Doctor's Notes on Cancer of the Mouth and Throat (Oral Cancer) Symptoms, Causes, Treatment, and Survival Rates
Signs and symptoms of cancer in the mouth and throat are not specific and may develop gradually; people may not notice them early in the disease. The signs and symptoms of this disease are painless lumps on the lips, in the mouth or in the throat, sores or ulcerations in the mouth or lips that do not heal, painless white patches or red patches on any of the mouth structures, or pain, bleeding or numbness inside the mouth. Other signs and symptoms include sore throat that doesn’t heal, swelling of the jaw, voice changes and/or pain in the ear. Patients usually exhibit one or more of these signs or symptoms before seeking medical care.
The causes of cancer of the mouth and throat multiple but about 50 – 90% of squamous cell cancers mouth and throat are due to human papilloma virus infections. Other risk factors contribute to causing these cancers; they are smoking, chewing tobacco, alcohol use, chewing betel nuts (common in India) and in some patients, sun exposure to the lips. Also, advancing age and being male is associated with a higher incidence of this disease.
Cancer of the Mouth and Throat (Oral Cancer) Symptoms, Causes, Treatment, and Survival Rates Symptoms
People may not notice the very early symptoms or signs of oral cancer. People with an oropharyngeal cancer may notice any of the following signs and symptoms:
- A painless lump on the lip, in the mouth, or in the throat
- A sore or ulceration on the lip or inside the mouth that does not heal
- Painless white patches or red patches on the gums, tongue, or lining of the mouth
- Unexplained pain, bleeding, or numbness inside the mouth
- A sore throat that does not go away
- Pain or difficulty with chewing or swallowing
- Swelling of the jaw
- Hoarseness or other change in the voice
- Pain in the ear
These symptoms are not necessarily signs of cancer. Mouth sores and other symptoms may be caused by many other less serious conditions.
Cancer of the Mouth and Throat (Oral Cancer) Symptoms, Causes, Treatment, and Survival Rates Causes
Today the understanding of oral health and the cause of cancers (especially those of the oropharynx) has changed dramatically. Historically most cancer of the head and neck was attributed to tobacco and alcohol use. Today we know that this explanation is both incomplete and often inaccurate.
Anywhere from 50%-90% of oropharynx squamous cell carcinomas are known to be caused by HPV (human papillomavirus) infection. Testing the cancers shows evidence of HPV infection. Such cancers are said to be HPV positive or HPV+.
The human papillomavirus can cause a sexually transmissible viral infection. Eighty percent of people between 18 and 44 have had oral sex with an opposite sex partner, likely accounting for much of the oral HPV infections observed. There are many forms of HPV. The high risk subtypes of HPV are responsible for 90% of cancer of the cervix. They also play an important role in other genital area cancers. These same subtypes of HPV, especially types 16 and 18, are found present in oropharyngeal area cancers.
HPV+ cancers occur in people who may or may not have a history of excessive tobacco or alcohol use. HPV negative, HPV-, cancers of the oropharynx are virtually always found in those with the history of heavy alcohol and tobacco use.
Both smoking and "smokeless" tobacco (snuff and chewing tobacco) increase the risk of developing cancer in the mouth or throat.
- All forms of smoking are linked to these cancers, including cigarettes, cigars, and pipes. Tobacco smoke can cause cancer anywhere in the mouth and throat as well as in the lungs, the bladder, and many other organs in the body. Pipe smoking is particularly linked with lesions of the lips, where the pipe comes in direct contact with the tissue.
- Smokeless or chewing tobacco is linked with cancers of the cheeks, gums, and inner surface of the lips. Cancers caused by smokeless tobacco use often begin as leukoplakia or erythroplakia.
Other risk factors for mouth and throat cancer include the following:
- Alcohol use: At least three quarters of people who have an HPV negative mouth and throat cancer consume alcohol frequently. People who drink alcohol frequently are six times more likely to develop one of these cancers. People who both drink alcohol and smoke often have a much higher risk than people who use only tobacco alone.
- Sun exposure: Just as it increases the risk of skin cancers, ultraviolet radiation from the sun can increase the risk of developing cancer of the lip. People who spend a lot of time in sunlight, such as those who work outdoors, are more likely to have cancer of the lip.
- Chewing betel nut: This prevalent practice in India and other parts of South Asia has been found to result in mucosa carcinoma of the cheeks. Mucosa carcinoma accounts for less than 10% of oral cavity cancers in the United States but is the most common oral cavity cancer in India.
These are risk factors that can be avoided in some cases. For example, one can choose to not smoke, thus lowering the risk of mouth and throat cancer. The following risk factors are outside of a person's control:
- Age: The incidence of mouth and throat cancers increases with advancing age.
- Sex: Mouth and throat cancer is twice as common in men as in women. This may be related to the fact that more men than women use tobacco and alcohol.
The relationship between these risk factors and an individual's risk is not well understood. Many people who have no risk factors develop mouth and throat cancer. Conversely, many people with several risk factors do not. In large groups of people, these factors are linked with higher incidence of oropharyngeal cancers.
Also called fever blisters, you don't get cold sores from fevers or colds but they can be triggered by them. The virus that causes cold sores is usually passed via a kiss, shared utensils, or other close contact. Over-the-counter creams and ointments may help discomfort and speed healing. Frequent sores may require a prescription. Cold sores are a top mouth problem. Other problems include canker sores, TMJ, bad breath, and mouth cancer.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.