Leading oral cancer treatment in San Diego
Leading oral cancer treatment in San Diego
Scripps MD Anderson Cancer Center is a leader in caring for people with cancer of the mouth, also known as oral cavity cancer and oropharyngeal cancer. Our oncology specialists treat mouth cancer with advanced therapies designed to eliminate cancer and prevent recurrence, including minimally invasive surgery that uses small incisions, potentially resulting in shorter hospital stays and a faster recovery.
Our multidisciplinary, collaborative board of cancer specialists reviews complex care plans to ensure patients receive the best possible care from diagnosis to recovery.
About mouth cancer
Mouth cancer is a head and neck cancer that starts in the mouth or throat. According to the American Cancer Society, it includes several different cancers depending on the area affected.
- Oral cavity and lip cancer is when cancer develops on the lips or in the mouth, including the middle and front sections of the tongue, gums, floor and roof of the mouth, and lining of the cheeks.
- Oropharyngeal cancer is when cancer starts in the middle section of the throat (pharynx) behind the mouth, including the back part of the tongue, soft palate, walls of the throat and tonsils.
- Salivary gland cancer is when cancer develops in the salivary glands.
Types of mouth cancer
Various types of cells make up the oral cavity and oropharynx, and different cancer types can develop in these cells. There are several types of mouth cancer.
Precancerous conditions are abnormal growths in the mouth or throat that are harmless but may become cancer. These include:
- Leukoplakia, which is a white or gray patch
- Erythroplakia, which is a flat or slightly raised red area that may bleed easily if scraped
- Erythroleukoplakia, which is a patch with both red and white areas
These areas may indicate a precancerous condition called dysplasia. Some cases of dysplasia may become cancer, while others will go away on their own. Dysplasia is most often caused by smoking or chewing tobacco, but sometimes the cause is not known.
Squamous cell carcinomas
More than 90% of oral cancers are squamous cell carcinomas. These develop in the squamous cells that line the mouth and throat.
- Carcinoma in situ is the earliest form of squamous cell cancer. These cancer cells have not spread beyond the outer layer of cells (epithelium).
- Invasive squamous cell carcinoma is cancer that has spread into the deeper layers of the cells.
- Verrucous carcinoma is an uncommon, slow-growing type of squamous cell cancer that can grow deeply into nearby tissue but rarely spreads to other parts of the body.
Minor salivary gland carcinomas
Minor salivary gland cancers can develop in the glands that line the mouth and throat.
Lymphomas are cancers that develop in immune system tissue, such as in the tonsils and base of the throat.
Mouth cancer causes, risks and family history
While all of the causes of mouth cancer are not known, there are several risk factors that significantly raise the likelihood of developing the disease. Known mouth cancer risk factors include:
Tobacco use is the most important risk factor for mouth cancer. This includes cigarettes, pipes, cigars and chewing tobacco. Smokers are much more likely to develop oral cancer than non-smokers.
Drinking alcohol increases the risk for mouth cancer. About 7 of 10 mouth cancer patients are heavy drinkers.
Tobacco and alcohol use combined
People who use tobacco and drink alcohol have a higher risk than people who just use one or the other.
Human papillomavirus (HPV) infection
Some oral cancers appear to be related to infection with human papillomavirus (HPV). There are more than 150 types of HPV viruses. The HPV 16 virus is most often linked with throat cancer. About 2 out of 3 throat cancers show HPV infection.
Weakened immune system
People who have weakened immune systems due to HIV infection, drugs that suppress the body’s immune system response (such as drugs taken for an autoimmune disease) or other reasons have an increased risk.
Graft-versus-host disease (GVHD)
GVHD occurs after a stem cell transplant when the recipient’s body attacks the donor’s stem cells. If GVHD affects mouth tissue, it can raise the risk for cancer.
People with certain inherited syndromes, including Fanconi anemia and dyskertosis congenita, have a very high risk of mouth and throat cancer.
Having any of these risk factors does not mean you will develop mouth cancer. But if you’re concerned about your risk, especially if you have a family history of mouth cancer or inherited gene mutations, talk with your doctor.
Mouth cancer prevention, screenings and early detection
There are no screening exams to detect mouth cancer. Your dentist may see abnormal areas during a dental exam, or you may notice them yourself. If you have a high risk of mouth cancer, your doctor may want to test for it even if you have no symptoms.
Oral cancer cannot be completely prevented, but taking steps to reduce the risk factors that are within your control may help with mouth cancer prevention.
The following preventive factors may help prevent mouth cancer:
- Avoid smoking or chewing tobacco
- Avoid heavy alcohol use
- Get tested for the HPV virus and treated if necessary
Mouth cancer symptoms, diagnosis and stages
As with most cancers, the earlier mouth cancer is found, the greater the likelihood of treatment being successful. Learn more about mouth cancer symptoms, diagnostic testing and stages below.
Mouth cancer symptoms
Oral cancer symptoms may include:
- A sore in the mouth that does not heal
- Pain in the mouth that persists
- A lump or thickening in the cheek or neck
- A white or red patch on the gums, tongue, tonsil or lining of the mouth
- A sore throat, or the sensation that something is caught in the throat
- Difficulty chewing or swallowing
- Difficulty moving the jaw or tongue
- Numbness of the tongue or other parts of the mouth
- Swelling of the jaw
- Loose teeth
- Pain in the teeth or jaw
- Voice changes
- Constant bad breath
Many of these symptoms are very likely to be caused by conditions other than cancer. But let your doctor know if you’re experiencing symptoms that last more than two weeks, so that you can identify and treat any potential problems.
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.
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 involves the use of small mirrors for examining the back of the mouth and throat.
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 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.
During exfoliative cytology, a physician scrapes cells from the mouth with a swab and then checks for abnormal cells under a microscope.
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.
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
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 mouth cancer is less than 2 cm in size and has not spread to lymph nodes.
Stage II mouth cancer is more than 2 cm but less than 4 cm in size, and has not spread to lymph nodes.
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 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.
Understanding your diagnosis
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.
Treatment and clinical trials
When you’ve been diagnosed with mouth cancer, you want a team of expert cancer specialists on your side. Scripps MD Anderson’s multidisciplinary oncology teams fight mouth cancer using the latest evidence-based treatments and therapies. Surgery is part of many mouth cancer treatment plans, and some may include radiation therapy, chemotherapy and targeted therapy.
Our approach to treating mouth cancer
Your Scripps MD Anderson cancer care team includes professionals from every area of oncology, including otolaryngologists (ear, nose and throat doctors or ENTs), surgeons, radiation oncologists, medical oncologists and nurses who specialize in cancer care.
In addition, we’ll help coordinate your care and ensure you have support and guidance throughout your treatment and recovery. Learn more about how Scripps puts you at the center of care.
Mouth cancer treatment options at Scripps MD Anderson
Your Scripps MD Anderson 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 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 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 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.
Mouth cancer clinical trials
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 custom cancer treatment plan
Your Scripps MD Anderson 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 cancer care team
Your mouth cancer care team includes health and medical professionals from a wide range of specialties. Scripps MD Anderson 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
- Oncology social workers
Visit your cancer care team for more on Scripps MD Anderson’s multidisciplinary approach to treatment.
Mouth cancer treatment locations
Scripps diagnoses and treats mouth cancer at numerous locations throughout San Diego County. From Chula Vista and La Jolla to Encinitas and beyond, our extensive network of Southern California cancer care centers includes:
- Four Scripps hospitals on five campuses
- Outpatient clinics
- Specialty cancer treatment centers
For details on specific centers and their services, visit cancer care locations.
Support groups, services and resources
Scripps offers a comprehensive lineup of support groups, support services and resources to help you along every step of your cancer journey.
Mouth cancer support groups, workshops and events
In addition to the mouth cancer support group listed below, we also host a handful of free workshops and health and wellness events on a number of topics such as:
- Expressive writing
Mouth cancer support group
This support group is open to all patients with cancers affecting the mouth, throat, head and neck.
Scripps Radiation Therapy Center, La Jolla
2nd Thursdays, 2 – 3 pm
10670 John Jay Hopkins Dr., La Jolla
Facilitator: Chrissy Fidler-Johnson, MA
Contact info: 858-626-5059
For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.
Support services for cancer patients
We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps MD Anderson offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:
- Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
- Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life.
- Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
- Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
- Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
- Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
- Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
- Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
- Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.
For the full spectrum of offerings, please visit our cancer patient support services section.
Additional resources for patients, caregivers and family members
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.