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Tumors of the Oral Cavity (mouth and lips)

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Oral cavity anatomy

oral cavity.jpg

The mouth consists of two regions: the vestibule and the oral cavity proper. The vestibule is the area between the teeth, lips and cheeks. The oral cavity is bounded at the sides and in front by the alveolar process (containing the teeth) and at the back by the isthmus of the fauces. Its roof is formed by hard palate at the front, and a soft palate at the back. The uvula projects downwards from the middle of the soft palate at its back. The floor is formed by the mylohyoid muscles and is occupied mainly by the tongue. A mucous membrane – the oral mucosa, lines the sides and under surface of the tongue to the gums, lining the inner aspect of the jaw (mandible). It receives the saliva from the submandibular and sublingual salivary glands. From a cancer staging standpoint, mouth and the lips, even the skin covering the lips, is considered part of the oral cavity.

evaluation of oral tumors

Evaluation of a growth or problem in the mouth is typically started with a history and physical examination by a head and neck surgeon, an oral surgeon, a dentist, or another physician. In a head and neck surgeon’s office, the examination involves inspection of all oral surfaces, checking the neck for enlarged lymph nodes, and using a scope to check the back of the tongue and the remainder of the throat. Visual inspection can identify these and also other lesions that are more dangerous looking. A small biopsy of a suspicious are can typically be performed in the clinic and sent for pathological diagnosis. If an enlarged neck lymph node is identified, it too may be biopsied with a needle. Imaging such as CT scan may follow. The pathology report(s) indicate whether the area is cancer and if so, what type of cancer.

types of oral cavity tumors

Commonly, a swelling in the mouth is not a tumor at all, instead proving to be an area of irritation, infection, or blocked saliva gland. A benign condition called tori  (torus mandibularis on the lower jaw and torus palatini on the roof of the mouth) in which bone slowly gets larger in this area rarely causes a problem. White patches of the surface of the mouth, if not a fungal infection called thrush, are considered pre-cancerous lesions (called leukoplakia), have about a 2% chance of becoming cancer, and usually undergo observation. Red patches of oral lining are more suspicious and can range from erythroplakia (which is not cancerous, but has 15-50% chance of becoming cancer). These are often biopsied to have a definitive diagnosis. Of cancers, the most common type is squamous cell carcinoma, which is often (but not always) associated with tobacco use. Adenocarcinoma, cancer arising from a gland, is the next most common and this category includes mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma, and polymorphous low grade adenocarcinoma. Melanoma can arise from the surface of the mouth. Sarcoma and lymphoma are also identified, although less commonly, in the mouth.  Salivary duct carcinoma and epithelial-myoepithelial carcinoma are much less common types of oral cancer.

surgery for oral cancer

Surgery remains the mainstay for treating oral cancer because it is the treatment type that has the highest success rate and the lowest complication rate. Advanced or high risk cancers, when treated for cure, may also undergo radiation or chemotherapy plus radiation. Surgery for cure consists of removing the entire cancer plus a cuff or margin of normal tissue around the cancer. Because of the many functions and complex anatomy of the oral cavity, this means very different things for different cancers. Removal of part or all of the tongue or floor of mouth differs from removing teeth and jawbone, which also differs from removing a portion of the lips or lining of the cheek. Every oral cancer surgery is customized to the cancer. Reconstruction is often needed for restoring function, including for eating, talking, and for appearance.

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