Oral cancer: Are you at risk for this growing cancer?

If someone asked you about the most common types of cancer, oral cancer probably wouldn’t be at the top of your list. While this type of cancer isn’t as common as breast, lung or prostate cancers, it isn’t rare either. Nearly 500,000 people will be diagnosed with oral cavity or oropharynx cancer this year, including almost 55,000 people in the United States alone. 

What’s even more is that doctors have seen an increase in oral cancer—particularly oropharynx (throat) cancer—in recent years. And many people aren’t aware that they could be at risk. Here’s what you need to know.

Oral cancer types

Understanding your risk for oral cancer starts with understanding the types of oral cancer and their causes. The term oral cancer includes cancer in both the oral cavity and the oropharynx.

• Oral cavity: Doctors typically refer to the mouth (the tongue, the cheeks, the lips, etc.) as the oral cavity.
• Oropharynx: The part of the throat located behind the oral cavity (where the tonsils and the back of the tongue are located) is called the oropharynx. 

“That may seem like picky semantics, but it’s actually a really important distinction,” said Jerry Barker, MD, a radiation oncologist on the medical staff at Baylor Scott & White All Saints Medical Center – Fort Worth. “Oral cavity and oropharynx cancers can have different causes.”

Causes and risk factors

In general, smoking and human papillomavirus (HPV) infection are the most common risk factors for oral cancer. It’s also important to note that more than twice as many men versus women develop these cancers. 

Most oral cavity (mouth) cancers occur in smokers. Because the rates of smoking are decreasing, oral cavity cancer cases are decreasing also. From the 1990s until today, oral cavity cancers have decreased by more than 50%.

However, most oropharynx (throat) cancers are related to previous HPV infection. It’s these HPV-related cancers that are fueling the increases in oral cancer overall. From the 1990s until today, oropharynx cancers have increased in frequency by more than 250%, and they are expected to continue to grow.

“There’s been a silent epidemic of HPV across the world over the last several decades,” Dr. Barker said. “Most people worldwide are infected with HPV—through sexual activity or oral sexual activity—by the time they are in their teens or 20s. And some of these people will develop cancers later in their life because of that infection.”

Other factors, such as secondhand smoke, pollution and chronic mouth irritation, may contribute to the risk of oral cancer too. It’s also possible for someone who doesn’t have any risk factors to develop this type of cancer.  

Protecting yourself from oral cancer

The two most important steps you can take to protect yourself from oral cancer are to stop smoking and get the HPV vaccine.

If you have never smoked, you’ve already reduced your chances of developing oral cancer. But if you do smoke, quitting now can significantly reduce your risk. Even more, both nonsmokers and former smokers are more likely to be cured if they are diagnosed with oral cancer.

Preteens, teens and adults up to age 45 are eligible for the HPV vaccine, which is typically given over two to three doses. This vaccine reduces the risk of ever developing cancer from HPV.

“These vaccines have been shown to be safe and really effective at reducing the risk for oropharynx cancer and several other cancers that HPV infection can lead to,” Dr. Barker said.

Know the oral cancer warning signs

While every case of oral cancer can’t be prevented, this type of cancer can be found early by listening to your body and knowing the signs.  

If you have any of the following symptoms that aren’t going away, it’s time to see your doctor:

• Sore in the mouth or throat
• Painful swallowing
• Spitting up or coughing up blood
• A change in your voice
• A new lump in the neck

“A great general principle is that any sore in the mouth or lump in the neck that isn’t going away after a week or so—it may not be cancer—but it does deserve to be evaluated by a doctor,” Dr. Barker said. “It’s easy for us to make sure the problem isn’t cancer.”

In addition to watching out for warning signs, it’s possible to find oral cancer before it causes any symptoms at all through screening. At-risk smokers or former smokers, and even nonsmokers, can attend a community screening or have a doctor or dentist examine their mouth and throat to look for signs of very early oral cancer. 

Why early diagnosis makes a difference

When you find oral cancer early, you have effective treatments available to care for you. Today, if oral cancers are found early, the cure rate is approximately 85%. For most mouth cancers, surgery to remove the cancer is the first step, and that may be the only treatment needed. If your oral cancer is more advanced or aggressive, you may have radiation therapy or chemotherapy after surgery too. 

For throat cancers, radiation therapy and chemotherapy are often used to try to avoid surgery. Fortunately, only a small group of people with these cancers will ever see their cancer spread to other parts of the body. 

“Survivors of oral cancer can have normal lives and good quality of life,” Dr. Barker said. “And there’s another reason to catch these cancers early: When these cancers are small and treatment is the least, the rest of that patient’s life can be as close to normal as possible.”

Next steps

• At risk because of smoking? Have your doctor or dentist check your mouth for early signs of oral cancer.
• Learn more about oral cancer treatment options.
• Ask your doctor about getting the HPV vaccine, or find a doctor near you.