Early Stage Oral Cavity Cancer

This information will help you understand early stage cancer of the oral cavity, including symptoms, diagnosis, and treatment.

Your Oral Cavity

The open mouth is called the oral cavity. It is designed for speaking, chewing, swallowing, and breathing. The oral cavity includes your:

  • lips
  • front two-thirds of the tongue
  • hard and soft palate (roof of the mouth)
  • floor of the mouth (under the tongue)
  • buccal mucosa (the lining of the inside of the cheeks)
  • upper and lower gingiva (gums)
  • retromolar trigone (the small area behind the wisdom teeth of the lower jaw)
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Risk Factors

  • Oral cancer usually affects people aged 65 to 74. This is because of their longer exposure to risk factors.
  • Men are twice as likely to get oral cancer compared to women.
  • Oral cancer can be caused by smoking cigarettes, cigars, pipes, or by chewing tobacco. It’s also seen in people who have never used tobacco at all.
  • Alcohol use also increases the risk for oral cancer. People who drink and smoke increase their risk even more.
  • Too much sun exposure can cause skin cancer of the lip.
  • Human papilloma virus (HPV), which can infect the skin and lining of the mouth, throat, genitals, and anal area, can lead to cancer.
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Signs and Symptoms

Changes in and around the oral cavity that may be signs of cancer include:

  • A sore, lump, or thickening on the lip or in the mouth that doesn’t heal.
  • An infection in the mouth that doesn’t get better with treatment within 1 month.
  • A white or red patch on the gums, tongue, or lining of the mouth.
  • Loose teeth or dentures that no longer fit well.
  • Chronic pain in the mouth or throat.
  • Bleeding or numbness in the lip or mouth.

These signs and symptoms may not be from cancer, but if you have any you should see your healthcare provider.

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A biopsy is the first step to diagnose cancer. It might be done during your first visit with your doctor if it wasn’t done already. During a biopsy a small amount of tissue is taken from the area where cancer is suspected. The tissue is sent to the pathologist who will examine it under a microscope. The biopsy results takes 5 days or longer to come back. If a biopsy was already done, your tissue samples (slides) will be given to our pathologist to confirm the diagnosis.

Special x-rays, such as a computed tomography (CT) scan, magnetic resonance imaging (MRI), or Panorex, may be done. A Panorex x-ray shows the full upper and lower jaw, including the jaw and sinuses. These provide more details about the lesions. It can show how deep it is and if it has spread.

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Pre-cancerous lesions are removed to prevent these from developing into cancers. The goals in the treatment of early oral cavity cancer are:

  • To cure the cancer.
  • To preserve your appearance and the functions of your mouth.
  • To prevent additional tumors.

Surgery is the most common treatment for pre-cancerous lesions and early cancers. The type and extent of surgery depends on the location. Your healthcare porvider will tell you which area is affected, then you can read below about the procedure you will have. These surgeries are all done through the open mouth.

  • Lip - The area with cancer and the nearby skin is cut out. The incision (surgical cut) is closed with sutures. The sutures inside the mouth and on the lip will dissolve. Non-dissolvable sutures are used on the skin.

  • Tongue - The area with cancer is cut out from the outer edge of the tongue. The extent of surgery depends on the size of the lesion. This surgery is called a partial glossectomy. The incision is closed with dissolvable sutures.

  • Hard Palate and Upper Gums - The extent of surgery depends on the size and depth of the cancer. Small superficial (on the surface) tumors are cut out and left open without sutures. New tissue forms to grow over and heal the opening. Larger and deeper tumors may require removing the underlying palate. The cut out area is covered with a graft of skin or man-made (synthetic) skin. The graft is covered with gauze that is held in place with a dental plate (obturator). It will be made by the dentist. The gauze is removed after five to seven days.

  • Soft Palate Tumors - The area with cancer is cut out. If the area is very small, the incision is closed with dissolvable sutures. Otherwise, it is left open without sutures. A dental plate (obturator) may be made by the dentist to help you swallow and speak.

  • Floor of the Mouth - The extent of surgery depends on the size and depth of the cancer. Small tumors that are close to the surface (superficial) are cut out and left open without sutures. New tissue forms to grow over and heal the area. Larger tumors are cut out and covered with a graft of skin or man-made (synthetic) skin. The graft is covered with gauze that is sutured to hold it in place. The gauze is removed after 5 days.

  • Buccal Mucosa (Lining of the cheek) - The area with cancer is cut out. The incision is closed using a graft of skin or synthetic skin.

  • Retromolar Trigone and Lower Gums - The area with cancer is cut out. Depending on the depth of the tumor, a small sliver of the underlying jaw bone (mandible) may be removed. This is called a marginal mandibulectomy. The incision is covered with a graft of skin or man-made (synthetic) skin. The graft is covered with gauze that is sutured to hold it in place. The gauze is removed after 5 days. No reconstruction of the jaw bone is needed. The shape of the jaw will not be affected.

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Post-Operative Care

Dietary Changes

  • If you do not need a feeding tube, you can drink liquids right after your surgery. The next day, start eating pureed foods. Begin to eat soft foods when you are able to. Review the resource Eating Guide for Pureed and Mechanical Soft Diets for suggestions on what to eat. You can also drink liquid supplements that are high in protein and calories. Examples are Ensure®, Boost®, and Carnation Instant Breakfast®. Do not eat regular foods until your doctor says it is okay.

  • Depending on your surgery, you may need a feeding tube. Do not take in anything by mouth until your doctor says you’re ready. The feeding tube will be passed into the stomach through your nose. After your surgery, you will be taught how to take liquid nutrition through the tube. Your doctor will remove the feeding tube when you are able to eat and drink on your own. At first, you will take only liquid and pureed foods.

  • If you had surgery of the lining of your mouth (buccal mucosa) or lower gums, you will need to change the way you eat. Chew on the opposite side of your mouth until you return for your first doctor’s visit.

Mouth Care

  • Keep your mouth clean by rinsing or using an oral irrigation set. Your nurse will give you an oral irrigation set if you need it and teach you how to use it.
  • Use a solution of 1 quart of warm water with 1 teaspoon of salt and 1 teaspoon of baking soda.
  • Rinse or irrigate frequently, at least 4 times a day. Rinse or irrigate after each meal.
  • Continue to rinse or irrigate until your surgical site is well healed.
  • Do not use mouthwash that contains alcohol. It can irritate the tissues and delay healing.

Incision Care

  • Dissolvable sutures will loosen and fall off in about 2 months. When you feel them in your mouth, you can just spit them out. There is no special care while these are in place other than keeping your mouth clean.
  • Non-dissolvable sutures will be removed at your first visit with your doctor after surgery. Keep the sutures on your lip or neck dry for the first 48 hours. After 48 hours you can shower or bathe as usual. Let the water run over the sutures and pat them dry. Apply Bacitracin® ointment once daily.
  • If you had surgery on your lip, avoid stretching the lip, such as by smiling, until the area is healed.

Possible Changes in Speech

  • If you had surgery of the tongue or floor of mouth, your speech may be different. Your tongue may feel swollen and numb and may not move freely. This will improve as the area heals.

Pain Management

  • You may have some discomfort after the surgery. You will be given a prescription for pain medication before you go home. Take it as prescribed.
  • If the pain medication is not helping you, call your doctor’s office.
  • Pain medication can cause you to have fewer bowel movements than usual (constipation). To prevent this, take a stool softener such as docusate sodium (Colace®) 3 times a day. If this doesn’t help, take a laxative (such as 2 tablets of Senokot®) at bedtime. Both are available without a prescription. If you still have constipation after using these medications, call your doctor’s office.

Follow up Visit

  • The day after your surgery, call your doctor’s office to schedule a post-operative visit. This will be in about 1 week.
  • If you use tobacco or alcohol, you’re at risk for more cancers in your oral cavity. We can help you to stop. If you would like help, talk with your healthcare provider.
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Call Your Doctor Or Nurse If You Have:

  • A temperature of 101° F (38.3° C) or higher
  • Increased discomfort, redness, or swelling around your incision (surgical cut)
  • Discharge from the incision
  • Any questions or concerns
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