Oral and Oropharyngeal Cancer

Oral and Oropharyngeal Cancer

Oral and Oropharyngeal Cancer

Oral cancer is a cancer that begins in the mouth or the throat at the back of the mouth, called the oropharynx. (Cancer that begins in the back of the mouth is also called oropharyngeal cancer.) About 90 percent of the cancers in the oral cavity and the oropharynx are squamous cell carcinomas. 

An oral or oropharyngeal cancer can appear anywhere in the oral cavity, including the lips, the lining of the mouth, under the tongue, the tongue, the gums, the area behind the wisdom teeth, the back of the throat, the tonsils, and the roof of the mouth.

Risk Factors

Using tobacco and drinking alcohol greatly increases your risk of developing an oral cancer, especially if you use chewing tobacco or snuff. People who both smoke and drink have an even higher risk of developing a cancer in the mouth. Other risk factors include prolonged sun exposure (for cancer of the lip) and human papillomavirus infection. Some studies show that infection with some subtypes of HPV increases the risk of oral cancer, in particular oropharyngeal cancer.

The human papillomavirus (HPV) has been linked to oral cancers in new research. This is the same virus that is now known to be linked to cervical cancer in women.

There are about 50,000 cases of oral cancers diagnosed in the United States every year. The most common risk factor for these diseases is excessive alcohol use and cigarette smoking. But there is a new demographic emerging in people in their 30s, 40s, and 50s who don’t have these habits but have oral cancers, especially in males, often linked to HPV. “The natural history of the HPV virus in the throat is unknown,” says Eduardo Méndez, MD, associate professor of head and neck surgery at UW Medicine. It is a cancer that is hard to detect and difficult to see because it doesn’t cause a white plaque. HPV-positive cancers form in the back of the throat. The positive thing about these cancers is that they respond very well to treatment, better in fact than oral cancers that are not HPV-positive.

Symptoms

The most common symptom of oral cancer is a sore in the mouth that does not heal. Other symptoms include:
    •    A lump in the mouth or throat or on the lip
    •    A white or red patch on the gums, tongue, or the lining of the mouth
    •    Bleeding, pain, or numbness in the mouth
    •    A sore throat that does not go away
    •    Difficulty or pain when chewing or swallowing
    •    Swelling of the jaw
    •    A change (hoarseness) in the voice
    •    Pain in the ear

Diagnosis

People who smoke or drink heavily should be examined for head and neck cancer at least once a year. This is a simple 10-minute procedure that includes looking in the nose, mouth, and throat; examining the skin in the head and neck region; and feeling for lumps in the neck. If cancer is suspected, the doctor may use mirrors and a lighted tube to examine hard-to-see areas. Your doctor may also suggest other tests or scans. If a suspicious area is found, the doctor may do a biopsy, in which a piece of tissue will be removed with either a scalpel or a needle and then examined by a pathologist for signs of cancer.

Treatment

While many cancers of the head and neck are curable, treatment depends on where the cancer is, the severity of the disease, and the patient's age and overall health. The primary method of treatment is surgery (removing the cancer cells). Radiation (using high-dose X-rays to kill cancer cells) and chemotherapy (using high-dose anti-cancer medication) are also used.

Surgery

Great advances have been made in surgical procedures so that structures affected by cancer can either be spared from removal, or reconstructed well enough that the patient is not disfigured. The larynx, or voice box, can be saved in half the cases in which it would have been removed in the past. When part of the lower or upper jaw needs to be removed, doctors can now refashion a jawbone using bone from the patient's leg, hip, or shoulder blade. The tongue can even be reconstructed with appropriate soft tissue from various parts of the body.

For patients in whom a structure cannot be saved or restored, there are several new ways of helping to improve speech, swallowing, and other functions. Doctors can now restore a patient's vocal ability using a quick implant procedure. Other options for restoring a person's vocals include an electrolarnyx - a device placed against the neck to help form words and a tracheosophageal puncture - a surgical procedure that restores the patient's ability to deliver air into the throat and eventually allows speech.

Using a simultaneous, two-team approach during surgery, oncologic and reconstructive surgeons work alongside one another. Their team efforts, combined with the anesthesia and operating room nursing staff, has significantly shortened procedure times. After surgery, the team of nurses, speech pathologists, and social workers work with patients to help them recover and rehabilitate quickly.

Radiation

Radiation typically involves external beam radiation. Another technique, known as intensity modulated radiation therapy, allows for very precise delivery of radiation therapy to tumors. Studies are showing that in some cases, radiation therapy alone, or sometimes combined with chemotherapy, is just as effective as surgery.

Chemotherapy

Chemotherapy is often used to enhance the response of cancer cells to radiation therapy and makes it possible to preserve organs, such as the larynx and tongue. Chemotherapy drugs include cisplatin, fluorouracil, methotrexate, carboplatin, and paclitaxel.

Targeted Agents

Recently, the use of targeted therapy has shown progress and we have started using agents that specifically target growth receptors on tumor cells, such as cetuximab and erlotinib.

While many cancers of the head and neck are curable, treatment depends on where the cancer is, the severity of the disease, and the patient's age and overall health. The primary method of treatment is surgery (removing the cancer cells). Radiation (using high-dose X-rays to kill cancer cells) and chemotherapy (using high-dose anti-cancer medication) are also used.

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