The mouth and throat

This booklet is about cancers that occur in the mouth (oral cavity) and the part of the throat at the back of the mouth (oropharynx). The oral cavity and oropharynx have many parts:

• Lips



• Lining of your cheeks



• Salivary glands (glands that make saliva)



• Roof of your mouth (hard palate)



• Back of your mouth (soft palate and uvula)



• Floor of your mouth (area under the tongue)



• Gums and teeth



• Tongue



• Tonsils

Understanding cancer

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

• Benign tumors are not cancer:



• Benign tumors are rarely life-threatening.



• Generally, benign tumors can be removed, and they usually do not grow back.



• Cells from benign tumors do not invade the tissues around them.



• Cells from benign tumors do not spread to other parts of the body.



• Malignant tumors are cancer:



• Malignant tumors are generally more serious than benign tumors. They may be life-threatening.



• Malignant tumors often can be removed, but sometimes they grow back.



• Cells from malignant tumors can invade and damage nearby tissues and organs.



• Cells from malignant tumors can spread to other parts of the body. The cells spread by breaking away from the original cancer (primary tumor) and entering the bloodstream or lymphatic system. They invade other organs, forming new tumors and damaging these organs. The spread of cancer is called metastasis.

Oral cancer

Oral cancer is part of a group of cancers called head and neck cancers. Oral cancer can develop in any part of the oral cavity or oropharynx. Most oral cancers begin in the tongue and in the floor of the mouth. Almost all oral cancers begin in the flat cells (squamous cells) that cover the surfaces of the mouth, tongue, and lips. These cancers are called squamous cell carcinomas.

When oral cancer spreads (metastasizes), it usually travels through the lymphatic system. Cancer cells that enter the lymphatic system are carried along by lymph, a clear, watery fluid. The cancer cells often appear first in nearby lymph nodes in the neck.

Cancer cells can also spread to other parts of the neck, the lungs, and other parts of the body. When this happens, the new tumor has the same kind of abnormal cells as the primary tumor. For example, if oral cancer spreads to the lungs, the cancer cells in the lungs are actually oral cancer cells. The disease is metastatic oral cancer, not lung cancer. It is treated as oral cancer, not lung cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.

Oral cancer: Who's at risk?

Doctors cannot always explain why one person develops oral cancer and another does not. However, we do know that this disease is not contagious. You cannot "catch" oral cancer from another person.

Research has shown that people with certain risk factors are more likely than others to develop oral cancer. A risk factor is anything that increases your chance of developing a disease.

The following are risk factors for oral cancer:

• Tobacco: Tobacco use accounts for most oral cancers. Smoking cigarettes, cigars, or pipes; using chewing tobacco; and dipping snuff are all linked to oral cancer. The use of other tobacco products (such as bidis and kreteks) may also increase the risk of oral cancer. Heavy smokers who use tobacco for a long time are most at risk. The risk is even higher for tobacco users who drink alcohol heavily. In fact, three out of four oral cancers occur in people who use alcohol, tobacco, or both alcohol and tobacco.



• Alcohol: People who drink alcohol are more likely to develop oral cancer than people who don't drink. The risk increases with the amount of alcohol that a person consumes. The risk increases even more if the person both drinks alcohol and uses tobacco.



• Sun: Cancer of the lip can be caused by exposure to the sun. Using a lotion or lip balm that has a sunscreen can reduce the risk. Wearing a hat with a brim can also block the sun's harmful rays. The risk of cancer of the lip increases if the person also smokes.



• A personal history of head and neck cancer: People who have had head and neck cancer are at increased risk of developing another primary head and neck cancer. Smoking increases this risk.

Quitting tobacco reduces the risk of oral cancer. Also, quitting reduces the chance that a person with oral cancer will get a second cancer in the head and neck region. People who stop smoking can also reduce their risk of cancer of the lung, larynx, mouth, pancreas, bladder, and esophagus. There are many resources to help smokers quit: The Cancer Information Service at 1-800-4-CANCER can talk with callers about ways to quit smoking and about groups that offer help to smokers who want to quit. Groups offer counseling in person or by telephone. Also, your doctor or dentist can help you find a local smoking cessation program. Your doctor can tell you about medicine (bupropion) or about nicotine replacement therapy, which comes as a patch, gum, lozenges, nasal spray, or inhaler. The "National Cancer Institute Information Resources" section has information about the Federal Government's smoking cessation Web site, http://www.smokefree.gov.

Some studies suggest that not eating enough fruits and vegetables may increase the chance of getting oral cancer. Scientists also are studying whether infections with certain viruses (such as the human papillomavirus) are linked to oral cancer.

If you think you may be at risk, you should discuss this concern with your doctor or dentist. You may want to ask about an appropriate schedule for checkups. Your health care team will probably tell you that not using tobacco and limiting your use of alcohol are the most important things you can do to prevent oral cancers. Also, if you spend a lot of time in the sun, using a lip balm that contains sunscreen and wearing a hat with a brim will help protect your lips.

What are the symptoms of oral cancer?

Early detection

Your regular checkup is a good time for your dentist or doctor to check your entire mouth for signs of cancer. Regular checkups can detect the early stages of oral cancer or conditions that may lead to oral cancer. Ask your doctor or dentist about checking the tissues in your mouth as part of your routine exam.

Symptoms

Common symptoms of oral cancer include:

• Patches inside your mouth or on your lips that are white, a mixture of red and white, or red



• White patches (leukoplakia) are the most common. White patches sometimes become malignant.



• Mixed red and white patches (erythroleukoplakia) are more likely than white patches to become malignant.



• Red patches (erythroplakia) are brightly colored, smooth areas that often become malignant.



• A sore on your lip or in your mouth that won't heal



• Bleeding in your mouth



• Loose teeth



• Difficulty or pain when swallowing



• Difficulty wearing dentures



• A lump in your neck



• An earache

Anyone with these symptoms should see a doctor or dentist so that any problem can be diagnosed and treated as early as possible. Most often, these symptoms do not mean cancer. An infection or another problem can cause the same symptoms.

Diagnosis of oral cancer

If you have symptoms that suggest oral cancer, the doctor or dentist checks your mouth and throat for red or white patches, lumps, swelling, or other problems. This exam includes looking carefully at the roof of the mouth, back of the throat, and insides of the cheeks and lips. The doctor or dentist also gently pulls out your tongue so it can be checked on the sides and underneath. The floor of your mouth and lymph nodes in your neck also are checked.

If an exam shows an abnormal area, a small sample of tissue may be removed. Removing tissue to look for cancer cells is called a biopsy. Usually, a biopsy is done with local anesthesia. Sometimes, it is done under general anesthesia. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if the abnormal area is cancerous.

If you need a biopsy, you may want to ask the doctor or dentist some of the following questions:

• Why do I need a biopsy?



• How much tissue do you expect to remove?



• How long will it take? Will I be awake? Will it hurt?



• How soon will I know the results?



• Are there any risks? What are the chances of infection or bleeding after the biopsy?



• How should I care for the biopsy site afterward? How long will it take to heal?



• Will I be able to eat and drink normally after the biopsy?



• If I do have cancer, who will talk with me about treatment? When?

Treatment for oral cancer

Staging

If the biopsy shows that cancer is present, your doctor needs to know the stage (extent) of your disease to plan the best treatment. The stage is based on the size of the tumor, whether the cancer has spread and, if so, to what parts of the body.

Staging may require lab tests. It also may involve endoscopy. The doctor uses a thin, lighted tube (endoscope) to check your throat, windpipe, and lungs. The doctor inserts the endoscope through your nose or mouth. Local anesthesia is used to ease your discomfort and prevent you from gagging. Some people also may have a mild sedative. Sometimes the doctor uses general anesthesia to put a person to sleep. This exam may be done in a doctor's office, an outpatient clinic, or a hospital.

The doctor may order one or more imaging tests to learn whether the cancer has spread:

• Dental x-rays: An x-ray of your entire mouth can show whether cancer has spread to the jaw.



• Chest x-rays: Images of your chest and lungs can show whether cancer has spread to these areas.



• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your body. You may receive an injection of dye. Tumors in the mouth, throat, neck, or elsewhere in the body show up on the CT scan.



• MRI: A powerful magnet linked to a computer is used to make detailed pictures of your body. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether oral cancer has spread.

Treatment

Many people with oral cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor -- to take part in the discussion, to take notes, or just to listen.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat oral cancer include oral and maxillofacial surgeons, otolaryngologists (ear, nose, and throat doctors), medical oncologists, radiation oncologists, and plastic surgeons. You may be referred to a team that includes specialists in surgery, radiation therapy, or chemotherapy. Other health care professionals who may work with the specialists as a team include a dentist, speech pathologist, nutritionist, and mental health counselor.

Getting a second opinion

Before starting treatment, you might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if you or your doctor requests it.

There are a number of ways to find a doctor for a second opinion:

• Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.



• The Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers.



• A local or state medical or dental society, a nearby hospital, or a medical or dental school can usually provide the names of specialists in your area.



• The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. The directory is available in most public libraries. Or you can look up doctors at http://www.abms.org. (Click on Who's Certified.)



• The American Dental Association (ADA) Web site provides a list of dentists by specialty and location. The ADA Member Directory is available on the Internet at http://www.ada.org.



• The NCI provides a helpful fact sheet on how to find a doctor called "How To Find a Doctor or Treatment Facility If You Have Cancer." It is available on the Internet at http://cancer.gov/publications.

You may want to ask the doctor these questions before treatment begins: What is the stage of the disease? Has the cancer spread? If so, where? What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment? What are the expected benefits of each kind of treatment? What are the risks and possible side effects of each treatment? How will treatment affect my normal activities? Will I be given anything to control side effects? How long will treatment last? Will I have to stay in the hospital? What is the treatment likely to cost? Is this treatment covered by my insurance plan? Would a clinical trial (research study) be appropriate for me? (See "The Promise of Cancer Research" for more information about clinical trials.) Should I try to quit smoking?

Preparing for treatment

The choice of treatment depends mainly on your general health, where in your mouth or oropharynx the cancer began, the size of the tumor, and whether the cancer has spread. Your doctor can describe your treatment choices and the expected results. You will want to consider how treatment may affect normal activities such as swallowing and talking, and whether it will change the way you look. You and your doctor can work together to develop a treatment plan that meets your needs and personal values.

Methods of treatment

Oral cancer treatment may include surgery, radiation therapy, or chemotherapy. Some patients have a combination of treatments.

At any stage of disease, people with oral cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care. Information about supportive care is available on NCI's Web site at http://cancer.gov and from NCI's Cancer Information Service at 1-800-4-CANCER.

You may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.

Surgery

Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. Patients may have surgery alone or in combination with radiation therapy.

You may want to ask the doctor these questions before having surgery: What kind of operation do you recommend for me? Do I need any lymph nodes removed? Why? How will I feel after the operation? How long will I be in the hospital? What are the risks of surgery? Will I have trouble speaking, swallowing, or eating? Where will the scars be? What will they look like? Will I have any long-term effects? Will I look different? Will I need reconstructive or plastic surgery? When can that be done? Will I lose my teeth? Can they be replaced? How soon? Will I need to see a specialist for help with my speech? When can I get back to my normal activities? How often will I need checkups? Would a clinical trial be appropriate for me?

Radiation therapy

Radiation therapy (also called radiotherapy) is a type of local therapy. It affects cells only in the treated area. Radiation therapy is used alone for small tumors or for patients who cannot have surgery. It may be used before surgery to kill cancer cells and shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area.

Radiation therapy uses high-energy rays to kill cancer cells. Doctors use two types of radiation therapy to treat oral cancer:

• External radiation: The radiation comes from a machine. Patients go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks.



• Internal radiation (implant radiation): The radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes put directly in the tissue. The patient stays in the hospital. The implants remain in place for several days. Usually they are removed before the patient goes home.

Some people with oral cancer have both kinds of radiation therapy.

You may want to ask the doctor these questions before having radiation therapy: Which type of radiation therapy do you recommend for me? Why do I need this treatment? When will the treatments begin? When will they end? Should I see my dentist before I start treatment? If I need dental treatment, how much time does my mouth need to heal before radiation therapy starts? What are the risks and side effects of this treatment? What can I do about them? How will I feel during therapy? What can I do to take care of myself during therapy? How will my mouth and face look afterward? Are there any long-term effects? Can I continue my normal activities? Will I need a special diet? For how long? How often will I need checkups? Would a clinical trial be appropriate for me?

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body.

Chemotherapy is usually given by injection. It may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a hospital stay may be needed.

You may want to ask the doctor these questions before having chemotherapy:

• Why do I need this treatment?



• Which drug or drugs will I have?



• How do the drugs work?



• Should I see my dentist before I start chemotherapy? If I need dental treatment, how much time does my mouth need to heal before the chemotherapy begins?



• What are the expected benefits of the treatment?



• What are the risks and possible side effects of treatment? What can I do about them?



• When will treatment start? When will it end?



• Will I need to stay in the hospital? How long?



• How will treatment affect my normal activities?



• Would a clinical trial be appropriate for me?

Side effects of treatment for oral cancer

Because treatment often damages healthy cells and tissues, unwanted side effects are common. These side effects depend mainly on the location of the tumor and the type and extent of the treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.

The NCI provides helpful booklets about cancer treatments and coping with side effects. Booklets such as Radiation Therapy and You, Chemotherapy and You, and Eating Hints for Cancer Patients may be viewed, downloaded, and ordered from http://cancer.gov/publications. These materials also may be ordered by calling the Cancer Information Service at 1-800-4-CANCER.

The National Institute of Dental and Craniofacial Research (NIDCR) also provides helpful materials. Head and Neck Radiation Treatment and Your Mouth, Chemotherapy and Your Mouth, and other booklets are available from NIDCR. See "National Institute of Dental and Craniofacial Research Information Resources" for a list of publications.

Surgery

It takes time to heal after surgery, and the time needed to recover is different for each person. You may be uncomfortable for the first few days after surgery. However, medicine can usually control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

It is common to feel tired or weak for a while. Also, surgery may cause tissues in your face to swell. This swelling usually goes away within a few weeks. However, removing lymph nodes can result in swelling that lasts a long time.

Surgery to remove a small tumor in the mouth may not cause any lasting problems. For a larger tumor, however, the surgeon may remove part of the palate, tongue, or jaw. This surgery may change your ability to chew, swallow, or talk. Also, your face may look different after surgery. Reconstructive or plastic surgery may be done to rebuild the bones or tissues of the mouth. (See "Reconstruction.")

Radiation therapy

Almost all patients who have radiation therapy to the head and neck area develop oral side effects. That is why it is important to get the mouth in good condition before cancer treatment begins. Seeing a dentist two weeks before cancer treatment begins gives the mouth time to heal after dental work.

The side effects of radiation therapy depend mainly on the amount of radiation given. Some side effects in the mouth go away after radiation treatment ends, while others last a long time. A few side effects (such as dry mouth) may never go away.

Radiation therapy may cause some or all of these side effects:

• Dry mouth: Dry mouth can make it hard for you to eat, talk, and swallow. It can also lead to tooth decay. You may find it helpful to drink lots of water, suck ice chips or sugar-free hard candy, and use a saliva substitute to moisten your mouth.



• Tooth decay: Radiation can cause major tooth decay problems. Good mouth care can help you keep your teeth and gums healthy and can help you feel better.



• Doctors usually suggest that people gently brush their teeth, gums, and tongue with an extra-soft toothbrush and fluoride toothpaste after every meal and before bed. If brushing hurts, you can soften the bristles in warm water.



• Your dentist may suggest that you use fluoride gel before, during, and after radiation treatment.



• It also helps to rinse your mouth several times a day with a solution made from 1/4 teaspoon baking soda and 1/8 teaspoon salt in one cup of warm water. After you rinse with this solution, follow with a plain water rinse.



• Sore throat or mouth: Radiation therapy can cause painful ulcers and inflammation. Your doctor can suggest medicines to help control the pain. Your doctor also may suggest special rinses to numb the throat and mouth to help relieve the soreness. If your pain continues, you can ask your doctor about stronger medicines.



• Sore or bleeding gums: It is important to brush and floss teeth gently. You may want to avoid areas that are sore or bleeding. To protect your gums from damage, it is a good idea to avoid the use of toothpicks.



• Infection: Dry mouth and damage to the lining of the mouth from radiation therapy can cause infection to develop. It helps to check your mouth every day for sores or other changes and to tell your doctor or nurse about any mouth problems.



• Delayed healing after dental care: Radiation treatment may make it hard for tissues in the mouth to heal. It helps to have a thorough dental exam and complete all needed dental treatment well before radiation therapy begins.



• Jaw stiffness: Radiation can affect the chewing muscles and make it difficult for you to open your mouth. You can prevent or reduce jaw stiffness by exercising your jaw muscles. Health care providers often suggest opening and closing the mouth as far as possible (without causing pain) 20 times in a row, 3 times a day.



• Denture problems: Radiation therapy can change the tissues in your mouth so that dentures do not fit anymore. Because of soreness and dry mouth, some people may not be able to wear dentures for as long as one year after radiation therapy. After the tissues heal completely and your mouth is no longer sore, your dentist may need to refit or replace your dentures.



• Changes in the sense of taste and smell: During radiation therapy, food may taste or smell different.



• Changes in voice quality: Your voice may be weak at the end of the day. It may also be affected by changes in the weather. Radiation directed at the neck may cause your larynx to swell, causing voice changes and the feeling of a lump in your throat. Your doctor may suggest medicine to reduce this swelling.



• Changes in the thyroid: Radiation treatment can affect your thyroid (an organ in your neck beneath the voice box). If your thyroid does not make enough thyroid hormone, you may feel tired, gain weight, feel cold, and have dry skin and hair. Your doctor can check the level of thyroid hormone with a blood test. If the level is low, you may need to take thyroid hormone pills.



• Skin changes in the treated area: The skin in the treated area may become red or dry. Good skin care is important at this time. It is helpful to expose this area to the air while protecting it from the sun. Also, avoid wearing clothes that rub the treated area, and do not shave the treated area. You should not use lotions or creams in the treated area without your doctor's advice.



• Fatigue: You may become very tired, especially in the later weeks of radiation therapy. Resting is important, but doctors usually advise their patients to stay as active as they can.

Although the side effects of radiation therapy can be distressing, your doctor can usually treat or control them. It helps to report any problems that you are having so that your doctor can work with you to relieve them.

Chemotherapy

Chemotherapy and radiation therapy can cause some of the same side effects, including painful mouth and gums, dry mouth, infection, and changes in taste. Some anticancer drugs can also cause bleeding in the mouth and a deep pain that feels like a toothache. The problems you have depend on the type and amount of anticancer drugs you receive, and how your body reacts to them. You may have these problems only during treatment or for a short time after treatment ends.

Generally, anticancer drugs affect cells that divide rapidly. In addition to cancer cells, these rapidly dividing cells include the following:

• Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of the body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired.



• Cells in hair roots: Chemotherapy can lead to hair loss. The hair grows back, but sometimes the new hair is somewhat different in color and texture.



• Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Many of these side effects can be controlled with drugs.

Nutrition

Eating well during cancer treatment means getting enough calories and protein to prevent weight loss, regain strength, and rebuild healthy tissues. But eating well may be difficult after treatment for oral cancer. Some people with cancer find it hard to eat because they lose their appetite. They may not feel like eating because they are uncomfortable or tired. A dry or sore mouth or changes in smell and taste also may make eating difficult.

If your mouth is dry, you may find that soft foods moistened with sauces or gravies are easier to eat. Thick soups, puddings, and milkshakes often are easier to swallow. Nurses and dietitians can help you choose the right foods. Also, the National Cancer Institute booklet Eating Hints for Cancer Patients contains many useful ideas and recipes. The "National Cancer Institute Information Resources" section tells how to get this publication.

After surgery or radiation therapy for oral cancer, some people need a feeding tube. A feeding tube is a flexible plastic tube that is passed into the stomach through an incision in the abdomen. In almost all cases, the tube is temporary. Most people gradually return to a regular diet.

To protect your mouth during cancer treatment, it helps to avoid:

• Sharp, crunchy foods like taco chips



• Foods that are hot, spicy, or high in acid like citrus fruits and juices



• Sugary foods that can cause cavities



• Alcoholic drinks

Reconstruction

Some people with oral cancer may need to have plastic or reconstructive surgery to rebuild the bones or tissues of the mouth. Research has led to many advances in the way bones and tissues can be replaced.

Some people may need dental implants. Or they may need to have grafts (tissue moved from another part of the body). Skin, muscle, and bone can be moved to the oral cavity from the chest, arm, or leg. The plastic surgeon uses this tissue for repair.

If you are thinking about reconstruction, you may wish to consult with a plastic or reconstructive surgeon before your treatment begins. You can have reconstructive surgery at the same time as you have the cancer removed, or you can have it later on. Talk with your doctor about which approach is right for you.

Rehabilitation

The health care team will help you return to normal activities as soon as possible. The goals of rehabilitation depend on the extent of the disease and type of treatment. Rehabilitation may include being fitted with a dental prosthesis (an artificial dental device) and having dental implants. It also may involve speech therapy, dietary counseling, or other services.

Sometimes surgery to rebuild the bones or tissues of the mouth is not possible. A dentist with special training (a prosthodontist) may be able to make you a prosthesis to help you eat and talk normally. You may need special training to learn to use it.

If oral cancer or its treatment leads to problems with talking, speech therapy will generally begin as soon as possible. A speech therapist may see you in the hospital to plan therapy and teach speech exercises. Often speech therapy continues after you return home.

Follow-up care for oral cancer

Follow-up care after treatment for oral cancer is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained in the body after treatment. The doctor monitors your recovery and checks for recurrence of cancer. Checkups help ensure that any changes in your health are noted. Your doctor will probably encourage you to inspect your mouth regularly and continue to have exams when you visit your dentist. It is important to report any changes in your mouth right away.

Checkups include exams of the mouth, throat, and neck. From time to time, your doctor may do a complete physical exam, order blood tests, and take x-rays.

People who have had oral cancer have a chance of developing a new cancer in the mouth, throat, or other areas of the head and neck. This is especially true for those who use tobacco or who drink alcohol heavily. Doctors strongly urge their patients to stop using tobacco and drinking to cut down the risk of a new cancer and other health problems.

The NCI has prepared a booklet for people who have completed their treatment to help answer questions about follow-up care and other concerns. Facing Forward Series: Life After Cancer Treatment provides tips for making the best use of medical visits. It describes how to talk to your health care team about creating a plan of action for recovery and future health.

Support for people with oral cancer

Living with a serious disease such as oral cancer is not easy. You may worry about caring for your family, keeping your job, or continuing daily activities. You may have concerns about treatments and managing side effects, hospital stays, and medical bills. Doctors, nurses, and other members of the health care team can answer your questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful if you want to talk about your feelings or discuss your concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group. The NCI's fact sheets "Cancer Support Groups: Questions and Answers" and "National Organizations That Offer Services to People With Cancer and Their Families" tell how to find a support group. See "National Cancer Institute Information Resources" for ordering information.

The Cancer Information Service can provide information to help patients and their families locate programs, services, and publications.

The promise of cancer research

Doctors all over the country are conducting many types of clinical trials. These are research studies in which people volunteer to take part. In clinical trials, doctors are testing new ways to treat oral cancer. Research has already led to advances, and researchers continue to search for more effective approaches.

People who join clinical trials may be among the first to benefit if a new approach is shown to be effective. And if participants do not benefit directly, they still make an important contribution to medical science by helping doctors learn more about the disease and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

Researchers are testing anticancer drugs and combinations of drugs. They are studying radiation therapy combined with drugs and other treatments. They also are testing drugs that prevent or reduce the side effects of radiation therapy.

If you are interested in learning more about joining a clinical trial, you may want to talk with your doctor. You may want to read Taking Part in Clinical Trials: What Cancer Patients Need To Know. The NCI also offers an easy-to-read brochure called If You Have Cancer...What You Should Know About Clinical Trials. These NCI publications describe how research studies are carried out and explain their possible benefits and risks.

NCI's Web site includes a section on clinical trials at http://cancer.gov/clinicaltrials with general information about clinical trials and detailed information about specific studies. The Cancer Information Service at 1-800-4-CANCER or at LiveHelp at http://cancer.gov can answer questions and provide information about clinical trials. Another source of information about clinical trials is http://clinicaltrials.gov.

National Cancer Institute information resources

You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.

Telephone

Cancer Information Service (CIS) Provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information Specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment.

Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615

Internet

http://cancer.gov
The NCI's Cancer.gov™ Web site provides information from numerous NCI sources. It offers current information on cancer prevention, screening, diagnosis, treatment, genetics, supportive care, and ongoing clinical trials. It also provides information about NCI's research programs and funding opportunities, cancer statistics, and the Institute itself. Cancer.gov provides live, online assistance through LiveHelp. Cancer.gov is at http://cancer.gov on the Internet.

http://www.smokefree.gov
The Tobacco Control Research Branch of NCI, in collaboration with the Centers for Disease Control and Prevention and the American Cancer Society, created a smoking cessation Web site. It offers online quitting advice through NCI's LiveHelp service. It also provides national and state telephone quitline numbers and access to printed materials about quitting tobacco. It is located on the Internet at http://www.smokefree.gov.

Print materials

You can order National Cancer Institute (NCI) publications by writing to the address below:

Publications Ordering Service
National Cancer Institute
Suite 3036A
6116 Executive Boulevard, MSC 8322
Bethesda, MD 20892-8322

Some NCI publications can be viewed, downloaded, and ordered from http://cancer.gov/publications on the Internet. If you are in the United States or one of its territories, you may order these and other NCI booklets by calling the Cancer Information Service at 1-800-4-CANCER.

National Institute of Dental and Craniofacial Research information resources

The National Oral Health Information Clearinghouse

This Clearinghouse is a service of the Federal Government's National Institute of Dental and Craniofacial Research (NIDCR). NIDCR's mission is to promote the general health of the American people by improving their oral, dental, and craniofacial health. Through the conduct and support of research and the training of researchers, the NIDCR aims to promote health, prevent diseases and conditions, and develop new diagnostics and therapies.

NIDCR directs the health awareness campaign, Oral Health, Cancer Care, and You: Fitting the Pieces Together. The campaign addresses the importance of preventing and managing the oral side effects of cancer treatments. It is a partnership among NIDCR, NCI, National Institute of Nursing Research, and Centers for Disease Control and Prevention.

NIDCR can supply free information about oral cancer and taking care of your mouth during cancer treatment. Booklets are available in English and Spanish:

Chemotherapy and Your Mouth
Head and Neck Radiation Treatment and Your Mouth
Quimioterapia y la Boca (Chemotherapy and Your Mouth)
Su Boca y el Tratamiento de Radiación en la Cabeza y el Cuello (Head and Neck Radiation and Your Mouth)

Materials may be obtained by contacting the Clearinghouse:
National Institute of Dental and Craniofacial Research
National Oral Health Information Clearinghouse
Attn: OCCT
1 NOHIC Way
Bethesda, MD 20892-3500
Tel: 301-402-7364

Materials are also available online at http://www.nidcr.nih.gov under "health information."

Oral Cancer At A Glance

• Oral cancer is caused by tobacco (smoking and chewing) and alcohol use.
• A sore in the mouth that does not heal can be a warning sign of oral cancer.
• A biopsy is the only to know whether as abnormal area in the oral cavity is cancer.
• Treatment of oral cancer depends on the location, size, type, and extent of the tumor, as well as the age and health of the patient.
• Surgery to remove the tumor in the mouth is the usual treatment for patients with oral cancer.

SOURCE: National Institutes of Health, National Cancer Institute, www.cancer.gov

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