At Boston Medical Center, the care of patients with oral cancer is a collaborative, multidisciplinary process. Organizing services around each patient, BMC providers bring together the expertise of diverse specialists and manage their patient's care from the first consultation and diagnosis through treatment and follow-up visits all in one location.
What is oral cancer?
Oral cancer starts in the mouth, also called the oral cavity. The oral cavity includes the lips, the inside lining of the lips and cheeks, the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth, and the roof of the mouth. There are several types of cancer that can start in the mouth including: squamous cell carcinoma, slow-growing verrucous carcinoma, salivary gland carcinoma, and lymphomas of the tonsils and base of tongue. Oral cancers are part of a group of cancers commonly referred to as head and neck cancers, and of all head and neck cancers they comprise are about 85% of that category.
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What are the symptoms of oral cancer?
It is important that you are screened annually for oral cancer; this is usually done by your dentist. If you notice any changes in your mouth or throat between examinations you should contact your dentist or physician. If you notice any of the following you should contact your physician or dentist immediately:
- Difficulty chewing or swallowing
- A white or red patch anywhere in the mouth
- A sore or lesion within the mouth that does not heal within two weeks
- Trouble moving the tongue or jaw
- Numbness in or around the mouth or jaw
- Chronic hoarseness
- Change in how dentures fit
What causes oral cancer?
Oral and pharyngeal cancer continues to pose a significant public health problem. Traditionally, head and neck cancer was considered a disease of older men who abused tobacco and alcohol. Recent studies have implicated the Human Papilloma Virus (HPV) as an inciting factor in some people with oropharyngeal cancer, particularly those people under 45 years of age.
A small percentage of people do get oral cancers from no currently identified cause. It is currently believed that these are likely related to a genetic predisposition.
How is oral cancer diagnosed?
From your first visit to BMC, you will receive highly coordinated, multidisciplinary care that is managed by a BMC Oral and Maxillofacial surgeon -- a doctor who specializes in treating tumors and cancers of the oral cavity and the head and neck area.
Your surgeon will most likely order testing to confirm the diagnosis of oral cancer. These tests may include: Computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). The surgeon may also order a combined PET CT test. All of these tests are important to help the surgeon come up with a diagnosis and a way to stage your cancer. Staging assesses the degree of local infiltration, involvement of regional lymph nodes, and the presence of distant metastases or second primary tumors.
The surgeon may also perform a fine needle aspiration (FNA) to make a tissue diagnosis.
Computed Tomography (CT) Scan
CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut. Doctors order CT scans when they want to see a two-dimensional image of the body to look for tumors and examine lymph nodes and bone abnormalities. If contrast dye is used to improve the computer image, the patient may need to avoid eating or drinking for 4 to 6 hours before the test. Patients should tell their provider before the test if they have any allergies or kidney problems.
Magnetic Resonance Imaging (MRI)
This test uses a magnetic field, radiofrequency pulses, and a computer to produce detailed images of body structures in multiple places. You may be asked to drink a contrast solution for better imaging, and you will most likely lie on a moving table as pictures are taken. MRI is a more detailed tool than x-ray and ultrasound and for certain organs or areas of the body, it provides better images than CT. MRI may not be recommended if you have a pacemaker or other metal implant.
Positron Emission Tomography (PET) scan
A PET scan is used to detect cellular reactions to sugar. Abnormal cells tend to react and "light up" on the scan, thus helping physicians diagnose a variety of conditions. For the PET scan, a harmless chemical, called a radiotracer, is injected into your blood stream. Once it has had time to move through your body, you will lie on a table while a scanner follows the radiotracer and sends three-dimensional images to a computer screen. Patients are generally asked to wear comfortable clothing and refrain from eating for 4 hours before the scan. Tell your doctor if you are pregnant or breastfeeding. Patients with diabetes should discuss diet guidelines with their physician for the hours leading up to the scan.
Any suspicious mass of tissue or tumor is subject to a biopsy, or removal of cells from the mass. This is the only technique that can confirm the presence of cancer cells. The doctor will use a general or local anesthetic depending on the location of the mass, and then remove a sample of tissue to send to the lab. The sample is sent to a pathologist, a physician who is an expert at identifying diseased cells in tissue samples. Very often, a few stiches are used to help the area heal, and tenderness is felt for a short period of time.
Fine Needle Aspiration (FNA) Biopsy
FNA uses a thin, hollow needle (thinner than the needles used to draw blood) to draw out fluid or tissue from a lump. Depending on the size and location of the lump, the needle is sometimes directed into the lump simply by feeling it. Other times it may be guided into the lump with the assistance of an ultrasound. FNAs are rarely painful and don’t tend to leave scars. Although FNA is the easiest type of biopsy to have, it doesn’t always provide a clear result.
If you have a suspected or confirmed diagnosis of oral cancer, your physicians will use a variety of diagnostic procedures to stage the disease and to determine its severity and spread.
How is oral cancer treated?
At BMC, your cancer care is integrated at all levels including diagnosis, treatment and supplementary therapy. Specialists from medical oncology, radiation oncology, otolaryngology, dentistry, speech/language pathology, and other medical disciplines combine their expertise to provide you with an integrated, individualized treatment plan.
With their depth and range of expertise, our specialists apply a wide array of state-of-the-art techniques to cure patients by removing and killing cancerous tissue. Your plan may include surgery, radiation, chemotherapy, or a combination of these treatments.
Surgery remains the primary method of treatment for cancers of the oral cavity. Our surgeons also use the most advanced techniques; some offered nowhere else in the region. Surgery includes removal of the cancerous tissue, lymph node sampling, and complex reconstruction.
Reconstruction of the lips, tongue, and floor of mouth is frequently performed with microvascular free tissue transfer. This technique optimizes quality of life by restoring function in the shortest time frame by "transplanting" the patient's own tissues. These reconstructive surgeries are complex and labor intensive and require the use of an operating microscope to connect blood vessels in transposed tissues.
Cancer Survivorship Program
A diagnosis of cancer can be a life-altering experience. The BMC Cancer Support Services Program provides a comprehensive set of services to help patients focus their energy on combating and coping with their disease. Designed to improve long-term outcomes and survivorship, these services address a range of medical, social, economic, and emotional needs.
At BMC, we understand that cancer affects patients and families in many ways. We are here to support you during all aspects of care—from diagnosis through treatment and recovery. We offer a comprehensive array of support groups, workshops, lectures, and activities designed with you in mind.
The Head and Neck Cancer Support Group meets monthly in the Moakley building and the schedule and location can be found in our Cancer Support Newsletter.