in a vein or muscle.
Chemotherapy is called a systemic treatment because the drug enters the
bloodstream, travels through the body, and can kill cancer cells throughout the
body.
If the doctor removes all the cancer that can be seen at the time of the
operation, the patient may be given chemotherapy after surgery to kill any
cancer cells that are left. Chemotherapy given after an operation to a person
who has no cancer cells that can be seen is called adjuvant chemotherapy.
Chemotherapy given before surgery to try and shrink the cancer so it can be
removed is called neoadjuvant chemotherapy.
Hyperthermia is a new treatment being tested in certain patients. It uses a
special machine to heat the body for a certain period of time to kill cancer
cells. Because cancer cells are often more sensitive to heat than normal
cells, the cancer cells die and the cancer shrinks.
Because the lips and mouth are needed to eat and talk, a patient may need
special help adjusting to the side effects of the cancer and its treatment.
The doctor will consult with several kinds of doctors who can help determine
the best treatment for the patient. Trained medical staff can also help a
patient recover from treatment and adjust to new ways of eating and talking. A
patient may need plastic surgery or help learning to eat and speak if a large
part of the lip or mouth is taken out.
[Back to top]
Treatment by stage
Treatment of cancer of the lip and oral cavity depends on where the cancer is,
the stage of the disease, and the patient’s age and overall health.
Standard treatment may be considered because of its effectiveness in patients
in past studies, or participation in a clinical trial may be considered. Not
all patients are cured with standard therapy and some standard treatments may
have more side effects than are desired. For these reasons, clinical trials
are designed to find better ways to treat cancer patients and are based on the
most up-to-date information. Clinical trials are ongoing in many parts of the
country for patients with cancer of the lip and oral cavity. To learn more
about clinical trials, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
[Back to top]
Stage I Lip and Oral Cavity Cancer
Treatment depends on where the cancer is in the lip or mouth.
[Back to top]
Lip cancer
If the cancer is in the lip, treatment may be one of the following:
- Surgery.
- Radiation therapy.
[Back to top]
Tongue cancer
If the cancer is in the tongue, treatment may be one of the following:
- Surgery.
- Surgery followed by radiation therapy to the neck.
- Radiation therapy to the mouth and the neck.
[Back to top]
Buccal mucosa cancer
If the cancer is in the lining of the inside of the cheeks and lips (buccal
mucosa), treatment may be one of the following:
- Surgery.
- Radiation therapy.
[Back to top]
Floor of the mouth cancer
If the cancer is in the bottom (floor) of the mouth, treatment may be one of
the following:
- Surgery.
- Radiation therapy.
[Back to top]
Lower gum cancer
If the cancer is in the lower gums (gingiva), treatment may be one of the
following:
- Surgery.
- Radiation therapy.
[Back to top]
Retromolar trigone cancer
If the cancer is in the small area behind the wisdom teeth, (retromolar
trigone), treatment may be one of the following:
- Surgery to remove part of the jawbone.
- Radiation therapy followed (if needed) by surgery.
[Back to top]
Upper gums and hard palate cancer
If the cancer is in the upper gums (gingiva) or the top bony part of the mouth
(hard palate), treatment may be one of the following:
- Surgery.
- Surgery followed by radiation therapy.
[Back to top]
Stage II Lip and Oral Cavity Cancer
Treatment depends on where the cancer is in the lip or mouth.
[Back to top]
Lip cancer
If the cancer is in the lip, treatment may be one of the following:
- Surgery.
- External and/or internal radiation therapy.
[Back to top]
Tongue cancer
If the cancer is in the tongue, treatment may be one of the following:
- Radiation therapy.
- Surgery and radiation therapy.
[Back to top]
Buccal mucosa cancer
If the cancer is in the lining of the inside of the cheeks and lips (buccal
mucosa), treatment may be one of the following:
- Radiation therapy.
- Surgery.
- Surgery plus radiation therapy.
[Back to top]
Floor of the mouth cancer
If the cancer is in the bottom (floor) of the mouth, treatment may be one of
the following:
- Surgery.
- Radiation therapy.
- Surgery followed by internal or external radiation therapy.
[Back to top]
Lower gum cancer
If the cancer is in the lower gums (gingiva), treatment may be one of the
following:
- Surgery.
- Radiation therapy.
[Back to top]
Retromolar trigone cancer
If the cancer is in the small space behind the wisdom teeth (retromolar
trigone), treatment may be one of the following:
- Surgery to remove part of the jawbone.
- Radiation therapy followed (if needed) by surgery.
[Back to top]
Upper gum or hard palate cancer
If the cancer is in the upper gums or the top bony part of the mouth (hard
palate), treatment will probably be surgery followed by radiation therapy.
[Back to top]
Stage III Lip and Oral Cavity Cancer
Treatment depends on where the cancer is in the lip or mouth. In addition to
the treatments listed below, a patient will probably have radiation therapy to
the neck with or without surgery to remove lymph nodes in the neck (lymph node
dissection).
[Back to top]
Lip cancer
If the cancer is in the lip, treatment may be one of the following:
- Surgery to remove the cancer plus internal or external radiation therapy.
- Radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of surgery followed by chemotherapy.
- A clinical trial of surgery, radiation therapy, and chemotherapy.
- A clinical trial of a new radiation therapy technique (superfractionated).
[Back to top]
Tongue cancer
If the cancer is in the tongue, treatment may be one of the following:
- External beam with or without internal radiation therapy.
- Surgery followed by radiation therapy.
[Back to top]
Buccal mucosa cancer
If the cancer is in the lining of the inside of the cheeks and lips (buccal
mucosa), treatment may be one of the following:
- Surgery to remove the cancer and the tissue around it.
- Radiation therapy.
- Surgery plus radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of surgery followed by chemotherapy.
- A clinical trial of surgery, radiation therapy, and chemotherapy.
[Back to top]
Floor of the mouth cancer
If the cancer is in the bottom (floor) of the mouth, treatment may be one of
the following:
- Surgery to remove the cancer and lymph nodes in the neck. Part of the
jawbone may also be removed if necessary.
- External beam therapy with or without internal radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
[Back to top]
Lower gum cancer
If the cancer is in the lower gums (gingiva), treatment will probably be
radiation therapy given before or after surgery to remove the cancer.
[Back to top]
Retromolar trigone cancer
If the cancer is in the small space behind the wisdom teeth (retromolar
trigone), treatment may be one of the following:
- Surgery followed by radiation therapy.
- A clinical trial of chemotherapy followed by surgery or radiation therapy.
- A clinical trial of surgery followed by chemotherapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
[Back to top]
Upper gum or hard palate cancer
If the cancer is in the top part of the gums (gingiva) or the top bony part of
the mouth (the hard palate), treatment may be one of the following:
- Radiation therapy.
- Surgery plus radiation therapy.
For all stage III lip and oral cavity cancers, clinical trials are testing
chemotherapy combined with radiation therapy.
[Back to top]
Stage IV Lip and Oral Cavity Cancer
Treatment depends on where the cancer is in the lip or mouth. In addition to
the treatments listed below, a patient will probably have radiation therapy to
the neck with or without surgery to remove lymph nodes in the neck (lymph node
dissection).
[Back to top]
Lip cancer
If the cancer is in the lip, treatment may be one of the following:
- Surgery to remove the cancer plus internal or external radiation therapy.
- A clinical trial of radiation therapy.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
[Back to top]
Tongue cancer
If the cancer is in the tongue, treatment may be one of the following:
- Surgery to remove the tongue and the voicebox (larynx) below it followed
by radiation therapy.
- Radiation therapy to relieve symptoms.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
[Back to top]
Buccal mucosa cancer
If the cancer is in the lining of the inside of the cheeks and lips (buccal
mucosa), treatment may be one of the following:
- Surgery to remove the cancer and the tissue around it.
- Radiation therapy.
- Surgery plus radiation therapy.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
[Back to top]
Floor of the mouth cancer
If the cancer is in the bottom (floor) of the mouth, treatment may be one of
the following:
- Surgery to remove the cancer followed by radiation therapy.
- Radiation therapy followed by surgery.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
[Back to top]
Lower gum cancer
If the cancer is in the lower gums (gingiva), treatment may be one of the
following:
- Surgery, radiation therapy, or both.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
[Back to top]
Retromolar trigone cancer
If the cancer is in the small space behind the wisdom teeth (retromolar
trigone), treatment may be one of the following:
- Surgery followed by radiation therapy.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
[Back to top]
Upper gum or hard palate cancer
If the cancer is in the top part of the gums (gingiva) or the top bony part of
the mouth, treatment may be one of the following:
- Surgery plus radiation therapy.
- A clinical trial of chemotherapy combined with radiation therapy.
- A clinical trial of fractionated (smaller doses) radiation therapy.
[Back to top]
Recurrent Lip and Oral Cavity Cancer
Treatment depends on the type of treatment the patient had before. If
radiation therapy was given, the patient may have surgery when the cancer comes
back. If surgery was used, the patient may have more surgery, radiation
therapy, or both. Patients may want to consider taking part in a clinical
trial of new chemotherapy drugs, chemotherapy plus additional radiation
therapy, or hyperthermia.
[Back to top]
Changes to This Summary (06/06/2003)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
