Head and Neck Cancers
Oral cancer is cancer found in the mouth area. Oropharyngeal cancer is cancer found in the oropharynx (the throat area at the back of the mouth). Oral cavity and oropharyngeal cancer will be diagnosed in 36,000 U.S. adults in 2013, according to the American Cancer Society (ACS).
The oral cavity includes:
The oropharynx includes:
Otolaryngology surgeons at Brigham and Women’s Division of Otolaryngology at Brigham and Women's Faulkner Hospital specialize in surgical techniques for oral cavity and oropharyngeal cancer. We offer the most current diagnostic methods and proven treatments, including minimally invasive surgical approaches aided by video technology. We are the surgical team for Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), an exceptional collaboration between two world-class medical centers.
The main causes of oral and oropharyngeal cancer are:
Other causes may include the following:
The following are the most common symptoms.
The symptoms of oral and oropharyngeal cancer may resemble other disorders or medical problems. Always consult your health care provider for a diagnosis.
Tumors can develop anywhere in the oral cavity and oropharynx (or the back of the mouth where it connects with the throat). Some tumors are benign (non-cancerous), some may be precancerous (a condition that may become cancerous), while others may be cancerous.
What are benign tumors?
Many forms of benign (non-cancerous) tumors can appear in the oral cavity or oropharynx including:
Condyloma acuminatum (also known as genital warts) - A small, moist, pink or red growth that grows alone or in cauliflower-like clusters
Eosinophilic granuloma - A benign tumor which most often affects children and adolescents and is usually found in a bone or the lungs
Fibroma - A benign tumor consisting of fibrous connective tissues
Keratoacanthoma - A flesh-colored, fast-growing bump on the skin with a keratin plug in the center (keratin, is the main component of the external layer of skin, hair, and nails)
Leiomyoma - A tumor of the smooth muscle, often found in the esophagus, small intestine, uterus, or stomach
Lipoma - A tumor made up of mature fat cells
Neurofibroma - A fibrous tumor consisting of nerve tissue
Odontogenic tumors - Tumors in the jaw that start in the tooth-forming tissues
Osteochondroma - A tumor made up of bone and cartilage
Papilloma - A tumor that resembles a wart, growing on the epithelium (the cells that form the skin and mucous membranes)
Pyogenic granuloma - A small, round bump that often has an ulcerated surface
Rhabdomyoma - A striated-muscle tumor that may appear on the tongue, pharynx, uterus, vagina, or heart
Schwannoma - A single tumor that grows in the neurilemma (Schwann's sheath) of nerves
Verruciform xanthoma - Wart-shaped tumors
What oral conditions may be precancerous?
Two conditions in the mouth — leukoplakia and erythroplakia —can be precursors to cancer. Often caused by smoking or chewing tobacco, these (initially) benign conditions can occur anywhere in the mouth. Only a biopsy can determine whether precancerous cells (dysplasia) or cancer cells are present in a leukoplakia or erythroplakia.
Treatment for leukoplakias or erythroplakias may include use of retinoids, medications that are related to vitamin A, to eliminate, reduce, and/or prevent dysplasia from forming.
What are malignant tumors?
Although there are several types of malignant oral and oropharyngeal cancers, more than 90 percent of all diagnosed oral and oropharyngeal cancers are squamous cell carcinoma.
Squamous cell carcinoma - Also known as squamous cell cancer, this type of cancer originates in the squamous cell layer in the lining of the oral cavity and oropharynx. In the early stages, this cancer is present only in the lining layer of cells (called carcinoma in situ). When the cancer spreads beyond the lining, it is called invasive squamous cell cancer.
Verrucous carcinoma - Although also considered a type of squamous cell carcinoma, this low-grade cancer rarely metastasizes (spreads to distant sites). Comprising less than five percent of all diagnosed oral cancers, verrucous carcinoma can spread deeply into surrounding tissue, requiring surgical removal with a wide margin of surrounding tissue.
Minor salivary gland cancers - The lining of the oral cavity and oropharynx contains numerous salivary glands. Sometimes cancer will originate in a salivary gland. Treatment depends on the type and location of the salivary gland cancer, as well as the extent of spreading. According to the ACS, salivary gland cancers are rare.
Although heredity also plays a factor, certain lifestyle habits and health conditions can increase a person's risk for developing oral and oropharyngeal cancers. A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity--such as smoking or diet, family history, or many other things.
Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.
Tobacco use - The majority of patients with oral and oropharyngeal cancers use tobacco in one form or another. Tobacco can damage cells in the lining of the oral cavity and oropharynx causing abnormal cells to grow more rapidly to repair the damage. According to the ACS, it is suspected that the DNA-damaging chemicals in tobacco are linked to the increased risk of oral and oropharyngeal cancers.
Alcohol use - The majority of patients with oral and oropharyngeal cancers use alcohol frequently. When paired with tobacco use, patients increase their risk of developing oral and oropharyngeal cancers even more.
Sunlight - Prolonged exposure to ultraviolet radiation from the sun can cause skin cancer. People who are outdoors for an extended period of time increase their risk of lip cancer, as well.
Chronic irritation - Chronic irritation to the lining of the mouth, due to poorly fitting dentures or other reasons, may increase a person's risk for oral cancer.
Lack of fruits and vegetables in diet - Research has suggested that fruits and vegetables, which contain antioxidants that can "trap" harmful molecules, can decrease the risk for oral and oropharyngeal cancers (and other cancers). It is speculated that persons with a low intake of these types of foods are at an increased risk for (oral and oropharyngeal) cancer.
Human papillomavirus (HPV) infection - HPV usually causes warts and has been linked to cervical, vaginal, and penile cancers. HPV also increases the risk for cancers of the oral cavity and oropharynx.
Males - Oral and oropharyngeal cancers are twice as common in men then in women, partly because men are more likely to use tobacco and alcohol.
In addition to a complete medical history and physical examination, diagnostic procedures for oral cancers of the oral cavity and oropharynx may include one or more of the following:
Once a diagnosis is made, the cancer will be staged (to determine the extent of the disease) before a treatment plan is established.
Specific treatment for cancers of the oral cavity and oropharynx will be determined by your health care provider based on:
Treatment may include:
Watch this video on Transoral Robotic Surgery (TORS).
Side effects of treatment for oral and oropharyngeal cancer
Side effects of treatment vary, depending on the type of treatment and the area being treated. Side effects can be temporary or permanent. The following are some of the more common side effects of treatment for cancers of the oral cavity and oropharynx:
Depending on the type of treatment, other side effects may include:
Types of rehabilitation after treatment for oral and oropharyngeal cancer
Rehabilitation may vary from person to person depending on the type of treatment, and the location and extent of the cancer. Rehabilitation may include:
Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.
If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.
If surgery is needed, you will be cared for in the operating room by an experienced otolaryngology surgeon. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced medical and nursing staff.
Brigham and Women’s Faulkner Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to Brigham and Women's Hospital’s world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.
When surgery is necessary, our board-certified surgeons offer extensive surgical experience, performing thousands of operations per year. Our otolaryngologists are faculty members at Harvard Medical School and active researchers who continually seek causes and investigate treatments for conditions and diseases affecting the ear, nose and throat.
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