Oral Cancer: Diagnosis, Stages, Treatments, Prevention & More

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Hi, I’m Dr. B, practicing functional dentist for 35 years. I graduated from the Dugoni School of Dentistry in San Francisco, CA in 1987 and am a member of the American Academy of Dental Sleep Medicine (AADSM), Academy of General Dentistry (Chicago, IL), American Academy for Oral Systemic Health (AAOSH), and Dental Board of California. I'm on a mission to empower people everywhere with the same evidence-based, easy-to-understand dental health advice that my patients get. Learn more about Dr. B

Oral Cancer

Growth of malignant cells beginning in the teeth, lips, oral tissue, front two thirds of the tongue, roof of the mouth, gums, or the floor of the mouth; may spread throughout the body

Prevalance: Uncommon (between 8,000-9,000 new cases per year)

Ages Affected: 40+ years (95% of cases)

    • Slow healing lip or mouth sores
    • Loose teeth with no apparent cause
    • Lumps or growths inside the mouth
    • Pain or difficulty when swallowing
    • Ear or mouth pain
    • Persistent sore throat
    • Colored patches inside the mouth for over two weeks
    • Surgery
    • Radiation
    • Chemotherapy
    • Clinical trials (experimental treatment)
    • Targeted therapy
    • Immunotherapy
    • Nutrition
    • Detoxification
    • Good dental hygiene
    • Lifestyle changes

Understanding and preventing cancer has become a top priority in the health world. Oral cancer is no exception to this rule and may be more common than you may think.

Though this particular type of cancer is often overlooked, learning the signs, treatments, and prevention of oral cancer can be a real lifesaver.

In this article, we’ll cover everything oral cancer related, from cutting down on risk factors to living a rich life after treatment.

What is mouth (oral) cancer?

Cancer is a growth of malignant (abnormal) cells which may spread throughout the body.

Oral cancer can span across a wide number of the mouth’s working parts. This disease can affect:

  • Teeth
  • Lips
  • Lining tissue of lips and cheeks
  • The front two thirds of the tongue
  • Roof of the mouth (both hard palate and soft palate)
  • Gums
  • Floor of the mouth underneath the tongue

Oral cancer is a disease of the genes; it disrupts normal cell division, creating malignant tumors that invade nearby tissue.

Environmental factors can affect how these genes express themselves and trigger the onset of cancer through a process called “epigenetics”.

While each case of cancer has a different set of conditions, the end result is the same. Cancer’s unwanted cell growth can spread also rapidly to other parts of the body, known as metastasis or “mets”.

Mouth cancer usually presents in the squamous cells—the flat cells lining your lips, oral cavity, and tongue. A white or red patch on the mouth or lips can be an indicator of oral cancer if it lasts longer than a few weeks.

A good rule of thumb: lesions that resolve within two weeks are typically non-cancerous.

Squamous cell carcinoma refers to a cancer of these flat cells, and accounts for up to 90% of oral cancer cases. This usually appears as head and neck cancer, according to the American Cancer Society.

However, despite the single name, these cancerous spots can have a myriad of appearances. Precancerous or squamous cell carcinomas can take on many colors, so read on for tips on identifying carcinomas.

Symptoms and Diagnosis of Oral Cancer

How do oral cancer signs appear, and what should you do if you notice them?

Though there are several different patterns that indicate developing tumors, the answer of what to do next is clear. Call your dentist if you have any of the following symptoms of oral cancer:

  • Lip or mouth sores that aren’t healing
  • Loose teeth with no apparent cause
  • Lumps or growths inside the mouth
  • Pain or difficulty when swallowing
  • Ear or mouth pain
  • Persistent sore throat
  • Colored patches inside the mouth that last more than two weeks

Diagnosing Oral Cancer

Diagnosing oral cancer will involve a physical exam with a doctor or dentist to inspect for lumps, growths, and other issues in the mouth, tonsils, or lips.

If a suspicious area is found, they may biopsy the area by removing some of the tissue to send to a lab. There, it can be tested for cancerous or precancerous cells.

If the biopsy reveals the presence of these malignant cells, further testing may be needed. This can involve imaging tests, like an x-ray or CT scan, or an endoscopy.

An endoscopy involves using a very small, flexible camera in the throat, or oropharynx, to see if the cancer has spread. This rules out throat cancers, also called oropharyngeal cancers.

Because dental health care professionals are more familiar with diagnosing oral cancerous lesions, they may detect early signs of oral cancer before you notice them. This is why twice yearly checkups with teeth cleanings at the dentist are so important.

One Harvard study suggests a potential link between multiple oral sexual partners (typically, more than 20) and higher rates of oral cancer caused by the human papilloma virus (HPV). 

Because HPV-related oral cancer isn’t easy to spot, signs must be found with a procedure called an endoscopy. If you’ve had a large number of oral sexual partners, it’s a good idea to talk to your dentist about an endoscopy to rule out HPV in the throat or at the base of your tongue.

Don’t wait to make this appointment, no matter how daunting the idea of an exam is—early detection doubles your chances of successful cancer treatment in oral cavity cancer.

Identifying Oral Cancer and Pre-Cancer (with Pictures)

Colored patches in the mouth can be the most noticeable sign that something is amiss. While these aren’t definitive proof of cancer, call your dentist if any of these occur and lasts more than two weeks.

Below, I cover the ways oral cancer may look when it presents as patches in the mouth.

A Mixture of Red and White

A mixture of red and white patches in your mouth is referred to as a erythroleukoplakia. While they may not cause any discomfort, that doesn’t rule out the possibility of cancer cells.

If they’re visible and last more than two weeks, you should see your dentist.

Red Patches Alone

Erythroplakia, or a velvet-textured red patch, are usually precancerous. Since 75% to 90% of these are cancerous, it’s important to see your dentist right away.

These red patches can also occur under the tongue, and can be inspected by gently looking underneath after cleaning your hands thoroughly.

WARNING: Graphic Image (Click to Show)

White Patches Alone

Leukoplakia, or keratosis, is a white or grayish patch in the mouth or lips. These can develop after exposure to carcinogens, irritants like broken teeth or dentures, or tobacco use. Chewing on the lips or lining of the mouth can also cause leukoplakia.

These white patches may not be cancerous, but they do indicate that the tissue could become problematic. Their appearance may also change over time, hardening and becoming difficult to remove. Leukoplakia typically grow slowly over weeks or months.

WARNING: Graphic Image (Click to Show)

Stages of Mouth Cancer

Mouth cancer, and in fact all cancers, are classified in four stages, as outlined by the National Cancer Institute. This practice of cancer staging is crucial for assessing the treatment needed and the severity of the case.

  • Stage 1: the tumor, patch, or lesion is two centimeters or less in diameter. The cancer has not spread to nearby lymph nodes.
  • Stage 2: the tumor is a larger size, measuring over two centimeters but under four. The cancer still has not spread to the lymph nodes.
  • Stage 3: two conditions can cause this classification. Either the tumor is larger than four centimeters, or is smaller but has spread to one lymph node. Disease hasn’t spread to further parts of the body.
  • Stage 4: the cancer has spread to other parts of the body, nearby tissues, or more than one lymph node.

The National Institute of Health has found that more than half of cancer cases have spread by the time they are detected, so consult your dentist as soon as you can to avoid much more invasive treatment.


10 Treatments for Oral Cancer (Conventional & Natural)

1. Surgery

Surgery is the most traditional treatment option for patients with oral cavity cancer. Up to 56% of these cases can be resolved with surgery alone, though the severity of the stage will determine what treatment options are available.

There are three types of surgery common in oral cancer treatment:

  1. Removing the tumor: Your surgeon may simply need to cut away the cancerous area and a small amount of tissue around it. This is generally an option for early stage cases. Later stage oral cancer generally requires a larger area removed, which may include areas of the jawbone or tongue.
  2. Removing cancer that has spread: If your oral cancer has spread into throat cancer as well, a more involved surgery will be necessary. A neck dissection and lymph node removal can prevent the cancer invading further into the body. This can also help doctors observe what treatment may be necessary following the surgery.
  3. Mouth reconstruction surgery: Surgery may be needed to reconstruct the mouth after removing cancer. This can include dental implants to replace lost teeth, transplanted tissue or bone, and rebuilding the lower lip. This reconstructive surgery prevents future difficulty chewing or speaking.

2. Radiation Therapy

Radiation therapy uses high-powered beams of energy to kill cancer cells. This is most commonly seen as a precautionary treatment after surgery, or as a standalone treatment in extremely low-risk cases.

Unfortunately, radiation therapy can cause dry mouth, jawbone damage, and tooth decay.

Each situation is different, but this cancer care generally is administered for anywhere between two and eight weeks.

3. Chemotherapy

Chemotherapy is an oral or intravenous (IV) mixture of drugs used to kill cancer. These drugs can be used alone or combined with other cancer treatments, and are often used in conjunction with radiation therapy.

Common side effects of chemotherapy include hair loss, vomiting, and nausea.

4. Clinical Trials

Your doctor or dentist may be able to recommend you to clinical trials for new drugs or cancer treatments that you qualify for. Your health care professionals will be able to determine what is a good fit for your oral cancer situation.

Want to see studies currently recruiting? Check out this custom search at ClinicalTrials.gov.

Keep in mind, these are experimental therapies with an unknown record of success. It’s critical to talk to your health care provider(s) at length before enrolling in a trial.

5. Targeted Therapy

Targeted therapy generally refers to prescription drugs designed to attach themselves to cancer cells. This can stop them from dividing and spreading, halting the invasion of cancer.

Targeted therapy can be used together with chemotherapy and radiation, or on its own.

6. Immunotherapy

Immunotherapy leverages your body’s natural cancer-fighting process: the immune system. When cancer strikes, it can sneak by the immune system by producing certain proteins.

However, immunotherapy interferes with this defense mechanism, allowing your body to fight off cancer. This cancer care is a common recommendation primarily for those who are not responding well to standard treatment.

7. Nutrition

Nutrition is an important aspect of your cancer treatment. Many patients with oral cancer experience weight loss, perhaps due to nausea after chemotherapy or difficulty chewing.

Your body needs certain nutrients to fight off this disease and the side effects you may be experiencing.

In general, a diet to support your body’s immune system and fight against cancer follows these guidelines:

  • Eliminate processed foods like processed meats, packaged foods, and fast food.
  • Avoid anything burnt or fried, which may contain acrylamide (a known carcinogen).
  • Stay away from added and processed sugars.
  • Eat a highly alkaline diet full of vegetables, antioxidant-rich fruits, and high-fiber nuts and seeds.
  • Get organic, grass-fed meats instead of non-organic.
  • Replace vegetable oils with healthier fats like butter, ghee, olive oil, and avocado oil.
  • Eat plenty of wild-caught, organic fish.
  • Drink inflammation-busting teas.

While this kind of a diet is not proven to reverse cancer, it will support your body’s immunity and reduce chronic inflammation that can accelerate disease.

Consult with your health care provider and a nutritionist or dietician about what type of diet works best for you as you combat oral cancer.

8. Detoxification

Your body often does a great job at eliminating toxins you’re exposed to throughout daily life. Some of these include EMFs from electronic devices, ingredients in certain health and beauty products, chemicals in household cleaners, mercury from amalgam fillings, and plastics chemicals.

By altering your diet as I described above, you can help support your body’s normal detoxification processes.

To eliminate these toxins from your life, check out the EWG’s Healthy Living app. They conduct safety ratings on hundreds of thousands of products to show you what’s least and most toxic.

9. Good Dental Hygiene

You can boost your body’s ability to conquer cancer by practicing good oral health.

Keeping your mouth moist can aid your salivary glands in preventing decay, and keeping your teeth and gums clean can prevent further dental woes after treatment.

A prescription fluoride toothpaste or, even better, a high-strength hydroxyapatite toothpaste can also help in dealing with the sensitivity experienced by many patients undergoing chemo and/or radiation.

10. Lifestyle

Lifestyle changes can boost the efficacy of cancer treatments and assist patients in coping with fatigue from battling oral cancer.

Walking for 30 minutes a day has been shown to help patients return to daily life after cancer fatigue.

Massage therapy can reduce pain and anxiety in individuals with cancer.

Finally, relaxation such as journaling, art, or meditation can reduce the stress that comes with a cancer diagnosis and subsequent treatment.

Mouth Cancer Causes and Risk Factors

Many different factors can increase the likelihood of oral cancer, when genetic changes cause cells to mutate, grow, and spread into tumors.

While there’s no single, identifiable cause of oral cancer, several risk factors make it far more likely to occur. These include:

  • Tobacco use. Any kind of tobacco, from smoking cigarettes to chewing tobacco, increases your odds of contracting oral cancer.
  • Heavy drinking. Consistent and substantial alcohol use also heightens the likelihood of oral cancer. The CDC defines this as more than eight drinks a week for women, and more than 15 for men.
  • Too much sun. While this may not be an obvious cause, excessive exposure to ultraviolet rays can cause cancer of the lip.
  • Human papillomavirus. HPV is responsible for up to 90% of oral cancer cases in recent years. Check out my in-depth look at this topic.
  • A weakened immune system. When the body’s defense system is down, it’s easier for disease of any kind to make progress.

Complications and Related Conditions

Unfortunately, some of the treatments for cancer can cause complications, especially within the mouth.

Radiation and chemotherapy can cause bleeding, infection, pain, and mucositis. Radiation can also damage salivary glands and create dry mouth, or do damage to the neck and jaw muscles, referred to as trismus. Bone damage in the oral cavity may also occur.

Oral cancer is accompanied by an increased risk for other cancers, including stomach, liver, colon, thyroid, and esophagus cancers. Lung cancer is also a concern, especially if the oral cancer is smoking-related.

Finally, depression and anxiety are more likely among cancer patients.

Mouth Reconstruction and Rehabilitation

Mouth reconstruction is possible for oral cancer patients who have lost part of their tongue, teeth, oral cavity, or jawbone. This is referred to as oral reconstructive surgery.

Often skin, muscle, or bone is borrowed from other parts of the body to recreate a healthy mouth. Dental implants are also available if teeth have been lost during cancer treatment, and artificial palates can be built in special cases.

Even nerves can be transplanted if needed, allowing for proper speech and swallowing. No matter what transplants are needed, the doctors will borrow what they need carefully. Bone, tissue, muscle, or nerves are taken from areas where their absence will not be noticeable.

Rehabilitation after mouth reconstruction can be extensive, and your physical therapists and doctors will help determine the best treatment for you. This team will partner with you as you recover, and it’s not uncommon to attend 20-25 rehabilitative appointments in your first year.

Speech pathologists are also available in necessary cases, as are occupational therapists and rehabilitation counselors. Though oral cancer can be a painful experience, you are not alone.

How to Prevent Oral Cancer

One extremely effective way to prevent oral cancer is by quitting—yes, you read that correctly. Saying goodbye to alcohol use and tobacco not only benefits your general health, but decreases your odds of oral cancer.

If you do continue to drink alcohol, stick to one drink a day for men over 65 and women of any age, or two drinks for men 65 and younger.

Avoid all forms of smoking, and avoid the smokeless tobacco that can prime your cells for lip cancer.

Protecting your face, and especially lips, from sun exposure is another form of prevention. Try a large-brimmed hat, and use a chapstick with SPF every single day.

Eat fruits and vegetables and load up on antioxidants, which help detoxify your body from potential cancer triggers.

Dental Visits, Self-Exams, and Screening

Oral cancer prevention gives you one more reason to stop avoiding your dentist! Your regular dental checkups every six months can help your dentist catch oral cancer even before you do. If you have one or more of the risk factors for oral cancer, inform your dentist and ask for an oral cancer screening.

During this procedure, your dentist can check for tumors, lesions, and patches that may cause concern. If needed, the dentist will order additional tests to investigate the possibility of cancer.

Remember, 90% of oral cancer has spread before it’s detected, so don’t be afraid to mention your concerns to your dentist. Though there is no available data on oral cancer screenings saving lives, awareness is important.

You can also perform self-exams at own, though they are never a substitute for a medical professional’s work. Use a light to examine for patches on the gums and roof and sides of the mouth. Don’t forget to use clean hands to check under the tongue.

If you have a suspicious lump, sore spot, or patch for more than two weeks, investigate and book a dental appointment.

Support for Living with Oral Cancer

There are support groups available to connect with fellow patients and receive encouragement and strength that comes with community. This can be particularly important as it’s been established that anxiety and depression are common conditions for those fighting oral cancer.

SPOHNC is a nonprofit with over 125 groups around the country for those with oral, head, or neck cancer. Click here to find a group.

Can’t get out of the house? The Mouth Cancer Foundation hosts this online chat board that’s been providing support since 2003.

Finally, be sure to loop in people close to you as you deal with your diagnosis. Bringing them to appointments can help you remember information and quell fear, and the emotional and social support is important to your general health.


Q: What is the survival (mortality) rate of mouth cancer?

A: The stage at which oral cancer is caught is a major determinant in mortality rates, though the overall five-year survival rate is 65% in the United States. For those who catch it in stage one or two, with no cancer spreading to lymph nodes or other tissue, the five year survival rates jump to an encouraging 84%.

Unfortunately, once it has spread in stages three or four, that figure drops to 39%.

Q: How fast does oral cancer spread?

A: No two cases have the exact same pattern, but oral cancer can spread as far as the heart, spine, and kidneys. Since most oral cancer cases aren’t detected until they’ve moved beyond the mouth, it’s important to visit a dentist if you notice any potential signs.

Key Takeaways: Oral Cancer

  • Oral cancer is caused when cells begin to multiply and form lesions and tumors anywhere in the oral cavity. These can affect lips, tonsils, gums, the mouth’s lining, and the floor or roof of the mouth.
  • Symptoms of oral cancer include any of the following that lasts more than two weeks: ear, mouth, or swallowing pains, lip and mouth sores, discolored patches, unexplained loose teeth, and sore throat.
  • Oral cancer severity is gauged by the classic four stage system, but most cases of oral cancer aren’t caught until later stages.
  • Treatment for oral cancer is usually traditional methods like surgery, radiation, and chemotherapy. However, lifestyle changes and maintaining good oral hygiene can also help treatment outcomes.
  • Heavy drinking, tobacco use, sun exposure, and HPV are the greatest risk factors for lip and mouth cancer. Avoiding these can prevent the incidence of this disease.
  • If the above risk factors apply to you, it’s important to maintain twice yearly dental visits and discuss an oral cancer screening with your dentist.
  • A rich network of support and rehabilitation is available for patients conquering oral cancer.

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