As the longest running clinic in Louisville, the Multidisciplinary Head and Neck Cancer Clinic at UofL Health - Brown Cancer Center brings together experts to treat cancers of the oral cavity (mouth) with cutting edge techniques and therapies.
Our team includes radiation oncologists, medical oncologists, surgeons, dentists, speech pathologists and nutritionists. These specially trained experts customize your care, including the most advanced therapies with the least impact on your body. Our head and neck cancer doctors don’t just specialize in cancer, they specialize specifically in the treatment of oral cancer.
At Brown Cancer Center, your care for oral cancer is personalized and may include surgery, radiation, chemotherapy or other treatments, such as targeted therapies or immunotherapy. If surgery is part of your treatment, you can count on our nationally recognized surgeons who use some of the latest, least-invasive techniques.
Oral cancer and its treatment can affect talking, swallowing, eating and breathing. Our speech pathologists, nutritionists and cancer rehab physicians are involved in your care from the very beginning to minimize the long-term effects of treatment and promote strength and well-being during treatment.
At Brown Cancer Center we treat all of you, not just your cancer.
Anything that increases your chance of getting cancer is a risk factor. The main risk factors for oral cancer are:
Tobacco use: Many people with oral cancer use or have previously used tobacco in some form. The risk increases with the length of the habit and the amount of tobacco used. For example, pipe smoking increases the risk for cancer of the lip and the soft palate. People who use chewing tobacco or snuff are more likely to develop cancer of the gums, cheek and lips. Living with a smoker or working in a smoking environment can cause secondhand or passive smoking, which also may increase risk.
Alcohol: Some people with oral cancer are heavy drinkers, consuming more than 21 alcoholic drinks each week. People who drink alcohol and smoke are six times as likely to get oral cancer as people who do not drink. The combination of tobacco and alcohol is particularly dangerous.
Other risk factors include:
- Gender: About two thirds of people with oral cancer are men.
- Race: The risk of oral cancer is higher for African-Americans.
- Age: These cancers are found most often in people over 45.
- Prolonged sun exposure (lip cancer)
- Long-term irritation caused by ill-fitting dentures
- Immunosuppressive drugs
- Infection with human papillomavirus (HPV)
- Previous head and neck cancer
- Radiation exposure
- Lichen planus, a disease that affects the cells that line the mouth
- Drinking maté, a beverage made from a type of holly tree common in South America
- Chewing quids of betel, a stimulant common in Asia
Not everyone with risk factors gets oral cancer. Oral cancers do not typically run in families, unless family members share some of the same risk factors for oral cancer.
Cancers of the mouth are among the most preventable cancers. One important thing you can do is visit a dentist once a year for a complete oral examination.
To minimize your risk of developing oral cancer:
- Avoid tobacco in all forms
- Drink alcohol in moderation, if at all
- Remove your dentures at night and clean them daily
- Have dentures evaluated by a dentist at least every five years
- Limit sun exposure; wear a lip balm with sunscreen and a hat with a brim
Symptoms of oral cancer vary from person to person. Often, symptoms may be caused by other problems that are not dangerous; however, since early detection is important for successful treatment of oral cancer see your doctor or dentist if you notice abnormal areas in your mouth. These may include the following:
- Sore in the mouth or throat that doesn't heal
- White spot in the mouth
- Red spot in the mouth, especially one that bleeds when scraped
- Loose teeth
- Lump or thickening in the neck, face, jaw, cheek, tongue or gums
- Dentures that cause discomfort or do not fit well
- Difficulty chewing, swallowing or moving the tongue or jaw
- Persistent bad breath
- Unexplained weight loss
If you have symptoms that may indicate cancer your dentist or doctor will examine the inside of your mouth and the lymph nodes in your neck. If your doctor suspects you may have oral cancer, he or she will recommend a biopsy of the suspicious lesion.
A biopsy may be done in the office if the suspicious lesion is easily accessible. If not, your doctor may recommend that the biopsy be done in an operating room under general anesthesia or by using an imaging test (such as CT or MRI) to locate the lesion, then insert a small needle into the area to remove some of the cells. A pathologist will then examine some of these cells under a microscope to determine if they are cancerous.
Your doctor may also order additional imaging tests (such as CT, MRI or PET scan) to see if your cancer has spread and determine the stage of your cancer.
Common cancer treatments include chemotherapy, targeted therapy, radiation treatment and surgery. Doctors select a treatment plan based on your diagnosis and disease stage.
Your care is followed closely by a team of health care professionals, led by doctors who specialize in treating oral cancers. Other members of your team may include:
- Head and neck surgeons, medical oncologists and radiation oncologists
- Plastic and reconstructive surgeons
- Speech pathologists
- Speech, occupational and physical therapists
- Cancer rehabilitation doctors
Surgery is the most frequent treatment for oral cancer. The type of surgery depends on the type and stage of the tumor. Surgical techniques to treat oral cancer and deal with the side effects of treatment include:
- Removal of the tumor or a larger area to remove the tumor and surrounding healthy tissue
- Removal of part or all of the jaw
- Maxillectomy (removal of bone in the roof of the mouth)
- Removal of lymph nodes and other tissue in the neck
- Plastic surgery, including skin grafts, tissue flaps or dental implants to restore tissues removed from the mouth or neck
- Tracheotomy, or placing a hole in the windpipe, to assist in breathing for patients with large tumors or after surgical removal of the tumor
- Dental surgery to remove teeth or assist with reconstruction
In cancer of the mouth, radiation therapy may be used alone to treat small or early-stage tumors. More often, radiation therapy is used after surgery, either alone or with chemotherapy for more advanced tumors. The method of radiation treatment used depends on the type and stage of cancer.
External-beam radiation therapy is the most frequently used method to deliver radiation therapy to the mouth. Intensity-modulated radiotherapy (IMRT) is aimed at treating the tumor while minimizing damage to surrounding normal tissue.
Internal radiation or brachytherapy delivers radiation with tiny seeds, needles or tubes that are implanted into the tumor. It is used sometimes for treating small tumors or with surgery in advanced tumors.
Chemotherapy may be used to shrink the cancer before surgery or radiation, or it may be combined with radiation to increase the effectiveness of both treatments. It also may be used to shrink tumors that cannot be surgically removed.
Tumor growth factors are hormone-like substances that occur naturally in the body and cause cell growth. Drugs that bind these substances or their partners on the cancer cell surface can inhibit tumor growth.
Immunotherapy is a type of medication, usually infused into a vein, which helps your own immune system attack the cancer cells and destroy them.