Gum Cancer Explained


Though you may not realize it, your dentist checks for signs of oral cancer every time you go in for a routine exam.
Though you may not realize it, your dentist checks for signs of oral cancer every time you go in for a routine exam.
Comstock/Thinkstock

When we worry about cancer, chances are it's breast, prostate, lung, colon or maybe melanoma -- the cancers that are so prevalent in the United States that one or more are bound to have touched any American's lives. But there are hundreds of types of cancers, affecting almost every part of our bodies.

Oral cancer affects roughly one percent, or about 250,000), of Americans [source: National Cancer Institute]. It's actually a group of cancers that include cancer of the tongue, the floor of the mouth (under the tongue), the roof of the mouth, the gums, the inside of the cheeks and the area behind the wisdom teeth (called the retromolar trigone). Gum cancer, in particular, accounts for fewer than 1.5 percent of all oral cancers [source: National Cancer Institute].

Didn't think you could get cancer in your gums? Gum cancer develops in the gingiva. Gingiva is the soft tissue that covers the part of the jawbone that holds your teeth: In other words, your gums. More than 90 percent of all oral cancers, including gum cancer, are a form of cancer known as squamous cell carcinoma. Squamous cells are thin, flat cells that cover our skin and cover and line internal organs, including the soft tissue inside the mouth and throat. Squamous cells, just as all other cells in our body, go through a three-part life cycle. They grow, they divide and they die. Cancer cells begin as normal cells but what makes them different is they begin to grow out of control, and unlike normal cells these abnormal types don't die. They multiply, and they also spread to other tissues in the body. Abnormal cells may develop anywhere from bones to nerve tissue to organs. Gum cancer, like many other cancers, begins with abnormal squamous cell development.

The remaining oral cancer diagnoses include verrucous carcinomas, a type of squamous cell carcinoma that occurs in the mucus membranes (the lining of the mouth). Fewer than 5 percent of all oral cavity cancers are diagnosed as verrucous carcinomas. There are also several kinds of minor salivary gland cancers (salivary glands are found in the mouth, neck and throat), but these are also rare.

Now that we know what they are, let's learn what oral and gum cancers look like, and what to do if you find an abnormal spot in your own mouth.

Gum Cancer Symptoms

Oral cancers commonly begin with a sore or lump on the lips, inside the mouth or on the tongue -- a spot that doesn't seem to want to heal. Gum cancer is the same: Most often it begins with a sore, lump or thick spot on the gums. There may be shiny red patches or white or red lesions on the soft tissues inside the mouth, and tissues may be swollen and bleed. Gums may bleed, teeth may become loose and there may be swelling along the jaw.

Other symptoms of oral cancers may include enlarged lymph nodes, lower lip and chin numbness, chronic earache, hoarseness or voice changes, chronic sore throat or a feeling something is stuck in the throat, and difficulty chewing, swallowing or speaking.

If you find a sore, lesion or lump in your mouth and it doesn't go away in less than two weeks -- with or without additional symptoms -- it's important to contact your dentist or doctor for evaluation.

Dentists perform basic oral cancer screenings at the recommended twice-yearly dental check-ups. If your dentist finds an area of concern, follow-up tests and procedures may be in order, including, but not limited to, a physical exam of the oral cavity and lips, endoscopy, X-rays, biopsy, MRI and CT scan. Some of these tests and procedures, such as X-rays and biopsy, are used to diagnose a primary oral cancer while others, such as the MRI and CT scan, are helpful in determining if the cancer has spread to the lymph nodes, blood vessels and surrounding tissue.

With a diagnosis of oral cancer, most of us would naturally question what caused it. The causes of gum cancer are not entirely clear, but there are a few known risk factors when it comes to developing oral cancers in general. First, sorry, men, but the very fact that you're male puts you at a higher risk here. Also, as our age increases so does our cancer risk, and to some extent heredity is at play here as well. But those are the factors we can't change. There are also environmental risk factors and our own habits to consider. What's the number one cause of gum cancer? One hint -- it's in your hands.

Gum Cancer Causes

If you suspected that smoking is a significant contributor to gum cancer risk, pat yourself on the back. Users of tobacco products have the highest risk of developing oral cancers.
If you suspected that smoking is a significant contributor to gum cancer risk, pat yourself on the back. Users of tobacco products have the highest risk of developing oral cancers.
Digital Vision/Thinkstock

Smoking causes cancer, and Gum cancer is just one of several cancers caused by smoking. Smokers have consistently been the greatest at-risk group for oral cancer over the decades. And it's not just smoking, but using any tobacco products: The risk of gum and cheek cancers is 50 times greater in long-term smokeless tobacco users [source: American Cancer Society]. People who drink, especially those who drink heavily, are also a higher risk group. And researchers have found that the risk for developing an oral cancer is 30 times greater when heavy smokers are also heavy drinkers [source: American Cancer Society].

Other causes of oral cancers include sun exposure (a common cause of lip cancer), eating too few fruits and vegetables, gastro-esophageal reflux disease, pre-cancerous conditions called leukoplakia (white lesions) and erythroplakia (red lesions), chronic periodontitis and, maybe more commonly than previously suspected, viruses. It's estimated that viral infections such as hepatitis B (HBV), Epstein-Barr (EBV) and human papillomavirus (HPV) contribute to 15 to 20 percent of all cancers [source: Brigham and Women's Hospital]. HPV, for example, is associated with nearly all instances of cervical cancer, and more recently has been linked to about 60 percent of oropharyngeal cancers (cancers in the back of the throat, base of the tongue and tonsils) [source: CDC, Harmon ]. Chronic irritation inside the mouth, such as from poorly fitted dental work, may also be a potential aggravator. The common link here? These are all things that could cause cell damage, and damaged cells may become cancerous.

Treating oral cancers includes, first, staging. The size of the tumor or lesion and its location are assessed, as is whether or not the cancer has spread to the lymph nodes or blood vessels and if there is a secondary cancer present. If gingival cancer is suspected, the bone and periodontal ligament will also be assessed. The patient's age and overall health as well as the patient's ability to chew, swallow and speak are also evaluated. Surgery and radiation therapy are the two most commonly used treatments for most types of oral cancer, including gum cancer.

When cancer affects the lower gums treatment often includes surgery, which may require removing part of the jawbone (mandible) and placing a skin graft, depending on advancement or the location of the tumor, in addition to radiation therapy. If the cancer affects the upper gums, the treatment plan often includes surgery, with or without radiation. Chemotherapy and other treatments, including clinical trials, are often tried in the more advanced stages of oral cancer, but treatments are always tailored to a patient's specific stage and needs.

Overall, the five-year relative survival rate for all types of oral cancers is just shy of 61 percent, but for gingival cancer the rate drops to 26 percent [source: National Cancer Institute, Sedano]. Early detection is key, as is practicing ways to avoid gum and other oral cancers: Quit using all tobacco products, quit drinking alcohol, fix any untreated dental problems and remember to brush and floss regularly.

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Sources

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