{"entity":{"id":"oral-cavity-cancer","kind":"cancer","name":"Oral cavity cancer (mouth and tongue)","aka":["Oral cancer","Mouth cancer","Tongue cancer","Oral squamous cell carcinoma"],"tldr":"Cancer of the mouth and tongue, a head and neck cancer, is caused mainly by tobacco, alcohol and betel quid and is usually visible or feelable early, yet often diagnosed late. Surgery is the mainstay, with radiotherapy or chemoradiation after operation for higher-risk disease, and reconstruction to restore speech and swallowing.","summary":"Oral cavity squamous cell carcinoma arises on the tongue, floor of mouth, gums, buccal mucosa, palate and lips, often from a white or red patch (leukoplakia or erythroplakia). Unlike oropharyngeal cancer it is rarely HPV-driven; tobacco, alcohol and, in South and South-East Asia, betel quid with areca nut are the causes, and a screening trial in Kerala showed that visual inspection by trained health workers reduces mouth cancer deaths in high-risk people. Treatment is surgical resection with neck dissection and free-flap reconstruction, with postoperative radiotherapy or cisplatin chemoradiation for advanced stage, positive margins or nodal spread with extranodal extension. Depth of invasion now determines stage and the need to treat the neck. Recurrent or metastatic disease is treated as for other head and neck cancers with pembrolizumab-based therapy, and metronomic methotrexate-celecoxib from Tata Memorial Hospital offers a low-cost option.","asOf":"2026-09-17","wikipedia":"https://en.wikipedia.org/wiki/Oral_cancer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Oral_cancer"}],"tags":["subtype-page"],"related":["hpv-negative-head-and-neck-cancer","laryngeal-cancer","oropharyngeal-cancer","recurrent-metastatic-hnscc"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["celecoxib"],"companies":[],"institutions":[],"pathways":[],"terms":["extranodal-extension","depth-of-invasion"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-dcruz-elective-neck-dissection-nejm-2015","paper-sankaranarayanan-oral-screening-lancet-2005","paper-keynote-048-lancet-2019","paper-bernier-eortc-22931-nejm-2004"],"journals":[],"dependsOn":[],"notes":[],"group":"head and neck","burden":"About 390,000 new cases a year worldwide, with the highest rates in South Asia from betel quid and tobacco chewing; it is the commonest cancer among men in India, and five-year survival is around 60 percent overall but far lower for late-stage disease.","subtypes":["Oral tongue","Floor of mouth","Buccal mucosa and gingiva (betel-quid related)","Lip (sun-related)","Hard palate and retromolar trigone"],"biomarkers":["Depth of invasion (staging and elective neck dissection)","Extranodal extension and margin status","TP53 mutation","PD-L1 combined positive score (recurrent disease)"],"standardOfCare":[{"setting":"Screening in high-risk populations","approach":"Visual oral examination by trained workers reduced mouth cancer deaths in the Kerala trial; opportunistic examination by dentists elsewhere.","refs":["head-and-neck"]},{"setting":"Early disease","approach":"Wide excision with elective neck dissection when depth of invasion exceeds about 3 to 4 mm; sentinel node biopsy in selected cases.","refs":["head-and-neck"]},{"setting":"Locally advanced disease","approach":"Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for positive margins or extranodal extension.","refs":["cisplatin","imrt-igrt"]},{"setting":"Recurrent or metastatic","approach":"Pembrolizumab with or without chemotherapy (KEYNOTE-048); low-cost metronomic methotrexate and celecoxib where access is limited.","refs":["pembrolizumab","keynote-048","methotrexate","metronomic-vs-cisplatin-tmh"]},{"setting":"Prevention","approach":"Tobacco and betel quid cessation, alcohol reduction, treatment of premalignant patches.","refs":["smoking-cessation-after-diagnosis"]}],"stateOfArt":["Elective neck dissection improves survival even in early tongue cancer (D'Cruz, Tata Memorial, 2015).","Free-flap reconstruction has made function-preserving resection routine.","India's low-cost trials have set standards for resource-limited care, from metronomic chemotherapy to screening."],"history":[{"year":1906,"title":"Crile describes radical neck dissection","refs":[]},{"year":2005,"title":"Kerala screening trial shows visual inspection cuts oral cancer deaths in high-risk people","refs":[]},{"year":2015,"title":"Elective neck dissection improves survival in early oral cancer (Tata Memorial)","refs":[]},{"year":2017,"title":"Depth of invasion enters staging (AJCC 8th edition)","refs":[]}],"pipeline":["pembrolizumab","nivolumab"],"openProblems":["Late presentation remains the norm in the highest-incidence countries.","Betel quid use is still rising in parts of Asia.","Field cancerisation causes second primaries in a fifth of survivors.","Speech and swallowing after large resections."],"parent":"head-and-neck"},"route":"/cancers/oral-cavity-cancer/","neighbours":{"cancer":[{"id":"buccal-mucosa-cancer","kind":"cancer","name":"Buccal mucosa and gingivobuccal cancer (oral cancer in India)","route":"/cancers/buccal-mucosa-cancer/"},{"id":"head-and-neck","kind":"cancer","name":"Head and neck squamous cell carcinoma","route":"/cancers/head-and-neck/"},{"id":"hpv-negative-head-and-neck-cancer","kind":"cancer","name":"HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer)","route":"/cancers/hpv-negative-head-and-neck-cancer/"},{"id":"laryngeal-cancer","kind":"cancer","name":"Laryngeal and hypopharyngeal cancer","route":"/cancers/laryngeal-cancer/"},{"id":"lip-cancer","kind":"cancer","name":"Lip cancer","route":"/cancers/lip-cancer/"},{"id":"oral-tongue-cancer","kind":"cancer","name":"Oral tongue and floor of mouth cancer","route":"/cancers/oral-tongue-cancer/"},{"id":"oropharyngeal-cancer","kind":"cancer","name":"Oropharyngeal cancer (tonsil and base of tongue)","route":"/cancers/oropharyngeal-cancer/"},{"id":"recurrent-metastatic-hnscc","kind":"cancer","name":"Recurrent or metastatic head and neck squamous cell carcinoma","route":"/cancers/recurrent-metastatic-hnscc/"}],"drug":[{"id":"celecoxib","kind":"drug","name":"Celecoxib","route":"/drugs/celecoxib/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"},{"id":"nivolumab","kind":"drug","name":"Nivolumab","route":"/drugs/nivolumab/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"}],"term":[{"id":"depth-of-invasion","kind":"term","name":"Depth of invasion (DOI)","route":"/terms/depth-of-invasion/"},{"id":"extranodal-extension","kind":"term","name":"Extranodal extension (ENE)","route":"/terms/extranodal-extension/"}],"paper":[{"id":"paper-sankaranarayanan-oral-screening-lancet-2005","kind":"paper","name":"Effect of screening on oral cancer mortality in Kerala, India","route":"/key-papers/paper-sankaranarayanan-oral-screening-lancet-2005/"},{"id":"paper-dcruz-elective-neck-dissection-nejm-2015","kind":"paper","name":"Elective versus therapeutic neck dissection in node-negative oral cancer","route":"/key-papers/paper-dcruz-elective-neck-dissection-nejm-2015/"},{"id":"paper-bernier-eortc-22931-nejm-2004","kind":"paper","name":"EORTC 22931: postoperative irradiation with or without concomitant cisplatin for locally advanced head and neck cancer","route":"/key-papers/paper-bernier-eortc-22931-nejm-2004/"},{"id":"paper-keynote-048-lancet-2019","kind":"paper","name":"KEYNOTE-048: pembrolizumab, alone or with chemotherapy, as first treatment for recurrent or metastatic head and neck cancer","route":"/key-papers/paper-keynote-048-lancet-2019/"},{"id":"paper-cooper-rtog-9501-nejm-2004","kind":"paper","name":"RTOG 9501: postoperative concurrent radiotherapy and chemotherapy for high-risk head and neck squamous cell carcinoma","route":"/key-papers/paper-cooper-rtog-9501-nejm-2004/"}],"technology":[{"id":"rejuv-recon-head-neck","kind":"technology","name":"Head and neck reconstruction: the free flap, and what it gives back","route":"/technologies/rejuv-recon-head-neck/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"smoking-cessation-after-diagnosis","kind":"technology","name":"Smoking cessation in cancer patients","route":"/technologies/smoking-cessation-after-diagnosis/"}],"trial":[{"id":"nct05893888","kind":"trial","name":"A Study Evaluating the Safety and Efficacy of PRV111, PRV211, and PRV131 in Subjects With Oral and Lung Cancers","route":"/trials/nct05893888/"},{"id":"checkmate-141","kind":"trial","name":"CheckMate 141","route":"/trials/checkmate-141/"},{"id":"nct04333537","kind":"trial","name":"Comparing Sentinel Lymph Node (SLN) Biopsy With Standard Neck Dissection for Patients With Early-Stage Oral Cavity Cancer","route":"/trials/nct04333537/"},{"id":"elective-neck-dissection-tmh","kind":"trial","name":"Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)","route":"/trials/elective-neck-dissection-tmh/"},{"id":"nct00911326","kind":"trial","name":"Evaluation of Sentinel Lymph Nodes in Head and Neck Squamous Cell Carcinoma","route":"/trials/nct00911326/"},{"id":"kerala-oral-screening","kind":"trial","name":"Kerala oral cancer visual screening trial (Trivandrum)","route":"/trials/kerala-oral-screening/"},{"id":"keynote-048","kind":"trial","name":"KEYNOTE-048","route":"/trials/keynote-048/"},{"id":"metronomic-vs-cisplatin-tmh","kind":"trial","name":"Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)","route":"/trials/metronomic-vs-cisplatin-tmh/"},{"id":"nct07121595","kind":"trial","name":"Personalized Neck Radiation Therapy Directed by Sentinel Lymph Node Biopsy for the Treatment of Oral Cavity Squamous Cell Carcinoma, PRECEDENT Trial","route":"/trials/nct07121595/"},{"id":"nct00003139","kind":"trial","name":"Pilocarpine in Preventing Mucositis and Dry Mouth in Patients Receiving Radiation Therapy for Head and Neck Cancer","route":"/trials/nct00003139/"},{"id":"nct05966194","kind":"trial","name":"RRx-001 for Reducing Oral Mucositis in Patients Receiving Chemotherapy and Radiation for Head and Neck Cancer","route":"/trials/nct05966194/"},{"id":"nct05312710","kind":"trial","name":"Safety and Efficacy of APG-157 in Head and Neck Cancer","route":"/trials/nct05312710/"}],"target":[{"id":"chchd7","kind":"target","name":"CHCHD7","route":"/targets/chchd7/"},{"id":"crtc1","kind":"target","name":"CRTC1","route":"/targets/crtc1/"},{"id":"crtc3","kind":"target","name":"CRTC3","route":"/targets/crtc3/"},{"id":"hmga2","kind":"target","name":"HMGA2","route":"/targets/hmga2/"},{"id":"maml2","kind":"target","name":"MAML2","route":"/targets/maml2/"},{"id":"myb","kind":"target","name":"MYB","route":"/targets/myb/"},{"id":"nfib","kind":"target","name":"NFIB","route":"/targets/nfib/"},{"id":"plag1","kind":"target","name":"PLAG1","route":"/targets/plag1/"},{"id":"tcea1","kind":"target","name":"TCEA1","route":"/targets/tcea1/"},{"id":"wif1","kind":"target","name":"WIF1","route":"/targets/wif1/"}]}}