Mouth Cancer

Head, Neck, Mouth, Throat, Salivary and Laryngeal CancersHead and neck cancers are diagnosed in more than 70,000 Americans each year. Men are nearly three times more likely to develop the disease than are women. Head and neck cancers include cancers of the mouth, such as lip and tongue, the pharynx or throat and the larynx or voice box. Early symptoms occur as a lump or nodule, numbness, swelling, hoarseness, sore throat or any difficulty moving the jaw or swallowing.

Risk Factors

Risk factors include smoking, excessive alcohol consumption and chewing smokeless tobacco. Kimmel Cancer Center doctors have found that people who smoke one pack of cigarettes a day are six times more likely than nonsmokers to get cancer of the head or neck. Those who also have two alcoholic drinks a day increase their risk 20-fold.

Diagnostic Tests

Otolaryngologists at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins are among the most experienced in the diagnosis of head and neck cancers, most of which are diagnosed by clinical examination, imaging tests and other specialized pathologic tests. These subspecialists are experts at differentiating benign from malignant tumors and accurately assessing the stage of progression. Patients suspected of disease see a physician within a few days to be evaluated for appropriate tests. Upon receipt of the test results, the physician develops an appropriate and highly individualized treatment plan.

Current Treatments

Of particular benefit to our patients is a team of specialists from a variety of departments who meet weekly to review each patient's test results and records to determine the best treatment plan. Specialists include head and neck surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, pathologists, rehabilitation therapists, radiologists, neurologists, oral surgeons and dentists. Each patient's care is coordinated with the multidisciplinary team to achieve the most comprehensive treatment, reconstruction and palliative care available.

After evaluation and consultation with team members, treatment is recommended based on the location, size and type of head or neck cancer. Treatment may include surgery, radiation and/or chemotherapy. Reconstructive techniques are planned before any treatment to optimize the patient's facial restoration, speech and swallowing. For example, one program that was developed at Hopkins five years ago is aimed at preserving speech and swallowing function in situations when standard surgery would result in severe impairment or loss of these functions. Initially, these patients are treated with chemotherapy and radiation. This treatment, on occasion, has cured patients with advanced cancers of the mouth, such as tongue and palate, and cancers involving the larynx or voice box.

New Treatment Approaches

More than a dozen clinical trials are in place for selected head and neck cancer patients at the Kimmel Cancer Center.
Gene therapy is under investigation in many areas at our Cancer Center and is planned for head and neck cancers to improve early diagnosis and enhance treatment. Our physicians are developing a number of sensitive tests that may help detect head and neck cancers early, before the cancer spreads, leading to more effective treatments. One study already has shown that if a patient with cancer has a specific gene mutation, the tumor will be more resistant to radiation therapy.
In another study, our researchers are investigating the use of a vitamin A derivative for prevention of secondary cancers. Here, drugs being studied for the treatment of these disorders include topotecan, taxotere and Taxol, shown to be effective against other cancers; and tirapazamine for patients requiring radiation treatments. Preliminary information suggests that tirapazamine makes a patient more sensitive to radiation and thus enhances the treatment effect.

One of the most exciting studies in progress at Hopkins involves molecular tests to examine surrounding tissue after removal of a cancerous tumor. Researchers are finding this new test so sensitive that cancer cells that once were missed during surgery -- enabling the cancer to grow back -- now can be detected. The test has shown remarkable accuracy in identifying the most minute traces of the cancer. This means that surgeons potentially could remove all the cancerous tissue the first time while leaving as much healthy tissue in place as possible. The procedure is undergoing rigorous, confirmatory testing.