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Risk factors for floor of mouth cancer

Your chance of getting floor of mouth cancer increases if you:

• Drink alcohol
• Use tobacco
• Have Fanconi anemia, a rare genetic disorder

Historically, oral cavity cancers have been found most often in people over age 45. We¡¯re now seeing an increase in people getting diagnosed with oral cavity cancer in their 20s and 30s, and the disease is often more aggressive. We¡¯re trying to understand why this is happening, but more research is needed.

Floor of mouth cancer symptoms

The most common early-stage symptoms of floor of mouth cancer are lesions in the mouth that are painful, bleeding and/or growing.

Leukoplakia (white patches in the mouth) and erythroplakia (red patches in the mouth) can also be oral dysplasia, which are abnormal cells that can turn into cancer later. The red patches are a little more concerning because they have a higher chance of being cancerous. 

Lesions in the cancer¡¯s early stages are typically confined to the lining of the floor of the mouth. If the lesion grows larger and deeper, it may begin to attach to the tongue, jawbone, or salivary glands under the floor of the mouth.

The anatomy in the mouth is so compact that a small lesion can advance very quickly. This is because, as it grows, it invades nearby structures. This can cause symptoms such as pain or swelling in the jaw or neck.

How floor of mouth cancer is diagnosed

If your doctor suspects cancer, a biopsy will be performed to confirm or rule out cancer.

Once a cancer diagnosis is made, doctors will get imaging of the lesion through a CT scan, MRI and/or ultrasound. This will help them see how big the lesion is and if it¡¯s spread.

We may do a CT scan and an ultrasound to see if there is spread to the lymph nodes. An MRI can tell us if it has spread to muscles, nerves or other nearby soft tissue. This helps us stage the cancer; it can also guide treatment.

See a doctor for any suspicious bumps

People often mistake a bump or mass in the mouth in the floor of the mouth as an abscess or infection. But those will heal. A cancerous lesion will not.

Sometimes a dentist will see a suspicious lesion or mass during a dental exam and refer you to a doctor.

Lesions in your mouth can be tricky because they can change over time. For example, your doctor could biopsy a lesion that came back benign, and three months later, it¡¯s cancerous. It doesn¡¯t necessarily mean your doctor missed the cancer; it could have started as a precancerous lesion.

It¡¯s important to see your doctor as soon as you notice any suspicious lesions in the mouth. MD Anderson has premalignancy and dysplasia clinics specifically to monitor patients with these precancerous lesions. This helps us catch cancer earlier, when it¡¯s easier to treat.

Floor of mouth cancer treatment

Surgery is typically used to treat early-stage floor of mouth cancer. In most cases, floor of mouth cancer is curable and can be removed with surgery when it¡¯s caught early.

Surgeries can become more complex for advanced stage cancers in which the lesions are larger and may grow into the jawbone. Plastic surgeons may assist with treating bigger lesions that require reconstructive surgery.

Sometimes, immunotherapy and/or chemotherapy may be used before surgery to shrink the tumor. In some cases, a combination of immunotherapy, chemotherapy and/or radiation therapy may be used after surgery to help prevent recurrence.

Our priority is getting rid of the cancer. And we want to do so in a way that allows you to retain as much function as possible. At MD Anderson, we have clinicians who can help you with speaking, swallowing or other functions affected by treatment.

Floor of mouth cancers can recur. So, we have an active surveillance program that closely monitors patients long-term. If the cancer does come back, we¡¯re able to catch it right away and treat it.    

Advances in early-stage floor of mouth cancer treatment

Research shows that 20% to 30% of patients diagnosed with early-stage oral cavity cancer will already have disease that has spread to their lymph nodes. Because of that, the standard of care for these patients has been elective neck dissections in which we remove all the lymph nodes in the neck.

What¡¯s challenging about floor of mouth cancer is if a lesion is close to the center of the floor of the mouth, it could spread to the left or right side of the neck. If we do an elective neck dissection and remove lymph nodes on both sides of the neck, that can have a lot of cosmetic and potential functional side effects for patients.

At MD Anderson, we¡¯re using sentinel lymph node biopsies more as part of early-stage oral cavity cancer treatment. Sentinel lymph nodes are the first nodes to which cancer is likely to spread.

During a sentinel lymph node biopsy, we use a radiotracer to see which lymph nodes are draining from the tumor first. Then we remove the lymph node, and a pathologist examines it to see if it¡¯s cancerous. If it is, your doctor will remove other lymph nodes that could be cancerous.

I¡¯m leading a clinical trial to see if sentinel lymph node biopsy is as effective as elective neck dissection for early-stage oral cavity cancer patients. This could mean the difference between doing a bilateral neck dissection where we remove 20 or 30 lymph nodes on both sides of the neck or potentially taking 2 or 3 lymph nodes from each side. If effective, this could reduce a patient¡¯s side effects and prevent them from needing more invasive surgery. 

We¡¯re doing a lot of research on side effects and recovery from floor of mouth cancer and its treatment. We want to treat the cancer effectively and help people maintain function and a good quality of life.

Prevention

While you can¡¯t prevent floor of mouth cancer, there are some things you can do to reduce your risk of developing it. They include:

• Avoid alcohol. For cancer prevention, it¡¯s best not to drink alcohol. If you do choose to drink, be aware of the risks, aim to drink less often and have fewer drinks.
• Don¡¯t use tobacco products. If you smoke or use tobacco, stop. There are resources to help you quit.
• Practice good oral hygiene. This includes brushing your teeth and flossing at least once a day.
• Get regular dental exams. During routine cleanings, your dentist can look for anything concerning in your oral cavity and refer you to a specialist for further examination if needed.

Living a healthy lifestyle and paying attention to changes in your mouth means you¡¯re doing your part to lower your chance for floor of mouth cancer.

, is a head and neck surgeon specializing in oral cavity cancer.

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