Lip and Oral Cavity Cancer Treatment (PDQ®): Treatment - Patient Information [NCI]
General Information About Lip and Oral Cavity Cancer
Lip and oral cavity cancer is a disease that starts in lips or mouth.
The oral cavity refers to the mouth. It includes:
- 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 lining the inside of the lips and oral cavity. Cancers that start in squamous cells 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 lip and oral cavity cancer.
Lip and oral cavity cancer is caused by certain changes to the way lip and oral cavity cells function, especially how they grow and divide into new cells. There are many risk factors for lip and oral cavity cancer, but many do not directly cause cancer. Instead, they increase the chance of DNA damage in cells that may lead to lip and oral cavity cancer. Learn more about how cancer develops at What Is Cancer?
A risk factor is anything that increases the chance of getting a disease. Some risk factors for lip and oral cavity cancer, such as tobacco and alcohol use, can be changed. However, risk factors also include things people cannot change, like their genetics. Learning about risk factors for lip and oral cavity cancer can help you make changes that might lower your risk of getting it.
Risk factors for lip and oral cavity cancer include:
- 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
Learn more about Tobacco, including help with quitting.
Having one or more of these risk factors does not mean that you will get lip and oral cavity cancer. Many people with risk factors never develop lip and oral cavity cancer, while others with no known risk factors do. Talk with your doctor if you think you may be at risk.
Signs of lip and oral cavity cancer include a sore or lump on the lips or in the mouth.
These and other signs and symptoms may be caused by lip and oral cavity cancer or by other conditions. Check with your doctor if you have any of the following:
- 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, 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 diagnose and stage lip and oral cavity cancer.
If you have symptoms that suggest lip and oral cavity cancer, your doctor will need to find out if these are due to cancer or another problem. They will ask when the symptoms started and how often you have been having them. They will also ask about your personal and family health history and do a physical exam. Based on these results, the doctor may recommend other tests. If you are diagnosed with lip and oral cavity cancer, the results of these tests will help you and your doctor plan treatment.
The following tests and procedures are used to diagnose and stage lip and oral cavity cancer:
- Physical exam of the lips and oral cavity is an exam to check the lips and oral cavity for abnormal areas. The medical 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 is 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.
- Biopsy is 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.
- Exfoliative cytology is 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.
- MRI (magnetic resonance imaging) 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).
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CT scan (CAT scan) uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. 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.
Computed tomography (CT) scan of the head and neck. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck. - Barium swallow is 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) uses a small amount of radioactive sugar (also called glucose) that is injected into a vein. Then a scanner rotates around the body to make detailed, computerized pictures of areas inside the body where the glucose is taken up. Because cancer cells often take up more glucose than normal cells, the pictures can be used to find cancer cells in the body.
- Bone scan is a procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
Some people decide to get a second opinion.
You may want to get a second opinion to confirm your cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes or another treatment approach, or provide more information about your cancer.
To learn more about choosing a doctor and getting a second opinion, see Finding Cancer Care. You can contact NCI's Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion. For questions you might want to ask at your appointments, see Questions to Ask Your Doctor About Cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis depends on:
- the cancer stage
- 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 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 website.
Stages of Lip and Oral Cavity Cancer
Cancer stage describes the extent of cancer in the body.
Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. Knowing the cancer stage helps plan treatment.
There are several staging systems for cancer that describe the extent of the cancer. Lip and oral cavity cancer staging usually uses the TNM staging system. The cancer may be described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to the cancer. When talking to you about your diagnosis, your doctor may describe the cancer as one of these stages.
Learn more about Cancer Staging.
The following stages are used for lip and oral cavity cancer:
Stage 0 (carcinoma in situ)
In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).
Stage I (also called stage 1) lip and oral cavity cancer
In stage I, cancer has formed. The tumor is 2 centimeters or smaller and the deepest point of tumor invasion is 5 millimeters or less.
Tumor sizes are often measured in millimeters (mm) or centimeters. Common items that can be used to show tumor size in mm include: a sharp pencil point (1 mm), a new crayon point (2 mm), a pencil-top eraser (5 mm), a pea (10 mm), a peanut (20 mm), and a lime (50 mm).
Stage II (also called stage 2) lip and oral cavity cancer
In stage II, the tumor:
- is 2 centimeters or smaller and the deepest point of tumor invasion is greater than 5 millimeters; or
- is larger than 2 centimeters but not larger than 4 centimeters and the deepest point of tumor invasion is 10 millimeters or less.
Stage III (also called stage 3) lip and oral cavity cancer
In stage III, the tumor:
- is larger than 2 centimeters but not larger than 4 centimeters and the deepest point of tumor invasion is greater than 10 millimeters; or
- is larger than 4 centimeters and the deepest point of tumor invasion is 10 millimeters or less; or
- has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor.
Stage IV (also called stage 4) lip and oral cavity cancer
Stage IV is divided into stages IVA, IVB, and IVC.
- In stage IVA, the tumor:
- is larger than 4 centimeters and the deepest point of tumor invasion is greater than 10 millimeters; or has spread to the outer surface of the upper or lower jawbone, into the maxillary sinus, or to the skin of the face. The cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor; or
- is any size or cancer has spread to the outer surface of the upper or lower jawbone, into the maxillary sinus, or to the skin of the face. Cancer has spread:
- to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
- to one lymph node that is larger than 3 centimeters but not larger than 6 centimeters, on the same side of the neck as the primary tumor; or
- to multiple lymph nodes that are not larger than 6 centimeters, on the same side of the neck as the primary tumor; or
- to multiple lymph nodes that are not larger than 6 centimeters, on the opposite side of the neck as the primary tumor or on both sides of the neck.
- In stage IVB, the tumor:
- has spread to one lymph node that is larger than 6 centimeters; or
- has spread to one lymph node that is larger than 3 centimeters, on the same side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
- has spread to one lymph node of any size on the opposite side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
- has spread to multiple lymph nodes anywhere in the neck, and cancer has spread through the outside covering of any lymph node into nearby connective tissue; or
- has spread further into the muscles or bones needed for chewing, or to the part of the sphenoid bone behind the upper jaw, and/or to the carotid artery near the base of the skull. Cancer may have also spread to one or more lymph nodes of any size, anywhere in the neck.
- In stage IVC, the tumor:
- has spread beyond the lip or oral cavity to other parts of the body, such as the lung, liver, or bone.
Stage IVC lip and oral cavity cancer is also called metastatic lip and oral cavity cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if lip and oral cavity cancer spreads to the lung, the cancer cells in the lung are actually lip and oral cavity cancer cells. The disease is called metastatic lip and oral cavity cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.
- has spread beyond the lip or oral cavity to other parts of the body, such as the lung, liver, or bone.
Lip and oral cavity cancer can recur (come back) after it has been treated.
Recurrent lip and oral cavity cancer is cancer that has come back after it has been treated. If lip and oral cavity cancer comes back, it may come back in the lip, mouth, or other parts of the body. Tests will help determine where in the body the cancer has returned. The type of treatment that you have for recurrent lip and oral cavity cancer will depend on where it has come back.
Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in the booklet When Cancer Returns.
Treatment Option Overview
There are different types of treatment for people with lip and oral cavity cancer.
Different types of treatments are available for lip and oral cavity cancer. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences. Your plan will include information about your cancer, the goals of treatment, your treatment options and the possible side effects, and the expected length of treatment.
Talking with your cancer care team before treatment begins about what to expect will be helpful. You'll want to learn what you need to do before treatment begins, how you'll feel while going through it, and what kind of help you will need. Learn more at Questions to Ask Your Doctor About Treatment.
People with lip and oral cavity cancer should have their treatment planned by a team of doctors who are expert in treating head and neck cancer.
An oncologist, a doctor who specializes in treating people with cancer, oversees treatment for lip and oral cavity cancer. Because the lips and oral cavity are important for breathing, eating, and talking, you may need special help adjusting to the side effects of the cancer and its treatment. The oncologist may refer you to other health care providers who are experts in treating head and neck cancer and also specialize in other areas of medicine. Other specialists may include:
- head and neck surgeon
- radiation oncologist
- dentist
- speech therapist
- dietitian
- psychologist
- rehabilitation specialist
- plastic surgeon
The following types of treatment are used:
Surgery
Surgery (removing the cancer in an operation) is a common treatment for all stages of lip and oral cavity cancer. Surgery may include:
- Wide local excision is the removal of the cancer and some of the healthy tissue around it. If cancer has spread into bone, surgery may include removal of the involved bone tissue.
- Neck dissection is the removal of lymph nodes and other tissues in the neck. This is done when cancer may have spread from the lip and oral cavity.
- Plastic surgery is an operation that restores or improves the appearance of parts of the body. Dental implants, a skin graft, or other plastic surgery may be needed to repair parts of the mouth, throat, or neck after removal of large tumors.
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Learn more about Surgery to Treat Cancer.
Radiation therapy
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing by damaging their DNA. External and internal radiation therapy are used to treat lip and oral cavity cancer:
- External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
External-beam radiation therapy of the head and neck. A machine is used to aim high-energy radiation at the cancer. The machine can rotate around the patient, delivering radiation from many different angles to provide highly conformal treatment. A mesh mask helps keep the patient's head and neck from moving during treatment. Small ink marks are put on the mask. The ink marks are used to line up the radiation machine in the same position before each treatment. - Internal radiation therapy (also called brachytherapy) uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Radiation therapy may work better in patients who have stopped smoking before beginning treatment. It is also important for patients to have a dental exam before radiation therapy begins so that existing problems can be treated.
Learn more about Radiation Therapy to Treat Cancer and Radiation Therapy Side Effects.
Immunotherapy
Immunotherapy helps a person's immune system fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs. Learn more about Biomarker Testing for Cancer Treatment.
Immunotherapy drugs used to treat squamous cell carcinoma of the lip and oral cavity cancer that has come back or spread to other parts of the body include:
- nivolumab
- pembrolizumab
Learn more about Immunotherapy to Treat Cancer.
New types of treatment are being tested in clinical trials.
For some people, joining a clinical trial may be an option. There are different types of clinical trials for people with cancer. For example, a treatment trial tests new treatments or new ways of using existing treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.
You can use the clinical trial search to find NCI-supported cancer clinical trials that are accepting participants. This search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Learn the basics about clinical trials at Clinical Trials Information for Patients and Caregivers.
Follow-up care may be needed.
As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
