Mouth Cancer

If you have mouth cancer symptoms or an increased risk of mouth cancer, your doctor may recommend testing. Scripps physicians use advanced imaging and lab tests to diagnose mouth cancer. These may include:

Physical and dental exam

A physician will check your head and neck for unusual lumps or swelling, and may check your mouth or have a dentist examine you for signs of cancer.

Barium swallow

During a barium swallow test, the patient drinks barium before having a series of X-rays. Barium is a chalky liquid that coats the walls of the throat and esophagus so that abnormal areas will show up on X-rays.

Indirect pharyngoscopy

Indirect pharyngoscopy involves the use of small mirrors for examining the back of the mouth and throat.

Laryngoscopy

During a laryngoscopy, the physician uses an endoscope to examine the back of the throat and other areas that aren’t visible with mirrors. The most common type is a direct fiber-optic laryngoscopy.

Panendoscopy

Panendoscopy involves the use of different types of endoscopes passed through the mouth or nose so a physician can thoroughly examine the mouth, throat, larynx (voice box), esophagus and airways. This procedure, also known as an upper GI endoscopy, is usually done under general anesthesia.

Exfoliative cytology

During exfoliative cytology, a physician scrapes cells from the mouth with a swab and then checks for abnormal cells under a microscope.

Biopsy

The physician removes a sample of tissue from a suspicious area of the mouth or throat to be examined under a microscope by a pathologist. A biopsy is the only way to confirm oral cancer. There are several types of biopsy:

• Incisional biopsy cuts a small piece of tissue from the area and is usually used for mouth or throat samples.
• Fine-needle aspiration biopsy uses a thin, hollow needle attached to a syringe to draw up cells from a tumor, and is usually used for lumps in the neck.

Chest X-ray

A chest X-ray may show if cancer has spread to the chest.

Computed tomography (CT) scan

A CT scan is an imaging test that captures images of the body from different angles. The images are combined to create detailed cross-sectional views of organs, bones and blood vessels.

Magnetic resonance imaging (MRI)

MRI relies on a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.

Positron emission tomography (PET) scan

A PET scan involves a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It’s combined with a CT scan to give physicians the ability to view a picture of potentially cancerous areas through the PET while also seeing more detailed images from a CT scan.

Mouth cancer stages describe how far cancer has (or has not) spread beyond its original starting point in the mouth or throat. Staging guides Scripps oncologists in developing a mouth cancer prognosis and treatment plan.

Stage I

Stage I mouth cancer is less than 2 cm in size and has not spread to lymph nodes.

Stage II

Stage II mouth cancer is more than 2 cm but less than 4 cm in size, and has not spread to lymph nodes.

Stage IIIA

Stage III mouth cancer is either of the following:

• The cancer is more than 4 centimeters in size.
• The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer, and the lymph node that contains cancer measures no more than 3 cm.

Stage IV

Stage IV mouth cancer can be any of the following:

• 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 cm.
• The cancer has spread to other parts of the body.

After a mouth cancer diagnosis, it’s completely normal to feel anxious, scared, depressed or overwhelmed. Learning all you can about your diagnosis and your options can help you make informed, confident decisions about the next steps to take.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of mouth cancer treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps cancer care team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones via Scripps.

Your Scripps cancer care team will customize your treatment plan based on several factors, including:

• The stage of your cancer
• Whether your cancer has spread
• Your age and overall health

Treatment for mouth cancer typically involves surgery. Other treatments, such as radiation and chemotherapy, may be given before or after surgery.

Mouth cancer surgery

Depending on the cancer type, location and stage, Scripps surgeons may perform several types of surgical treatments for mouth cancer. Cancer that involves the teeth or gums may be treated by a dental specialist, such as an oral and maxillofacial surgeon.

Whenever possible, Scripps surgeons use minimally invasive robotic surgical techniques, which can mean smaller incisions, faster recovery time and less bleeding and scarring. Should you need reconstructive surgery after your mouth cancer treatment, count on our plastic surgeons for the expertise that has restored function and brought comfort and confidence to many patients. Types of surgery include:

• Mohs surgery of the lip shaves off very thin layers of a tumor until no cancerous cells can be seen when examined with a microscope. The procedure preserves maximum healthy tissue in delicate areas of the body, such as the face and lips.
• Glossectomy may be used to remove tongue tumors. Partial glossectomy removes part of the tongue. Total glossectomy is the complete removal of the tongue.
• Mandibulectomy is used to remove all or part of the jawbone (mandible) when a tumor has grown into the bone.
• Maxillectomy treats cancer in the roof of the mouth (hard palate) by removing part or all of the palate.
• Neck dissection removes lymph nodes and nearby tissue in the neck. There are several types of neck dissection:
• Partial neck dissection removes a few lymph nodes.
• Modified neck dissection removes most lymph nodes and some muscle tissue on one side of the neck.
• Radical neck dissection removes nearly all lymph nodes, a greater portion of muscle tissue, nerves and veins.

Rarely, surgery to remove tumors of the throat or tongue also affect a patient’s ability to swallow, speak or breathe. In such cases, additional surgeries may be needed:

• Tracheostomy (also known as tracheotomy) places a permanent incision through the front of the neck to the windpipe (trachea) to help a patient breathe if cancer treatment has interfered with normal breathing.
• Laryngectomy removes part or all of the voice box (larynx) if treatment has interfered with normal swallowing.

Radiation therapy

Radiation therapy may be the main treatment for small tumors, or part of a mouth cancer treatment plan that also includes surgery and other therapies. Scripps provides the most advanced radiation treatments for mouth cancer, including:

• Intensity-modulated radiation therapy (IMRT) is an advanced form of radiation therapy. With IMRT, the radiation oncologist can specify the dose of radiation for the tumor while restricting the dose to surrounding healthy tissues.
• 3-D conformal radiation therapy allows the radiation oncologist to visualize a patient’s anatomy in 3-D. The specialized software for : 3-D conformal radiation therapy matches radiation doses to the size and shape of a tumor and thereby minimizes exposure to nearby tissues and organs.

If radiation therapy is part of the treatment plan, dental extraction may be required before radiation is given. Teeth that have been exposed to radiation can cause infections and bone problems in the jaw.

Chemotherapy

Chemotherapy may be used in combination with radiation therapy for advanced-stage lip and oral cavity cancers that cannot be treated by surgery. It also may be given before surgery to shrink large tumors, or after surgery to eliminate any remaining cancer cells.

Targeted therapy

Targeted therapy uses specific drugs to target receptors on the surface of cancer cells and slow or stop their growth. The drug certuximab, which is a monoclonal antibody, can be effective in treating oral cancer cells. Certuximab may be combined with radiation or chemotherapy, or used alone.

Some cancer treatment plans may involve clinical trials. Talk with your physician about whether a mouth cancer clinical trial is right for you.

For a list of clinical trial that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your mouth cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your mouth cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need.

Your team may include:

• Otolaryngologists (ear, nose, throat specialists or ENTs)
• Oral and maxillofacial surgeons
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more on Scripps' multidisciplinary approach to treatment.

Patient education is an integral part of understanding and coping with your mouth cancer diagnosis and treatment. To stay informed, we encourage our patients, along with their caregivers and family members, to:

• Bookmark the Scripps glossary of cancer terms for easy referencing.
• Download our cancer care patient guide and other useful forms from our resources page.
• Consult your oncology team for educational materials and a list of trusted online sources beyond the Scripps site. 

Navigating cancer might seem overwhelming — especially with so much information online. To ensure you receive the most accurate details, always look to your multidisciplinary team of cancer care experts first.