Oral cancer is a major global health concern, affecting hundreds of thousands of people every year. According to the World Health Organization (WHO), oral cancer is among the top 20 most common cancers worldwide, with a rising number of cases in low- and middle-income countries.
Despite its prevalence, oral cancer is one of the most preventable and treatable cancers.
What Is Oral Cancer?
Oral cancer refers to malignant tumors that develop in the oral cavity, including lips, tongue, floor of the mouth, buccal mucosa (inner cheeks), gums, hard palate, and retromolar trigone. It is a subset of head and neck cancers and is also known as oral cavity cancer. The majority of oral cancers are squamous cell carcinomas, meaning they develop from the thin, flat cells lining the mouth.
Oral cancer can spread to nearby structures (tongue muscles, jawbone, lymph nodes) and metastasize to distant organs if not detected early.
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Types of Oral Cancer
- Squamous Cell Carcinoma (Most Common): This accounts for over 90% of all oral cancers.
- Verrucous Carcinoma: A slow-growing, wart-like cancer that rarely spreads.
- Minor Salivary Gland Carcinomas: Includes mucoepidermoid carcinoma, adenoid cystic carcinoma, etc.
- Lymphomas: Occasionally develop in the tonsils or base of the tongue.
- Melanomas: Can develop on oral mucosa but are extremely rare.
Causes and Risk Factors of Oral Cancer
Oral cancer is multifactorial, meaning many genetic, environmental, and lifestyle factors contribute to its development.
Below are the leading causes and risk factors, as identified by major health organizations.
- Tobacco Use (Smoking & Smokeless Tobacco): Tobacco remains the number one cause of oral cancer. This includes: Cigarettes, Cigars, Pipes, Snuff, and Chewing tobacco.
According to the Centers for Disease Control and Prevention (CDC), tobacco users are 6 to 10 times more likely to develop oral cancer than non-users.
- Alcohol Consumption: Heavy alcohol use greatly increases oral cancer risk. The American Cancer Society (ACS) reports that the risk is multiplied when alcohol and tobacco are used together.
- Human Papillomavirus (HPV) Infection: HPV, especially HPV-16 is a major cause of oropharyngeal and some oral cancers.
- Prolonged Sun Exposure: UV radiation increases the risk of lip cancer, especially in outdoor workers.
- Poor Diet (Low in Fruits & Vegetables): A diet lacking antioxidants weakens the body’s ability to fight abnormal cell growth.
- Chronic Irritation: Examples include Poorly fitting dentures, Chronic cheek biting, Long-term mouth ulcers, and Sharp or broken teeth. Although irritation alone does not cause cancer, it can increase susceptibility.
- Genetic Predisposition: Family history plays a role. Some individuals inherit genetic mutations that make them more vulnerable.
- Weakened Immune System: People with compromised immunity (HIV/AIDS, post-transplant immunosuppression) are at greater risk.
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Symptoms of Oral Cancer
Signs of oral cancer may vary depending on location and severity. Early signs are often subtle and painless, making regular dental checkups crucial.
Early Symptoms
- Persistent mouth sores that do not heal within 2 weeks
- Red or white patches (erythroplakia or leukoplakia)
- Unexplained lumps or thickening in the oral tissues
- Difficulty chewing or swallowing
- Persistent sore throat
- Numbness in the lips, tongue, or mouth
- Unexplained bleeding from the mouth
Advanced Symptoms
- Persistent jaw stiffness or pain
- Ear pain without ear infection
- Loose teeth
- Difficulty moving the tongue
- Dramatic weight loss
- Swelling in the neck (enlarged lymph nodes)
- Voice changes
- Visible lesions or growths
Symptoms lasting over two weeks should be evaluated immediately.
How Oral Cancer Is Diagnosed
Early detection drastically improves survival rates. According to the ACS, early-stage oral cancer has a 5-year survival rate of 84%, compared to 39% for late-stage cancers.
- Physical Examination: The doctor or dentist examines for Abnormal lumps, Discoloration, Non-healing ulcers, Neck lymph node enlargement
- Brush Biopsy or Exfoliative Cytology: A painless technique that collects cells for microscopic analysis.
- Incisional Biopsy (Gold Standard): A tissue sample is removed and tested for cancerous cells.
- Imaging Tests: Used to determine cancer spread (staging):
- MRI (Magnetic Resonance Imaging) – Best for soft tissue evaluation.
- CT Scan (Computed Tomography) – Shows bone involvement.
- PET Scan (Positron Emission Tomography) – Detects metastasis.
- X-rays – Check for jawbone invasion.
- Endoscopy: A small camera is used to check the throat, larynx, and esophagus for abnormal lesions.
- HPV Testing: If cancer is suspected in the oropharyngeal region, HPV tests may be done to guide treatment.
Stages of Oral Cancer
Cancer staging ranges from Stage 0–IV:
- Stage 0: Carcinoma in situ
- Stage I: Tumor ≤2 cm
- Stage II: Tumor 2–4 cm
- Stage III: Larger tumor or lymph node involvement
- Stage IV: Advanced cancer spreading to nearby or distant organs
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Treatment Options for Oral Cancer
Treatment depends on Tumor size and location, Stage of cancer, HPV status, Patient’s overall health, and Whether cancer has metastasized.
Below are the most common treatment approaches.
- Surgery (Primary Treatment): Most early-stage oral cancers are treated surgically. Surgical Procedures include:
- Tumor Resection – Removal of the cancerous tissue with margins.
- Mohs Micrographic Surgery – Precise removal of thin cancer layers.
- Lymph Node Dissection – Removal of cancerous or high-risk lymph nodes in the neck.
- Reconstructive Surgery – Used to restore facial structures, tongue function, or jawbone.
- Radiation Therapy: Radiation uses high-energy beams to destroy cancer cells. It may be used:
- Alone (early-stage cancers)
- After surgery (to kill remaining cells)
- With chemotherapy (advanced cases)
Common forms of Radiation Therapy:
- External beam radiation therapy (EBRT)
- Intensity-modulated radiation therapy (IMRT)
- Chemotherapy: Uses drugs to kill cancer cells or stop them from multiplying. Chemotherapy is often combined with radiation (chemoradiation) for advanced cancers. Common chemotherapy drugs are: Cisplatin, Carboplatin, 5-fluorouracil (5-FU), and Docetaxel.
- Targeted Therapy: These drugs attack specific molecules that allow cancer cells to grow. The most commonly used targeted therapy in oral cancer is Cetuximab (Erbitux). This targets the EGFR protein on cancer cells.
- Immunotherapy (Newest Approach): Immunotherapy boosts the immune system to fight cancer.
Approved immunotherapy drugs for oral cancer include Pembrolizumab (Keytruda), and Nivolumab (Opdivo). These drugs target PD-1/PD-L1 pathways.
- Nutritional and Supportive Care: Patients often experience Difficulty eating, Weight loss, Pain, Dry mouth, and Difficulty speaking.
Supportive care focuses on:
- Pain control
- Nutritional therapy
- Speech therapy
- Physiotherapy
- Psychosocial support
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Prevention of Oral Cancer
Oral cancer is largely preventable, this is achievable via the following means:
- Avoid Tobacco Completely: No form of tobacco is safe.
- Reduce or Avoid Alcohol: The risk multiplies when combined with smoking.
- Get HPV Vaccination: The HPV vaccine significantly reduces oropharyngeal cancer risk, according to CDC.
- Protect Lips from UV Radiation: Use SPF lip balm and limit sun exposure.
- Maintain Good Oral Hygiene: Regular brushing, flossing, and professional dental cleanings.
- Eat Nutrient-Rich Diet: High in fruits, vegetables, and antioxidants.
- Regular Oral Cancer Screenings: Dentists can detect early lesions during routine visits.
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