Oral Cancer

What it is

Overview

Oral cancer encompasses malignancies of the lips, tongue, floor of the mouth, hard palate, and gingiva (gums). It is most commonly squamous cell carcinoma. Oral cancer is highly curable when detected early, but approximately 60% of cases are diagnosed at a late stage — contributing to a five-year survival rate of only about 67%. HPV-negative oral cavity cancers carry a worse prognosis than HPV-related oropharyngeal cancers.

Biology

How It Develops

Repeated carcinogen exposure (tobacco, alcohol, betel nut) causes cumulative DNA mutations in oral mucosal epithelium. TP53 mutations and CDKN2A deletions are early events. Chronic inflammation promotes progression from oral leukoplakia or erythroplakia (precancerous lesions) to invasive carcinoma. HPV drives a subset of oral cancers — particularly those at the tongue base.

Warning signs

Symptoms

• —A sore or ulcer in the mouth that doesn't heal in 2–3 weeks
• —Red or white patches in the mouth
• —Persistent pain in the mouth or ear
• —Difficulty swallowing or moving the jaw/tongue
• —Unexplained tooth loss or poorly fitting dentures
• —Lump or thickening in the cheek

Detection

Diagnosis Methods

• —Oral examination and palpation
• —Biopsy (incisional or punch)
• —CT, MRI, and PET for staging
• —HPV and p16 testing
• —Panendoscopy to rule out second primary tumors

Medical care

Treatment Options

• —Surgery (wide local excision ± neck dissection)
• —Radiation therapy
• —Concurrent cisplatin-based chemoradiation (for advanced disease)
• —Targeted therapy (cetuximab)
• —Immunotherapy (pembrolizumab, nivolumab for recurrent/metastatic)

Data

Statistics

Prevention

Risk Factors

• —Tobacco use (cigarettes, cigars, smokeless tobacco)
• —Heavy alcohol consumption
• —HPV infection (HPV-16)
• —Betel nut chewing
• —Sun exposure (lip cancer)
• —Poor oral hygiene

Further reading

Resources