Oral and Oropharyngeal Cancer

Oral cancer symptoms

Symptoms of oral cancer may frequently be confused with normal mouth issues initially, but regular or abnormal symptoms must be checked by a medical professional. The best symptoms to observe are as follows:

Symptoms of Oral Cancer:

• Mouth sore that won't heal
• Thickening or bump in the mouth or cheek
• White, red, or mixed (red and white) lesions in the tongue or mouth (erythroplakia or leukoplakia)
• Pain, numbness, or tenderness in the mouth or lips
• Swallowing, chewing, or moving the jaw or tongue difficulty
• Hoarseness or change in voice
• Unexplained weight loss
• Bad breath that does not go away
• Jaw or neck swelling
• Possible cause is swollen lymph nodes
• Loose dentures or ill-fitting dentures (without dental reason)
• Ear pain without infection

Oropharyngeal cancer signs

Oropharyngeal cancer occurs in the middle region of the throat (oropharynx), such as the back of the tongue, tonsils, soft palate, and the walls of the pharynx. The symptoms may be subtle during early onset but become more pronounced as the illness advances.

Common Oropharyngeal Cancer Signs and Symptoms

Chronic sore throat

• Doesn't improve with normal treatments

Trouble swallowing (dysphagia)

• Sense that something is stuck in the throat

Ear pain (typically one-sided)

• Without an ear infection

Lump in the neck

• Often caused by swollen lymph nodes

Change in voice or hoarseness

Unexplained weight loss

Coughing up blood (hemoptysis)

Pain on swallowing or speaking

A sore or mass in the mouth or throat that doesn't heal

Bad breath (halitosis)

• Persistent, not associated with oral hygiene

Numbness or pain in the tongue, jaw, or throat

Enlarged tonsils

• One tonsil bigger than the other

Fatigue or general weakness (in later stages)

Stages of oral cancer

The oral cancer stages identify how extensive the spread of cancer in the body has become. Staging establishes the treatment plan and prognosis. The most widely used is the TNM system:

• T (Tumor): Size and spread of the original tumor
• N (Nodes): Spread to nearby lymph nodes
• M (Metastasis): Spread to distant parts of the body

Oral cancers are cancers of the lips, tongue, gum, cheeks, floor of the mouth, hard palate, and other oral tissues.

Stage 0 (Carcinoma in situ)

• Abnormal cells are only in the surface layer (epithelium)
• Not cancer yet, but will possibly develop into cancer
• Also referred to as precancerous or in situ carcinoma

Stage I

• Tumor ≤ 2 cm (approximately ¾ inch) in diameter
• No spread to lymph nodes or other places (T1, N0, M0)

Stage II

• Tumor > 2 cm but ≤ 4 cm
• Still no spread to lymph nodes or distant organs (T2, N0, M0)

Stage III

Any of the following:

• Tumor > 4 cm (T3), OR
• Cancer has invaded 1 lymph node in the same side of the neck (≤ 3 cm in size), but not distant organs (N1, M0)

Stage IV (Advanced Stage)

Further divided into IVA, IVB, and IVC:

Stage IVA

• Tumor invaded surrounding tissues (e.g., jaw, skin, deep muscles) OR
• Spread to 1+ lymph nodes (larger than 3 cm or multiple), but no distant spread

Stage IVB

• Wider lymph node infiltration or extension to such structures as skull base or carotid artery

Stage IVC

• Cancer has spread to distant organs such as lungs or liver (M1)

Mouth cancer early signs

Early diagnosis of mouth cancer can greatly enhance the success of treatment. These warning signs can be subtle and therefore easy to ignore, so any long-standing changes within the mouth should be checked.

Early Warning Signs:

Sore or ulcer that does not heal (longer than 2 weeks)

• Usually painless initially

White (leukoplakia), red (erythroplakia), or mixed white-red patches in the mouth or on the tongue

• These patches can become cancerous

Lump, swelling, or sore spot in the mouth, on the tongue, or inside the cheeks

Chronic pain or numbness in the mouth or lips

Sudden bleeding in the mouth with no apparent reason

Loose teeth or ill-fitting dentures in the absence of dental problems

Chewing, swallowing, moving the jaw or tongue difficulty

Bad breath with no known cause

Voice change or chronic hoarseness

Jaw or neck swelling

Oropharyngeal cancer prognosis

The prognosis (outcome) for oropharyngeal cancer is based on a number of significant factors, namely the stage at diagnosis, HPV status, general health, and treatment response.

Important Factors Affecting Prognosis

Stage of cancer

• Early-stage cancers respond better.

HPV status

• HPV-positive oropharyngeal cancers (particularly HPV-16) have a very much improved prognosis.

Tumor location and size

Distant organ or lymph node spread

Treatment administered (surgery, radiation, chemotherapy)

Age, immune status, and overall health of the patient

Survival Rates (Relative Survival Rates for 5 Years)

Approximate stage and HPV status-based averages:

HPV-Positive Oropharyngeal Cancer

• Localized (early): 85–90%
• Regional (lymph node spread): 70–80%
• Distant (spread to other organs): 50–60%

HPV-Negative Oropharyngeal Cancer

• Localized: 60–65%
• Regional: 40–50%
• Distant: 20–30%

Oral cancer survival rate

The 5-year survival rate for mouth cancer is largely based on:

Stage at diagnosis

• Location of the cancer (e.g., tongue, floor of mouth, lip)
• Spread to lymph nodes or distant organs
• General health and how well they respond to treatment

General 5-Year Survival Rates (All Oral Cavity Cancers)

Based on information from groups such as the American Cancer Society:

• Localized (stayed in mouth): ~85%
• Regional (spread to surrounding lymph nodes): ~66%
• Distant (spread to other organs): ~40%
• Total (total of all stages): ~60–65%

Oral cancer treatment options

Oral cancer treatment is based on the stage, location, overall health, and if the cancer has spread. In many instances, a multidisciplinary treatment is employed, along with surgery, radiation, and chemotherapy.

Surgery

• Most initial treatment for the majority of early-stage oral cancers.

Types:

• Tumor resection: Excision of the tumor along with some surrounding healthy tissue.
• Mandibulectomy or maxillectomy: When there is cancer in the jaw or palate.
• Neck dissection: When cancer has metastasized to lymph nodes.
• Reconstructive surgery: To restore form and function after tumor removal.

Radiation Therapy

• Uses high-energy beams to destroy cancer cells.

Commonly used:

• After surgery (to destroy remaining cells)
• As sole treatment for small tumors
• Together with chemotherapy for advanced stages

Types:

• External beam radiation
• Intensity-modulated radiation therapy (IMRT)

Chemotherapy

• Drugs that destroy or inhibit the growth of cancer cells.
• Usually used for advanced or recurrent cancer
• Sometimes with radiation (chemoradiation)
• Examples include: Cisplatin, 5-fluorouracil, Carboplatin

Targeted Therapy

• Specific molecules responsible for cancer growth.
• Example: Cetuximab (Erbitux) – inhibits EGFR protein
• May be utilized when chemotherapy is not tolerated or in HPV-related disease

Immunotherapy

• Assists the immune system to combat cancer.
• Utilized in advanced, recurrent, or metastatic disease
• FDA-approved medications: Nivolumab (Opdivo), Pembrolizumab (Keytruda) – for PD-L1 positive tumors

Rehabilitation & Support

• Speech therapy and swallowing therapy
• Facial/jaw reconstruction surgery
• Nutritional support, psychological counselling

Oropharyngeal cancer stage 4

Stage 4 oropharyngeal cancer is advanced in the sense that the cancer has invaded beyond the oropharynx to surrounding tissues, lymph nodes, or distant organs. It is also subdivided into Stages IVA, IVB, and IVC, with each having different degrees of seriousness.

Stage IVA

• Tumor can have extended to adjacent regions (e.g., jaw, larynx, base of skull).

Lymph nodes:

• Can affect one or more lymph nodes (usually >3 cm but <6 cm).
• No metastasis (M0).

Treatment:

• Combined radiation + chemoradiation or surgery + radiation
• HPV-positive patients often respond better to treatment.

Stage IVB

• Tumor can have invaded vital structures (e.g., spine, carotid artery, deep neck muscles).

Lymph node involvement more widespread:

• Multiple nodes or larger than 6 cm.
• Still no distant metastasis (M0).

Treatment:

• Often not surgery (chemoradiation)
• May need palliative surgery if the tumor obstructs the airway or causes severe symptoms

Stage IVC

• Cancer has metastasized to distant organs (e.g., lungs, liver, bones).
• Tumor and/or lymph nodes can be large or extensive.

Treatment:

• Palliative therapy to enhance quality of life

Systemic therapies:

• Chemotherapy
• Immunotherapy (e.g., nivolumab, pembrolizumab)
• Targeted therapy (e.g., cetuximab)

Oral cancer pictures

How to detect mouth cancer?

Early diagnosis of mouth cancer is necessary for successful treatment and better survival. Mouth cancer can usually be detected by self-exams, dental examination, and medical check-up.

Self-Examination (Monthly Oral Self-Check)

You can perform this at home in front of a mirror and good light:

What to observe:

• Sores or ulcers in the mouth that do not heal (2+ weeks)
• Red, white, or mixed spots on the tongue, gums, or inside cheeks
• Peculiar lumps, thickened regions, or rough patches
• Mouth or lip numbness or pain
• Loose teeth with no dental cause
• Chronic sore throat or trouble swallowing

Examination:

• Tongue (top, bottom, sides)
• Lips and gums
• Roof and floor of mouth
• Inside of cheeks
• Throat (as far back as you can see)

Dental Check-Up

Dentists are usually the first to notice suspicious lesions when they come in for a regular dental check-up. They will:

• Look at oral tissues visually
• Feel (palpate) for bumps
• Inquire about symptoms such as pain, difficulty swallowing, or ulcers
• Recommendation: Get a dental check-up every 6 months, particularly if you are a tobacco or alcohol user.

Medical Evaluation & Tests

If something suspicious is detected, your doctor or dentist can suggest:

Biopsy

• Most specific test: A tiny bit of tissue is taken out and studied under the microscope.

Exfoliative Cytology

• Scraping cells from mouth surface to be examined.

Imaging Tests (to determine extent/spread):

• MRI or CT scan
• PET scan (for determining distant spread)
• X-ray (if bone involvement is suspected)

Toluidine Blue Staining or VELscope

• Used to illuminate abnormal regions during clinical examinations.

Oral cancer risk factors

Mouth or oral cancer results from cells in the mouth growing rapidly. Various lifestyle, environmental, and biological factors can elevate the risk.

Principal Risk Factors:

Tobacco Use

• Comprises cigarette, cigar, and pipe smoking, and smokeless tobacco (gutkha, khaini, paan, snuff, betel quid) chewing
• Comprises 60–70% of oral cancers in India

Alcohol Use

• Particularly heavy, chronic use
• Use of alcohol and tobacco together increases the risk to several fold

Human Papillomavirus (HPV) Infection

• Particularly HPV type 16
• More frequently associated with oropharyngeal cancers but on the rise in oral cancers

Poor Oral Hygiene

• Chronic irritation due to rough teeth, ill-fitting dentures, or sharp fillings

Age

• Risk factor after age 40, but HPV infection is on the rise in younger adults

Sun Exposure

• Long-term exposure to UV raises lip cancer risk

Weakened Immune System

• From diseases or immunosuppressive drugs

Is oropharyngeal cancer curable?

Yes — oropharyngeal cancer is curable, particularly if found early and treated. The cure rate depends on various factors:

Major Factors Influencing Curability:

HPV Status

• HPV-positive oropharyngeal cancers are far more favorable.
• Radiation and chemotherapy often work well.
• Improved survival and cure rates.

Stage at Diagnosis

• Early-stage (Stage I–II): High cure rates, frequently >80%.
• Locally advanced (Stage III–IVA): Potentially curable with aggressive treatment.
• Stage IVB–IVC (advanced/metastatic): Less curable, but disease can be controlled and survival prolonged by treatment.

Treatment Plan

• Radiation, chemotherapy, and occasionally surgery combined.
• HPV-positive cases may have lower doses but good results.

Patient's General Health

• General fitness influences whether aggressive treatments can be tolerated.
• Young patients and non-smokers generally do better.