Mouth (Oral Cavity) Cancer
At UChicago Medicine Comprehensive Cancer Center, our survival rates for tongue and other mouth cancers are among the best in the world. Most of our patients are able to beat cancer while preserving their ability to taste, chew, swallow and talk.
We have been able to achieve these outstanding outcomes because of the personalized treatment approach we use for mouth cancer, also known as oral or oral cavity cancer. Our goal is to cure your cancer, while aiming to preserve your ability to taste, chew, speak and swallow.
To achieve these goals, our internationally esteemed head and neck cancer specialists, believe in a team approach to mouth cancer that considers all possible treatments. This means that all of our experienced cancer specialists—medical oncologists, radiation oncologists, head and neck surgical oncologists, speech pathologists and others—will be involved in your case, combining their deep expertise to determine how to best treat the cancer.
Cancer can strike the mouth, or oral cavity, in the following places:
- The front two-thirds of the tongue
- Lips
- Gums
- The floor of the mouth underneath the tongue
- The hard roof of the mouth
- The inside of the cheeks (also known as the buccal mucosa)
- The space behind the wisdom teeth (also called the retromolar trigone)
Cancers that affect the back (or base) of the tongue, tonsils and other areas of the throat are classified as throat or oropharyngeal cancers.
Most mouth cancers are squamous cell cancers, which grow in the thin, flat squamous cells of the mouth. Risk factors for mouth cancer include tobacco and alcohol use and sun exposure (for lip cancer).
Typically, mouth cancer is suspected when patients or their dentists notice symptoms such as the following:
- A sore that does not heal
- White or red patches
- Persistent and unexplained pain, numbness or bleeding
- Swelling
Diagnosis often requires a biopsy, or removal of a tiny part of abnormal tissue. This allows UChicago Medicine pathologists, who specialize in head and neck cancers, to provide a very specific diagnosis. For instance, using advanced laboratory tests, they can determine if your cancer is tied to specific genetic mutations. Other tests may also be needed for diagnosis, such as CT, MRI, and/or PET scans.
At UChicago Medicine, we treat a significant number of patients with mouth cancers, including complex cases, such as recurrent mouth cancers. You and your family will likely meet with medical oncologists, radiation oncologists, head and neck surgical oncologists, speech pathologists and others. Together, our team determines how to best cure your cancer with the fewest side effects, while aiming to preserve your ability to taste, chew, speak and swallow.
Your care plan will involve one or more of the following treatments:
- Surgery
- Radiation therapy
- Chemotherapy, or cancer-killing drugs
- Other drug therapies, such as immunotherapy
We are also always exploring novel treatments. At UChicago Medicine, we offer more clinical trials for patients with head and neck cancer than any other hospital in the Chicago area.
Below is a broad overview of how we typically treat early-stage and advanced mouth cancer. However, every patient’s treatment plan is personalized to reflect their particular cancer diagnosis and their treatment preferences.
Early-Stage Cancer
For early-stage mouth cancer that only affects a small area of the mouth, surgery may be the best treatment choice for ensuring favorable functional outcomes, or the ability to taste, chew, speak and swallow.Our highly experienced head and neck surgeons take a thoughtful and judicious approach to surgery. We only remove tissue that has cancer in it as well as a small area of tissue around the cancer (margin) to ensure we do not leave any microscopic cancer cells behind. Our surgeons are also highly experienced in facial and oral cavity reconstruction to restore speech and swallowing function following removal of cancers.
Advanced Stage Cancers
Patients with advanced stage tongue and other mouth cancers are often told that surgery is the first and only treatment choice. About 20 years ago, our team of head and neck cancer specialists asked if there was a way to treat very advanced stage mouth cancer that would also ensure the best possibly function and quality of life for our patients. We decided to challenge the traditional surgery-first approach.
We began giving patients chemotherapy and radiation therapy first, prior to any surgery. We soon discovered that this nonsurgical approach works well in many of our patients with advanced oral cavity and throat cancer. (Read about our results.) This approach often eliminates the need for surgery, or significantly reduces the amount of tissue that needs to be removed surgically.
Our highly experienced medical oncologists and radiation oncologists know how to reduce side effects as much as possible during treatment, by using effective drugs and pinpointing the amount of radiation truly needed to treat the cancer (and no more). In addition, radiation can be targeted at the precise location of the tumor, versus a larger area of the mouth. This helps reduce any damage to surrounding tissues.
At UChicago Medicine, our speech pathologists, nutritionists and other rehabilitation team members get involved in your care from the very beginning. This can help reduce treatment side effects. For instance, by evaluation of swallowing at the time of diagnosis, the speech pathologists take a proactive role to maintain the highest level of function and safety with individualized care plans. Early evaluation allows the speech pathologists to identify any potential speech and swallowing problems that you may develop during or after treatment, and provide ways to prevent or lessen these issues with the focus on function and quality of life.
In addition, our dedicated supportive oncology program provides a range of supportive care services to patients and their families, including mental health counseling, social work services and more.
If you smoke, it is important that you stop smoking during and after treatment for mouth cancer. UChicago Medicine’s No Smoker Left Behind program can provide you with the support you need to stop the habit.
Chef Triumphs Over Tongue Cancer
Cancer specialists across the country told top chef Grant Achatz that his only option for treating a stage 4 tumor was to remove most of his tongue. The head and neck cancer team at UChicago Medicine offered him a different approach, one that saved his tongue and his life.
And in the beginning, I was met with a very antiquated approach. There was nothing creative going on. It seemed incredibly barbaric to me.
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I got a call from the team there and talked to them briefly on the phone, found the clinical trial, read about it, and said, this is exactly what I was looking for. And Grant said, no, I'm done. Like, we made that decision. It was a very difficult decision. And I'm done. And I said, like, one more.
And we sat in a room with Dr. Vokes and Dr. Haraf, Dr. Blair. And first of all, I was surprised because I had been to about four major institutions prior to going to the University of Chicago. And I only met with one doctor each time. And here we were in this room with a team, with three doctors-- each in their own specialty, but clearly working together.
I still don't understand how surgeons say, the only anything we can do is cut your tongue out. We have to cut your tongue out. First step, cut your tongue out. And I go, why should that be the first step? Why should you sacrifice that important organ-- not only for Grant, who was a chef and needs it for his culinary abilities, but for an average guy that wants to talk or kiss his wife.
And so at no point here do we rule out surgery. We have brilliant surgeons. But it is not what we want to do first. And so what we already had experience with at the time was to start out with chemotherapy to try and tame this tumor-- to take the inflammation down, to take the size down-- and then go in with chemotherapy and radiation.
And so we were concerned at the time that even though we gave the patient chemo and radiation therapy, if it came back in a lymph node, or maybe it was like 90% gone in the lymph node, if it regrew, it would be much harder to treat.
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Years and years and years later, it really helped me become a better chef, engendering the spirit of teamwork, allowing us to grow, take wonderful ideas from other members of the team and implement them into our programs. So really, that individualistic approach-- it never gets you far. You have to work as a team in order to succeed. And, again, it's the same in the restaurant. I feel strongly it's the same in the medical profession.
Oh, I think the reentry into normalcy takes a long time. It's a very mentally challenging experience to go through. But I mean, he's got tons of advocates. And it's been great.
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There was a lot of, obviously, anxiety about, not only was I going to live or die, but was I going to be able to continue my life's passion? And now all of that's dispelled. I've been doing what I love to do for 12 years since treatment. And I think the restaurant, me as a person, me as a chef, are better than ever.
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To refer a patient for head and neck cancer care, please call UCM Physician Connect at 1-800-824-2282.
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