Lip and oral cavity cancer is a disease in which malignant (cancer) cells form in the lips or mouth.

The oral cavity includes the following:

• The front two thirds of the tongue.
• The gingiva (gums).
• The buccal mucosa (the lining of the inside of the cheeks).
• The floor (bottom) of the mouth under the tongue.
• The hard palate (the roof of the mouth).
• The retromolar trigone (the small area behind the wisdom teeth).

Anatomy of the oral cavity. The oral cavity includes the lips, hard palate (the bony front portion of the
roof of the mouth), soft palate (the muscular back portion of the roof of the mouth), retromolar trigone (the area behind the wisdom teeth), front two-thirds of the tongue, gingiva (gums), buccal mucosa (the inner lining of the lips and cheeks), and floor of the mouth under the tongue.

Most lip and oral cavity cancers start in squamous cells, the thin, flat cells that line the lips and oral cavity. These are called squamous cell carcinomas. Cancer cells may spread into deeper tissue as the cancer grows. Squamous cell carcinoma usually develops in areas of leukoplakia (white patches of cells that do not rub off).

Lip and oral cavity cancer is a type of head and neck cancer.

Tobacco and alcohol use can affect the risk of developing lip and oral cavity cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for lip and oral cavity cancer include the following:

• Using tobacco products.
• Heavy alcohol use.
• Being exposed to natural sunlight or artificial sunlight (such as from tanning beds) over long periods of time.
• Being male.
• Being infected with human papillomavirus (HPV).

Possible signs of lip and oral cavity cancer include a sore or lump on the lips or in the mouth.
These and other symptoms may be caused by lip and oral cavity cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• A sore on the lip or in the mouth that does not heal.
• A lump or thickening on the lips or gums or in the mouth.
• A white or red patch on the gums, tongue, tonsils, or lining of the mouth.
• Bleeding, pain, or numbness in the lip or mouth.
• Change in voice.
• Loose teeth or dentures that no longer fit well.
• Trouble chewing or swallowing or moving the tongue or jaw.
• Swelling of jaw.
• Sore throat or feeling that something is caught in the throat.

Lip and oral cavity cancer may not have any symptoms and is sometimes found during a regular dental exam.

Tests that examine the mouth and throat are used to detect (find), diagnose, and stage lip and oral cavity cancer.

The following tests and procedures may be used:

• Physical exam of the lips and oral cavity: An exam to check the lips and oral cavity for abnormal areas. The doctor or dentist will feel the entire inside of the mouth with a gloved finger and examine the oral cavity with a small long-handled mirror and lights. This will include checking the insides of the cheeks and lips; the gums; the roof and floor of the mouth; and the top, bottom, and sides of the tongue. The neck will be felt for swollen lymph nodes. A history of the patient’s health habits and past illnesses and medical and dental treatments will also be taken.

• Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.

• X-rays of the head, neck, and chest: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. If leukoplakia is found, cells taken from the patches are also checked under the microscope for signs of cancer.

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

• Exfoliative cytology: A procedure to collect cells from the lip or oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, mouth, or throat. The cells are viewed under a microscope to find out if they are abnormal.

• Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken. This procedure is also called an upper GI series.

• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Certain factors affect prognosis (chance of recovery) and treatment options.

Prognosis (chance of recovery) depends on the following:

• The stage of the cancer.
• Where the tumor is in the lip or oral cavity.
• Whether the cancer has spread to blood vessels.

For patients who smoke, the chance of recovery is better if they stop smoking before beginning radiation therapy.

Treatment options depend on the following:

• The stage of the cancer.
• The size of the tumor and where it is in the lip or oral cavity.
• Whether the patient's appearance and ability to talk and eat can stay the same.
• The patient's age and general health.

Patients who have had lip and oral cavity cancer have an increased risk of developing a second cancer in the head or neck. Frequent and careful follow-up is important. Clinical trials are studying the use of retinoid drugs to reduce the risk of a second head and neck cancer. Information about ongoing clinical trials is available from the NCI Web site

Dr Neophytos Demetriades (DDS, MD, MSc)

American Medical Center, Nicosia

215, Spyrou Kyprianou Ave Strovolos,
P.O.Box 25610 Nicosia,

T.: +357 70007484  |  M.: +357 99400200  |  Fax: +357 22 476797
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