Lip and oral cavity cancer is where cancerous cells form on the lips or in the mouth, including the middle and front sections of the tongue, the gums, the floor and roof of the mouth, the lining of cheeks, and the small areas behind the rear molars. These cancers can also include:
- Oropharyngeal cancer, which starts in the middle section of the throat (pharynx) behind the mouth, including the back portion of the tongue, soft palate, walls of the throat and tonsils.
- Salivary gland cancer, which is found in the salivary glands just below the ears (parotid glands); under the tongue (sublingual glands) and below the jawbone (submandibular glands).
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Detection and diagnosis of lip and oral cavity cancer (including oropharyngeal cancer and salivary gland cancer) may include:
- Dental exams and physical exam.
- Indirect pharynoscopy, in which a physician uses small mirrors to better see the back of the mouth and throat.
- Laryngoscopy, in which a physician uses a laryngoscope to examine the back of the throat and vocal cords. The most common type is known as a direct fiber-optic laryngoscopy.
- Panendoscopy (also known as an upper GI endoscopy) where a doctor examines the lining of the esophagus, using an endoscope.
- Exfoliative cytology, in which cells from the the mouth are scraped with a swab and then checked for cancer cells under a micorscope.
- Computed tomography (CT) scan that can help physicians to determine a tumor’s size and extent. CT scans combine multiple digital images of soft tissues and organs inside the body to provide a more detailed picture than a standard X-ray.
- Magnetic resonance imaging (MRI) scan that uses radio waves and magnets instead of X-rays to provide detailed pictures of the body’s soft tissues and organs.
- Positron emission tomography (PET) scan that includes an injection of radioactive sugar into the blood, then a digital imaging exam to determine if cancer cells are present. A PET scan is typically performed in conjunction with a CT scan.
- Barium swallow that involves a series of X-rays taken after a patient drinks barium, which is a chalky liquid that coats the walls of the throat and esophagus.
- Incisional biopsy.
- Fine needle aspiration (FNA) biopsy, in which a thin, hollow needle is used to remove tissue for testing to determine the cause of an enlarged lymph node in the neck and whether an endoscopic biopsy will be required as part of the diagnosis.
Treatment of lip and oral cavity cancer (including oropharyngeal cancer) may include:
- Mohs procedure of the lip, in which very thin layers of a tumor are shaved off 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, which can be a full removal of the tongue (total glossectomy) or a portion (partial glossectomy). This may be an option when other treatments have been unsuccessful.
- Mandibulectomy, in which all or part of the jawbone (mandible) is removed when a tumor has grown into the bone.
- Maxillectomy, in which the front of the mouth’s roof (hard palate) is removed or a portion (partial maxillectomy).
- Laryngectomy, in which all or part of the voice box (larynx) is removed.
- Neck dissection, in which lymph nodes and nearby tissue in the neck are removed. It may involve a few lymph nodes (partial neck dissection), most lymph nodes, plus some muscle tissue on one side of the neck (modified neck dissection), or nearly all lymph nodes, a greater portion of muscle tissue, as well as nerves and veins (radical neck dissection).
- Tracheostomy (also known as tracheotomy), in which a permanent incision through the front of the neck to the wind pipe (trachea) is made to help a patient breathe.
- Gastrostomy tube, in which a feeding tube is inserted through the skin and muscles of the abdomen and into the stomach of patients who are unable to swallow enough food to maintain proper nutrition.
- Dental surgery, in which some or all teeth may be removed before radiation therapy treatment to prevent potential infection and spread to the jawbone.
- Reconstructive surgery, in which the lips and mouth may require a plastic surgeon’s expertise in restoring appearance or function.
Intensity modulated radiation therapy (IMRT) and 3-D conformal radiation therapy are two types of external-beam radiation therapy that can be used to treat oral cancer.
Chemotherapy can be provided in combination with radiation therapy for advanced stages of lip and oral cavity cancers that are not candidates for surgical removal.
Immunotherapy treatment can be provided through use of the drug cetuximab, which is known as a monoclonal antibody.
To enhance the care of people dealing with oral cancer, Scripps Health also offers patient support services.