Tobacco and Oral Cancer

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Smoking is by far the major risk factor for developing oral cancer. The use of alcohol and smoking further increases the risk of oral cancer, along with cancer of the larynx, and esophagus. According the the American Cancer Society statistics, there were 28,000 new cases and 7,400 deaths from oral cavity and pharynx cancer in the United States in 2002.

Patients with head and neck cancer that smoke are more likely to develop spread of the cancer to their lymph nodes and once in the nodes the cancer is more likely to spread into the soft tissues. View Article's Abstract   The picture on the right shows a cancer of the uvula in a patient that had a 75 pack year history of smoking and consumed alcohol. Both smoking and alcohol are risk factors for oral cancer.  This patient also had a second cancer in his lungs and eventually developed spread of the cancer to his brain. Click on Pictures to Enlarge

Use of tobacco products produces changes in all of the cells that are exposed. Thus, the entire oral cavity, lungs and larynx are at risk for developing tumors. Patients do not just develop one tumor but may develop a second or a third lesion. Vaamonde (2004) found that of 636 patients with head and neck cancer 48, or 7.5%, developed a second lesion.   View Article's Abstract

The picture on the right is from a 22 year old male who has used over 1 can per day of snuff for the past 15 years. He has high blood pressure from the vasoconstrictive (contraction of blood vessels) effect of nicotine and gastroesphageal reflux disease (stomach acid coming up from the stomach towards the mouth) which is also made worse from using tobacco products. The picture on the right shows extensive leukoplakia forming between his gums and lips.   This is a pre-cancerous condition and if it does not resolve with his cessation of using tobacco products, it will need to be surgically removed.
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Below is a picture from the New Mexico Dept of Health of a patient who had a "Jaw-Tongue-Neck" procedure. Surgery and radiation therapy or combination of chemotherapy and radiation therapy are the treatments of choice.

The picture on the right shows a patient undergoing a jaw, tongue, neck operation. The lip is split and the neck skin and cheeks are reflected. The jaw, tongue, neck and part of the soft palate and uvula can then be removed.

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The picture to the right shows the removed surgical specimen.

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Even if treated, many cancers may recur. In this patient, a cancer is recurring in his neck with a massive slowly growing fungating mass. The mass will slowly erode into the carotid artery causing massive bleeding and sudden death.

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This patient is a 87 year old who used to smoke 1 pack per day for many years. She was not sure how long she smoked. This patient has a tumor on both her tongue and right floor of the mouth. The tumor is over her alveolus and extends onto the anterior tonsillar pillar. These types of tumors are sometimes treated with a commando operation which consists of resection of the mandible, floor of mouth and tongue; along with a radical neck dissection which removes the muscles and lymph nodes in the neck.

Squamous Cell Carcinoma of the Floor of Mouth and Tongue

The patient below is a 70 year old who smoked 1 pack per day for 50 years. He also drank alcohol heavily. He presented with severe dysphagia (trouble swallowing) and on examination was found to have a very small airway. He underwent an emergency tracheotomy (breathing hole placed in the neck) under local anesthesia no IV sedation or analgesia was given. He was then put to sleep with general anesthesia and had his oral tumor debulked. The pictures below show a large oral tumor in the hypopharynx with a very small airway under the epiglottis.

Large Cancer of the Hypopharyxn Causing Airway Obstruction

This patient is a 56 year old who had a 100 pack year history of smoking. He had a large tumor involving the floor of his mouth and jaw (see picture on the right). The tumor had eroded through the skin and produced a large mass over his right jaw and chin (see pictures below). This patient also had a small cell carcinoma of the lung which was inoperable.

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Lateral picture of jaw and floor of mouth tumor eroding through skin

Although smoking is a risk factor for development of oral cancer, the human papillomavirus is an even greater risk in developing cancer of the base of tongue and tonsil. The viral DNA has been found in over 70% of tumors. The virus is know to be spread by sexual contact. Go to ENT USA to learn more.

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