Oral cancer and throat cancer account for about 3 percent of all new cancers in the United States — about 54,000 new cases each year. (1)

Oral cancer occurs in the tongue, lips, and floor of the mouth, but it can also begin in the gums, minor salivary glands, lining of the lips and cheeks, and roof of the mouth. (2)

Oral cancer is most commonly found in squamous cells, the thin, flat cells that line the inside of the mouth and throat, including the lips and oral cavity. (3)

If diagnosed early, the five-year survival rate for oral cancer is 86 percent, compared to 40 percent if it’s caught at a more advanced stage. (1)

Oropharyngeal cancer might sound similar, but oral and oropharyngeal cancer are two different types of cancer with unique risk factors. Oropharyngeal cancer affects the throat region past the mouth, which includes the soft palate, walls of the throat, tonsils, and back third of the tongue. Unlike oral cancer, which has its own unique risk factors, the majority of oropharyngeal cancer — approximately 60 to 70 percent of cases — is caused by human papillomavirus. (4)

• Tobacco Many people diagnosed with oral cancer use or have previously used tobacco in some form. The longer people use tobacco and the more they use it, the higher their risk. The type of tobacco matters, too. People who use chewing tobacco, for example, are more likely to develop gum, cheek, or lip cancer. Pipe smokers have an increased risk of developing cancer in the lips or soft palate. And secondhand smoke can put those who don’t use tobacco at risk. (2)
• Alcohol and Smoking “Alcohol by itself is not an independent risk factor, meaning that we think if you drink heavily but don’t smoke, you’re probably not at an increased risk,” says Brian Schmidt, MD, DDS, director of New York University’s Oral Cancer Center in New York City. “But if you smoke and drink, you’re at a very much higher risk.” (2)
• Gender About two-thirds of people diagnosed with oral cancer are men. (2) The gender difference could be attributed to the historic trend of men using tobacco and alcohol more frequently than women, according to a 2016 study. (5)
• Age The risk of oral cancer becomes more intense after age 50 and peaks between 60 and 70. While the average age of diagnosis is 62, oral cancer can still occur in young people. A little more than a quarter of cases occur in people younger than 55, but it’s very rare in children. (6)
• Geography Oral cancer is about as equally common in Black and white Americans, but oral cancer rates significantly fluctuate between countries. (5,6) For example, oral cancer is much less common in countries like Mexico and Japan, compared to the United States, but much more common in countries like Hungary and France. (5) One possible reason is the variance in tobacco consumption between countries. It’s the most common type of cancer in South Asian countries, such as India, Sri Lanka, Pakistan, and Bangladesh. (5)
• Nutrition A diet high in fruits and vegetables is linked to a decreased risk of oral cancer, which may be attributed to the high levels of vitamin A, vitamin C, folic acid, flavonoids, and other antioxidants, according to a 2017 study. The Mediterranean diet appears to be associated with a reduced risk of oral and oropharyngeal cancer. (7)

Sun exposure, immunosuppressive drugs, genetic disorders, radiation exposure, a previous head and neck cancer, drinking maté (a beverage made from a type of holly tree in South America), and using betel (a chewing stimulant common in Asia) can increase the risk as well. It is unclear, at this point, whether vaping increases the risk of oral cancer. (2)

Among the common signs and symptoms of oral cancer are:

• A mouth sore that does not heal
• Mouth pain
• White or red patches that appear on the gums, tongue, tonsils, or inner lining of the mouth
• Voice changes
• A lump in the neck
• Weight loss
• Bad breath
• Changes to the voice
• Pain in the jaw
• Loose teeth
• A swollen jaw
• Trouble chewing, swallowing, or moving the tongue and jaw (8)

Oral cancer consists of five stages, 0 through 4. The stage is determined by the size of the tumor, whether it has spread to nearby lymph nodes, and if it has spread to distant sites, such as the lungs.

Stage 0

The cancer is still within the top layer of cells lining the oral cavity. It has not yet grown into deeper layers and has not spread to nearby lymph nodes or distant sites.

Stage 1

The cancer is 2 centimeters (cm) or smaller and is not growing into nearby tissues. It also hasn’t spread to distant sites or lymph nodes.

Stage 2

The cancer is between 2 and 4 cm. It has not grown into nearby tissues, spread to nearby lymph nodes, or spread to distant sites.

Stage 3

In stage 3, two scenarios could occur:

• The cancer hasn’t spread to nearby lymph nodes or to distant sites, but the cancer is larger than 4 cm.
• The cancer is any size and has spread to one lymph node on the same side as the primary tumor. In this case, the cancer has not grown outside of the lymph node, which is no larger than 3 cm, and hasn’t spread to distant sites.

Stage 4

Three scenarios qualify an oral cancer as stage 4. The medical community uses letters to designate them, with A being the least serious and C being the most serious. While stage 4 is the most serious of the four stages and may sound scary, it still does not mean the oral cancer is beyond a cure.

Stage 4A The cancer is any size and growing into nearby structures, which can include nearby bone such as the jawbone, the floor of the mouth, the skin of the chin or nose, deep muscles in the tongue, or the maxillary sinus. The cancer has not spread to nearby lymph nodes, or it has spread to one lymph node smaller than 3 cm on the same side as the main tumor.

Another stage 4A situation is when the cancer is any size and may have grown into nearby structures but has not spread to distant organs. It’s also spread to one of the following:

• One lymph node
• More than one lymph node but is not greater than 6 cm
• One or more lymph nodes on any side but has not grown outside of the nodes and none are larger than 6 cm

Stage 4B The cancer is any size and has grown into nearby soft tissues or structures. It has not spread to distant organs, but any of the following are also occurring:

• The cancer has spread to one lymph node that’s larger than 6 cm.
• It’s spread to one lymph node that’s smaller than 3 cm, but it’s grown outside the lymph node.
• It’s spread to more than one lymph node on any side of the primary cancer and has grown outside the lymph nodes.
• It’s spread to one lymph node on the opposite side of the primary cancer and is smaller than 3 cm, but it has grown outside of the lymph node.

Another stage 4B possibility is that the cancer is any size and growing into nearby structures such as bone. It might not have spread to nearby lymph nodes or distant organs, but it’s known to be very advanced.

Stage 4C The cancer is any size and may have grown into nearby soft tissues or structures, and it may have spread to nearby lymph nodes. It has spread to distant sites such as the lungs. (9)

Oral cancer has long been associated with baseball players because of the tradition of using chewing tobacco while on the field. Tony Gwynn, who spent his 20-year career with the Padres, was inducted into the Baseball Hall of Fame before dying from oral cancer at age 54. (10) Legendary baseball player Babe Ruth also died from cancer in his upper throat. (11)

Celebrities with oral and throat cancer include Michael Douglas, Eddie Van Halen, and George Harrison. (12)

The best treatment for oral cancer will depend on the type of cancer, where the cancer is located, and what stage it is.

Tongue cancer is the most common form of oral cancer in the United States and is at a high risk of spreading to the lymph nodes, according to Penn Medicine. Mouth cancer, which includes any part of the mouth, such as the gums and tongue, is often treated first with surgery. Mouth reconstruction is sometimes necessary after surgery. Radiation therapy, chemotherapy, targeted drug therapy, and immunotherapy may also be used. (13)

Lip cancer, another common form of oral cancer, is treated based on the size, location, and stage of the cancer. Surgery is typically the first treatment option if the cancer is detected early, but it may also be included in late-stage treatment. Radiation therapy, chemotherapy, and targeted drug therapy will be used if necessary. (13)

Radiation therapy has become much more precise in recent years and has been designed to spare healthy tissue and shorten procedure times. External-beam radiation therapy and brachytherapy are the two most common radiation therapies used to treat mouth cancer. (13)

Approximately 90 to 100 percent of the people who receive radiation to the oral cavity will develop some degree of oral complications in either the short or long term, according to a 2014 study. (14)

According to Dr. Schmidt, people with oral cancer greatly benefited from medical advancements in the early 1980s, when surgeons and plastic surgeons started transferring tissue from other regions of the body to rebuild the head and neck, an operation called microvascular tissue transfer.

Still, quality of life may be impacted by the treatment. “Some patients go from eating, drinking, talking, having a normal work and social life to a situation where they can’t go out to dinner, they can’t eat things by mouth, they have to be fed through a stomach tube, they can’t talk, and oftentimes they can’t smell,” says Schmidt. “It can have a drastic impact on quality of life.”

There’s no proven way to prevent mouth cancer, but there are several ways to reduce your risk: (15)

• Avoid tobacco. Tobacco and tobacco combined with alcohol consumption are two of the leading causes of oral cancer.
• Reduce sun exposure. The Mayo Clinic recommends reducing sun exposure to your lips by staying in the shade, wearing a hat, and applying lip products with SPF.
• Visit a dentist regularly. Often, a dentist is the first person to spot oral cancer, since they’re looking at the oral cavity.