Cancer of the Mouth and Throat

Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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The oral cavity (mouth) and the upper part of the throat (pharynx) have roles in many important functions, including breathing, talking, chewing, and swallowing. The mouth and upper throat are sometimes referred to as the oropharynx or oral cavity. The important structures of the mouth and upper throat include the following:

• Lips
• Inside lining of the cheeks (buccal mucosa)
• Teeth
• Gums
• Tongue
• Floor of the mouth
• Back of the throat, including the tonsils (oropharynx)
• Roof of the mouth (the bony front part [hard palate] and the softer rear part [soft palate])
• Area behind the wisdom teeth
• Salivary glands

Picture of oral cancer (cancer of the mouth)

Many different cell types make up these different structures. Cancer occurs when normal cells undergo a transformation whereby they grow and multiply without normal controls. Malignant tumors of the oral cavity can encroach on and invade neighboring tissues. They can also spread to remote sites in the body through the bloodstream or to lymph nodes via the lymph vessels. The process of invading and spreading to other organs is called metastasis.

Tumors in the mouth and throat include both benign and malignant types.

• Benign tumors, although they may grow and penetrate below the surface layer of tissue, do not spread by metastasis to other parts of the body. Benign tumors of the oropharynx are not discussed in this article.

Premalignant conditions are cell changes that are not cancer but which may become cancer if not treated.

• Dysplasia is another name for these precancerous cell changes.
• Dysplasia can be detected only by taking a biopsy of the lesion.
• Examining the dysplastic cells under a microscope indicates how severe the changes are and how likely the lesion is to become cancerous.
• The dysplastic changes are usually described as mild, moderately severe, or severe.

The two most common kinds of premalignant lesions in the oropharynx are leukoplakia and erythroplakia.

• Leukoplakia is a white or whitish area on the tongue or inside of the mouth. It can often be easily scraped off without bleeding and develops in response to chronic (long-term) irritation. Only about 5% of leukoplakias are cancerous at diagnosis or will become cancerous within 10 years if not treated.
• Erythroplakia is a raised, red area. If scraped, it may bleed. Erythroplakia is generally more severe than leukoplakia and has a higher chance of becoming cancerous over time.
• Mixed white and red areas can also occur and represent premalignant lesions of the oral cavity.
• These are often detected by a dentist at a routine dental examination.

Several types of malignant cancers occur in the mouth and throat.

• Squamous cell carcinoma is by far the most common type, accounting for more than 90% of all cancers. These cancers start in the squamous cells, which form the surface of much of the lining of the mouth and pharynx. They can invade deeper layers below the squamous layer.
• Other less common cancers of the mouth and throat include tumors of the minor salivary glands and lymphoma.
• Cancers of the mouth and throat do not always metastasize, but those that do usually spread first to the lymph nodes of the neck. From there, they may spread to more distant parts of the body.

Statistics about oral cancer reveal that over 39,000 new cases of oral cancer are diagnosed in the U.S. yearly, with about 7,900 people dying of these cancers each year. Approximately 1 out of 95 people will develop an oral cancer at some time in their lives.

• Cancers of the mouth and throat occur in twice as many men as women.
• These cancers can develop at any age but occur most frequently in people aged 45 years and older.
• Incidence rates of mouth and throat cancers vary widely from country to country. These variations are due to differences in risk factor exposures.

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