The upper and lower mucosal lips (or pink lips) are a subsite of the oral cavity. The skin above and below the pink lips is still considered part of the lips, but not the mucosal lip, and is grouped in with skin cancers.
More than 90 percent of lip cancers are located on the lower lip. This is probably because the lower lip is more exposed to ultraviolet radiation from the sun, particularly in people who spend a great deal of time outside in sunny weather. Therefore, while lip cancer is still associated with tobacco and alcohol like other oral cancers, sun exposure plays a major role as well.
Most lip cancers are diagnosed at an early stage. In fact, according to a national database, 83 percent of lip cancers are diagnosed in Stage I. Because lip cancers are usually caught early, there is a good chance they can be cured.
Read below to learn about Lip Cancer:
Anatomy of Lip Cancer
Understanding the Anatomy
The upper and lower lips are the gateway to the rest of the oral cavity. They are responsible for protecting the mouth and for keeping food and drink in the mouth when you are eating or drinking. They also play a role in articulation (clear sounds) when you speak.
The upper lip extends from the bottom part of the nose, and the lower lip starts at the mental crease (top part of the jawbone). However, cancers that arise on the part of the upper and lower lips that look like facial skin are grouped in with skin cancer. Cancers on the pink part of the lips (mucosal lips) are grouped in with oral cavity cancers and will be discussed here.
The mucosal lip starts from the vermillion border (junction of facial skin with the pink lip) and ends at the point where the upper and lower lips meet when the mouth is closed.
On each side of the mouth is the commissure. This is where the upper and lower mucosal lips come together. Cancers in this part of the lip are very rare.
The mucosal lip is made up of squamous epithelium. There are several minor salivary glands under that layer. There is also a muscle layer. The upper and lower lips transition with the “labial mucosa,” which extends to the upper and lower gingiva (gums).
Causes of Lip Cancer
Causes of Lip Cancer
As with most cancers, doctors can’t tell you with certainty what causes lip cancer. It’s a combination of genetic predisposition and factors in your environment.
- Ultraviolet radiation:This is just like skin cancer. People who are outdoors a great deal are more likely to get lip cancer. Also, lip cancer is more likely to be on the lower lip because it is less protected from the sun than the upper lip.
- Tobacco:Smoking cigarettes, cigars or pipes and using chewing tobacco greatly increase your chance of getting any oral cancer.
- Alcohol:Drinking excessive amounts of alcohol is also strongly associated with getting oral squamous cell cancers. Moreover, if you both smoke and drink heavily, the risk more than doubles.
- Betel nut: This is the seed of the areca tree. It is often chewed by people from Southeast Asia and is known to cause oral cancer.
Other factors that can increase your chance of getting any oral cancer include:
- Bad dental hygiene
- Food and nutrition
- Genetic factors
Signs & Symptoms of Lip Cancer
Signs and Symptoms of Lip Cancer
For cancers in the mouth, you, your dentist or your general doctor can see or feel something abnormal in most cases. This is different from cancers in other parts of the head and neck, which can remain hidden for some time.
Symptoms to watch for include:
- A lump or lesion on the lip: This is the most common way for a cancer on the lip to be identified. If you have a lesion that just doesn’t go away after a couple of weeks, or maybe even after trying some medicines, you should be evaluated for lip cancer.
- Painful sores in the mouth: Most commonly, an oral cancer will start as a painful sore in the mouth. In some cases, a dentist or dental hygienist will see a sore in the mouth that you didn’t even realise was there. In general, a patch or sore in the mouth that doesn’t heal after a few weeks should be evaluated in more detail by a specialist.
In some cases, a dentist or oral surgeon will see something in the mouth, remove it and a week later get the report that it is a cancer.
If a lesion was removed and later found to be cancer: In this case, you should still see a specialist in head and neck cancers because it is important to review the pathology in detail to see if any more treatment is needed. Some questions to review are:
- What type of cancer was it?
- How big was it?
- How deeply did it invade?
- Was it completely removed with a rim of normal tissue around it? (This is known as having “clear margins.”)
In rare cases, the first sign of a lip cancer could be a lump in the neck.
- A lump in the neck: This means that the tumour has spread to the lymph nodes in the neck. This is less common for oral cancers than other types of cancers in the head and neck because the primary cancer is usually the main problem.
A more thorough list of possible symptoms from lip cancer include:
- Recurrent bleeding from the mouth: This can happen when the cancer makes a hole in some part of the mouth (this is called an ulcer) or if cancer cells are accidently rubbed off while brushing your teeth or eating certain foods.
- Loose teeth or dentures that don’t fit correctly: This happens if the tumour gets into the tooth sockets or the bones in which the teeth are rooted.
- Difficulty opening the mouth: This can happen if the cancer gets into any of the muscles that help to open and close the mouth. This is called trismus.
- Numbness (for example in the lower teeth or lower lip/chin area): This means that the cancer cells have gotten into nerves that allow you to feel. The main nerve responsible for this when dealing with oral cancer runs just inside the lower jawbone, and a branch even runs in the middle of the jawbone and comes out under the skin of your chin.
- Pain or difficulty with swallowing: This can happen when tumours get large and either get in the way of eating or involve the muscles and nerves of swallowing.
- Bad breath: In rare circumstances, when cancer cells start to become necrotic, the dead cells can lead to a bad smell from the mouth. This is called halitosis.
But don’t jump to any conclusions. You could have one or more of these symptoms but NOT have a lip cancer. There are several non-cancerous causes of the same symptoms. That’s why you need to see a specialist.
What to Expect at Doctors Visit for Lip Cancer
What to Expect at Your Doctor’s Visit?
Step 1: History
First, your head and neck specialist will take a thorough history of your health and address any specific concerns you may have.
Your doctor might ask questions such as:
- How long has the problem been there?
- Is it getting worse, better or staying the same?
- Does it come and go?
- Have you tried anything to make it better?
- Is it painful?
- Do you have numbness or tingling anywhere in your face or mouth?
- Do you have any lumps or bumps in your neck?
- Are you losing weight?
- Do you have any other medical conditions?
- Have you had any surgeries in the past?
- What medications do you take? And do you have any allergies?
- Have you ever been exposed to radiation in the head and neck?
- What do you (or did you) do for a living?
- Do you have a family history of cancer?
Step 2: Physical Exam
Next, your doctor will examine you. Typically, if you’re seeing a specialist in head and neck disorders, you will get a thorough physical examination focused on the area of concern. Your doctor will see how wide you can open your mouth and then look and feel inside your mouth. The doctor is likely to feel around very thoroughly, especially against the bone. Knowing whether the tumour is fixed to the bone will be an important part of treatment and reconstructive recommendations.
You should also expect the doctor to:
- Feel your neck thoroughly and carefully to check for any lumps or bumps
- Look inside your ears
- Look inside the front of your nose
- Check your cranial nerves by asking you to move your face, stick your tongue out, lift your shoulders, follow his or her fingers around with your eyes, do some simple hearing tests and test your sense of touch all over your face
Your doctor might even put a camera in through your nose to take a look at the back of your throat and your vocal cords.
Step 3: Reviewing Tests
After getting your history and performing a physical exam, your doctor will review any imaging, laboratory work and pathology results you may have already had. Be sure to bring all of these with you to your appointment. Bring actual discs of any scans you’ve had, as well as any reports of those scans. If you are seeing a head and neck cancer specialist after a lesion was removed by a non-cancer specialist, you need a thorough review of the pathology to discuss whether additional treatment is necessary. Try to obtain the actual glass slides that were prepared by the pathologist with the specimen taken during your biopsy procedure so your doctor can conduct a complete review. You might need more tissue removed or further treatment.
Step 4: Recommendations
Finally, your doctor will make recommendations about your next steps. This will likely include reviewing some of the studies you’ve already had done or ordering more tests. Once your doctor has all the necessary information, you should be given a preliminary stage and discuss treatment plans.
If the tumour is very large and is putting your breathing at risk, your doctor might recommend you undergo a tracheotomy, which is a breathing tube placed into the front part of your neck directly into your windpipe.
Also, if you are having difficulty getting enough nutrition by mouth because of a tumour, your doctor might recommend a feeding tube. This will help ensure that you are able to undergo the treatment that you will need to beat the cancer.
Diagnosing Lip Cancer
Diagnosing Lip Cancer
Getting to a diagnosis begins with a history and physical examination. If the symptoms haven’t been present for very long, or if the history and physical examination make the doctor less suspicious that your lesion is cancer, your doctor might try some medications and rehabilitation before jumping to a diagnosis of cancer.
At some point, if your doctor is not certain of a diagnosis, and if symptoms aren’t getting better (and if symptoms are getting worse), your doctor should raise the possibility of starting a cancer work-up. Like most cancers in the head and neck, this will include some combination of biopsy and imaging tests, which is the term that doctors use to refer to X-rays, MRIs, CT scans, etc.
If you came to a specialist after having something small removed from your mouth and found it was cancer only afterwards, your doctor might skip some of the tests and jump to close follow-up or additional treatment. Be sure to bring all the reports and images from any prior treatment with you to your appointment with your head and neck cancer specialist.
Imaging refers to radiologic studies, or scans, that create pictures of the structures inside your head and neck. In general, for small tumours that are easily evaluated on physical examination (especially those in the front of the mouth or lips), imaging might not be necessary. For larger tumours, or tumours in locations in the mouth that are difficult to examine, your doctor will probably order some sort of imaging to get more information about the tumour location and possible spread to regional lymph nodes. An important reason to get a scan for oral cavity tumours is to see if there is any evidence of spread into the jawbones. Spread into the jawbones will influence what treatment your doctor recommends for you.
For lip cancers, if imaging is required, your doctor will most likely start with a computed tomography (CT) scan with contrast. Other tests might include magnetic resonance imaging (MRI) and/or a positron emission tomography (PET) scan.
Other tests might include jaw X-rays (Panorex), Dentascans or Cone Beam CT scans. These can help determine the extent of tumour invasion into the jawbones from the cancer.
A biopsy is the removal of a small piece of tissue to examine under a microscope to see if it is cancerous. At some point, you will need a biopsy of the suspicious lesion on your lip (or a mass in your neck).
Fortunately, almost all tumours on the lips can be biopsied in the office with a little numbing medicine (either a spray or a tiny injection or both). Just keep your mouth open and stay still. It will only take a few seconds to do the biopsy. After a piece of the lesion is removed, you will probably apply pressure with a bit of gauze to stop any tiny amount of bleeding that will result from the biopsy. The bleeding usually stops after a few minutes, or your doctor might dab it with a chemical to stop the bleeding.
In some cases, your doctor might take you to the operating room to perform a surgical biopsy.
The most common ways to do a biopsy inside the mouth include:
- Incisional oral biopsy: This is a biopsy in which your doctor will take a piece of the suspicious lesion without removing it all. He or she must be sure to get deep enough to make a good diagnosis.
- Punch biopsy:This is just another way to perform an incisional biopsy. Your doctor will use a tool called a punch forceps, which makes a quick snip to remove a piece of the suspicious area in your mouth.
- Excisional oral biopsy: In this technique, the whole area of concern is removed. Typically, if the diagnosis is unknown, it is better to do an incisional biopsy to find out what the diagnosis is and then determine how much normal tissue needs to be removed around the lesion.
- Brush biopsy: This is often used by dentists, and they basically rub a few cells off the surface of a suspicious lesion. This is not ideal for diagnosing oral cancer because it doesn’t get into deeper layers of tissue. However, it can give some information and lead to a diagnosis of cancer.
The biopsy report is extremely important. Sometimes a doctor or dentist who cares and wants to help you will remove something that looks abnormal and send it off to a pathologist; unfortunately, the pathology report may be missing some important information, such as the grade of tumour, how deep it goes, whether it is endophytic, exophytic or ulcerated and whether there is a rim of normal tissue around the cancer. All these factors need to be evaluated either after a biopsy or after a more definitive removal of the cancer. Ask your doctor about the CAP Protocols, which are a standard way for pathology doctors to report results of their analysis.
If there is also a lump in the neck, your doctor might decide to biopsy that as well. There are a few different ways to do a biopsy of the neck:
- Fine needle aspiration biopsy: The most common and easiest way to biopsy is fine needle aspiration biopsy (FNAB), in which a tiny needle is placed into the tumour and some cells are drawn out through a syringe. The pathology doctor, known as a cytologist or cytopathologist, will then immediately look at the cells under the microscope and let your doctor know if there were enough cells to make a diagnosis. Several “passes” might be done to increase the likelihood that there are enough cells to make a diagnosis. The final diagnosis may take a few days to come back, so be patient.
DIFFERENT TYPES OF FINE NEEDLE ASPIRATION BIOPSIES
|“By Feel” FNAB||Ultrasound Guided FNAB||CT-Guided FNAB|
|When Your Doctor Might Use This Technique||If the lump can be easily felt by your doctor||If your doctor thinks it will be difficult to get the needle directly into the lump with certainty||If your doctor doesn’t think he or she will be able to get into the tumour by feel or with ultrasound guidance|
|What to Expect||Your doctor will feel the lump and place a tiny needle directly into it to extract some cells.||Your doctor will use a gentle probe on your face or neck, identify the tumour with the ultrasound and then watch the needle go directly into the tumour on the ultrasound machine.||You will be placed into a CT scanner, and a few low-dose CT scans will be performed—first to localise the tumour and then to make sure the needle that is placed is within the tumour. There is new technology known as fluoroscopic CT scanning in which the radiologist can quickly take a few scans without leaving the room in order to quickly insert the needle into the right place.|
Core biopsy: Core biopsy is an alternative to fine needle aspiration. A core biopsy is done in the same way as an FNA biopsy, but it uses a larger needle and removes a core of tissue from the tumour rather than just a few cells. The likelihood of false positives and false negatives is much lower with a core needle biopsy than with a fine needle biopsy.6
Open Neck biopsy: An open biopsy involves making an incision over the tumour and removing a piece or all of the tumour to make a diagnosis. An open biopsy of a neck mass is performed through an incision over the lump, and either a piece (incisional open neck biopsy) or the entire lump (excisional open neck biopsy) is removed to make a diagnosis. Except in a few special circumstances (such as if the tumour is likely a lymphoma or if other methods of diagnosis have not worked), this method should not be used to find the diagnosis of a neck mass.
Sentinel lymph node biopsy (SLNB): A sentinel lymph node biopsy is a new type of lymph node biopsy being used for some cancers of the head and neck. They are mainly used in skin cancers, such as melanomas and Merkel cell cancers, but some doctors are using them in oral cancers as well.7, 8
Cancer cells spread from a tumour to regional lymph nodes by traveling through a channel of lymph and making a stop in the first lymph node along the way—the sentinel node. In SNLB, special techniques are used to figure out where that first lymph node is located. Then, that lymph node is removed and analysed. If there is cancer in that lymph node, then the rest of the lymph nodes in the region are removed. If there is no cancer in that lymph node, then your doctor will closely watch the area but save you from undergoing additional treatment that might not be necessary.
For oral cancer, the advantages and disadvantages of SLNB are not very clear and are still being studied.
Determining the Type of Lip Cancer
Determining the Type of Lip Cancer
Only after a pathologist analyses some cells or actual pieces of tissue from the lesion will your doctor be able to tell you if you have cancer. Your doctor and pathologist should specialise in oral cancers because some benign (non-cancerous) lesions can look like cancer on a small biopsy.
If you do have cancer, it will probably be squamous cell carcinoma.
Squamous cell carcinoma: This is a cancer that starts from abnormal cells on the surface layer of the lips or mouth lining. More than 85 percent of mouth cancers are squamous cell carcinomas.
Other epidermoid cancers (meaning cancers that start from the lining of the mouth) include:
- Carcinoma in situ (also called severe dysplasia):This is really an early stage of squamous cell carcinoma. It is called carcinoma in situ when there are cancerous cells on the tissue lining the oral cavity but they have not invaded past the outermost layer of tissue. These should be removed completely, before they start invading (penetrating more deeply).
- Verrucous carcinoma: This is a type of squamous cell carcinoma that has a better prognosis because it is less likely to spread. It should be treated as any other squamous cell carcinoma.
But there are other cancers that can start in the mouth, which include:
- Salivary gland cancers:There are minor salivary glands located under the lining of the mouth. This is why cancers in this region can be glandular malignancies referred to as adenocarcinomas, including mucoepidermoid carcinomas, and adenoid cystic carcinomas. See Salivary Gland Cancer for more information. In rare instances, salivary gland cancers may grow inside the bone itself.
- Lymphoma: The mouth also has lymphoid cells under the surface. Therefore, lymphoma could in rare cases appear as a lump in the mouth.
- Mucosal melanoma: These cancers come from skin cells (melanocytes) that give skin its colour. In rare cases, melanoma can be found in the lining of the mouth, nose and/or throat.
- Kaposi’s sarcoma: This cancerous tumour is usually associated with AIDS. While it usually presents on the skin, it can be found with a similar appearance in the mouth. It looks like a purple lesion in the mouth filled with blood vessels.
- Osteogenic sarcoma (also called osteosarcoma):This is a type of bone cancer that typically begins in the long bones of the arms and legs, though it can also occur very rarely in the jaw. It is the most common type of bone cancer among children and adolescents.
Determining the Grade of Lip Cancer
Determining the Grade of the Tumour
Squamous cell cancers of the oral cavity are typically given a grade by a pathologist after looking at the cells under a microscope. Grade means that the tumour falls on a scale from well differentiated (Grade I) to poorly differentiated (Grade IV). Even though there are some studies that show grade is important in predicting outcome, as of now, grade does not really factor heavily into most doctors’ treatment decisions, nor your prognosis.
Determining the Stage of Lip Cancer
Determining the Stage of the Cancer
The final step before discussing treatment options is a determination of the stage of the cancer. As with all cancers of the head and neck, in Australia it is mandatory for doctors to use the AJCC Cancer Staging Manual (7th Ed) to determine the stage based on three factors.
|Factors that go into determining the stage of the cancer|
|T||Characteristics of the main tumour mass|
|N||Status of the lymph nodes in the neck (i.e., evidence of cancer spread)|
|M||Status of cancer spread to parts of the body outside of the head and neck|
At first, you will be given a clinical stage based on all of the available information.
Clinical staging (cTNM) is determined from any information your doctor might have about how extensive the cancer is BEFORE starting any treatment. Stage is determined based on your doctor’s physical exam, imaging studies, laboratory work and biopsies. Classification of clinical stage is described using the lower-case prefix c (e.g., cT, cN, cM).
If there is surgical removal of the cancer as part of your treatment, a pathologist will analyse the tumour and any lymph nodes that may have been removed. You will then be assigned a pathologic stage.
Pathological staging (pTNM) provides more data. Classification of pathology stage is described using the lower-case prefix p (e.g., pT, pN, pM). This may or may not differ from the clinical stage.
There are also several other lower-case prefixes that might be used in the staging of your cancer.
- The subscript y(yTNM) is used to assign a cancer stage after some sort of medical, systemic or radiation treatment is given (posttherapy or Postneoadjuvant stage). It is typically combined with either a clinical or pathologic stage. For example, ycT2N0M0 indicates that after some sort of non-surgical therapy, the new clinical stage is T2N0M0.
- The subscript r(rTNM) is used when the tumour has recurred after some period in which it was gone. This is called Retreatment Classification Stage. Your doctor will use all the available information to assign you a retreatment stage.
T stage: The main tumour mass
Based on a physical examination and review of any imaging, your doctor should be able to give you a T stage that falls within one of the following categories.
|Tx||The doctor is unable to assess the primary tumour.|
|T0||The doctor is unable to find the primary tumour.|
|Tis||Carcinoma in situ (or severe dysplasia); this means there are cancer type cells, but they have not yet invaded deep into tissue. This is more of a pre-cancer lesion.|
|T1||The tumour is 2 centimetres or less in greatest dimension.|
|T2||The tumour is more than 2 centimetres but less than or equal to 4 centimetres in greatest dimension.|
|T3||The tumour is more than 4 centimetres in greatest dimension.|
|T4a||This is moderately advanced local disease. Your tumour is in this stage if the tumour clearly invades into the skin of the face, through the upper or lower jawbone or into the nerve that allows you to feel the teeth and chin area, or the floor of the mouth. Note: A little bit of bone or tooth socket invasion from a tumour of the gums does NOT make it a T4a cancer.|
|T4b||This is very advanced local disease. This stage is assigned if the tumour is invading into the masticator space, pterygoid plates, base of the skull and/or encases the carotid artery.|
N stage: Spread of cancer to the lymph nodes in the neck
Next, your doctor will use all the available information and assign you an N stage. This is based on the assessment as to whether the cancer has spread to lymph nodes in the neck.
|Nx||The neck lymph nodes cannot be assessed.|
|N0||There is no evidence of any spread to the nodes.|
|N1||There is a single node, on the same side of the main tumour, that is 3 centimetres or less in greatest size.|
|N2a||Cancer has spread to a single lymph node, on the same side as the main tumour, and it is more than 3 centimetres but less than or equal to 6 centimetres in greatest dimension.|
|N2b||There are multiple lymph nodes that have cancer on the same side as the main tumour, but none are more than 6 centimetres in size.|
|N2c||There are lymph nodes in the neck on either the opposite side as the main cancer or on both sides of the neck, but none are more than 6 centimetres.|
|N3||There is spread to one or more neck lymph nodes, and the size is greater than 6 centimetres.|
M stage: Spread of cancer outside the head and neck
Finally, based on an assessment on the entire body, you will be assigned an M stage.
|M0||No evidence of distant (outside the head and neck) spread.|
|M1||There is evidence of spread outside of the head and neck (i.e., in the lungs, bone, brain, etc.).|
Your cancer stages
After TNM staging, your doctor can assign a cancer stage based on the following chart.
|Stage IVB||Any T||N3||M0|
|Stage IVC||Any T||Any N||M1|
Your clinical stage
Once the diagnostic tests are completed, before deciding what type of treatment you are going to undergo, you should be given a clinical stage that will look like the example below.
|Type||Squamous Cell Carcinoma|
* The lower-case subscript c indicates that this is a CLINICAL STAGE, the stage assigned based on all information available to your doctor before starting treatment.
After surgery, you should get a pathological stage of your tumour. It will look almost like the clinical stage you received before starting treatment, but notice the “p” that indicates the stage group is based on an analysis of the entire tumour, with or without lymph nodes, under a microscope by a pathologist. In many cases, the pathological stage will be the same as the clinical stage, but sometimes it will change. You should consider the pathological stage to be a more accurate assessment of your tumour at the time you start treatment.
After surgery, and after the pathologist has evaluated all the tumour that was removed, you should be given a pathological stage that looks something like this:
|Type||Squamous Cell Carcinoma|
* The lower-case subscript p indicates that this is a PATHOLOGICAL STAGE, the stage assigned after tumour removal and confirmation of cancer by a pathologist.
Deciding a Treatment Plan for Lip Cancer
Deciding on a Treatment Plan
Before starting treatment, your doctor will make sure that the following steps are completed.
- A full history and physical examination, including a complete head and neck exam (mirror and/or fibreoptic examination if needed)
- An evaluation by the members of a head and neck cancer team
- A biopsy to confirm a diagnosis of cancer
- Imaging of the lungs to check for spread, if needed
- Imaging of the primary tumour and the neck with CT and/or MRI
- A dental evaluation, with or without jaw X-rays, when necessary
- Pre-treatment medical clearance and optimisation of medical conditions
Then, your doctor will recommend a course of treatment for you, depending on a number of factors.
Depending on whether the cancer has spread or not, there are three general therapeutic options to consider:
- Surgical removal (with or without reconstruction)
- Radiation (a few different types)
- Medications (chemotherapy and biologic medications)
Surgery is the recommended treatment when possible in almost all cases of oral cancer. Also, if a positive margin (rim of tissue around the tumour that should be normal tissue but has cancer cells in it) is found after removal of the cancer, all efforts should be made to resect and get to negative margins (rim of normal tissue around the tumour).
Except for the lip, the treatment recommendations for oral cancers do not really vary by sub-site, though there are certain subtle differences for lip cancer. The surgery your doctor recommends does vary depending on the location of the cancer as well as the stage. You should have an extensive discussion with your care team about different surgeries that might be required for your cancer.
Also, the reconstruction that your doctor recommends will change depending on what is removed.
Below are the recommended treatment options for lip cancer, depending on your T and N stages.
For cancers in this category, the treatment options are:
Surgical removal of the cancer (preferred treatment)
Surgical removal of the cancer with or without a sentinel lymph node biopsy may also be performed. A neck dissection may also be performed depending on the results of the biopsy.
The treatments above should then be followed by either no additional treatment, radiation alone, surgery again, or chemotherapy with radiation, depending on what is found in initial surgery.
Radiation alone as primary treatment is also an option. This may be followed by either no additional treatment or surgery/reconstructions, depending if there is left over disease from the initial radiation.
T3, T4a, N0 or
Any T, N1-3
The preferred initial treatment is surgical removal of the cancer of the lip, along with possible same-sided or both-sided neck dissection, depending on several factors including the clinical N stage and/or certain features of the tumour itself. For cancers of the upper lip or commissure, your doctor might discuss the need to remove lymph nodes around the parotid gland.
If a neck dissection is done, and there are no cancerous lymph nodes, then you need close follow-up.
If a neck dissection is done, and there is one cancerous lymph node (without any adverse features), then radiation can be considered.
If there are multiple positive nodes, or invasion into/around nerves, vessels or lymphatics, then chemotherapy with radiation (preferred), additional surgery, or radiation alone are reasonable options after performing a neck dissection.
However, if there is any evidence of spread of cancer outside of the lymph node, or if on the lip there is a positive margin that cannot be removed, then radiation alone or chemotherapy with radiation is recommended.
Other options for the initial treatment of lip cancer in this category is to either give definitive radiation or chemotherapy with radiation. Then surgical removal of the cancer or a neck dissection should be performed only if there is evidence of residual cancer in the neck or the lip. In some instances, when the expertise is available, implanting radiation may be considered in addition to external beam radiation.
T4b, any N or
Unresectable neck disease
|In cases that are very advanced, or in patients who are extremely sick, an extensive discussion with your doctors should be undertaken.|
What to Expect After Treatment for Lip Cancer
What to Expect After Treatment is Completed?
Once you have made it through treatment, you need to have close follow-up with your doctor. This follow-up plan is recommended after being treated for an oral cancer:
- Visit your head and neck specialist on a regular schedule (or earlier if you have any concerning symptoms). This allows your doctor to examine you for any signs that the cancer has come back.
- For the first year, you should go every one to three months.
- For the second year, you should go every two to six months.
- For the third to fifth year, you should go every four to eight months.
- After five years, you can start going every year.
- Your doctor may request imaging. If something suspicious comes up, you might need another biopsy.
- Check your thyroid function every six to twelve months if you have had radiation to the neck area.
- Get help with a therapist as needed for difficulties with speaking, hearing and swallowing.
- See a specialist about appropriate nutrition and diet
- Alert your doctor if you experience any signs of depression.
- Stop smoking and stop drinking; counselling may help.
- See a dentist.
*This section is supported by the following sources:
Cohen, E. E., LaMonte, S. J., Erb, N. L., Beckman, K. L., Sadeghi, N. , Hutcheson, K. A., Stubblefield, M. D., Abbott, D. M., Fisher, P. S., Stein, K. D., Lyman, G. H. and Pratt‐Chapman, M. L. (2016), American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA: A Cancer Journal for Clinicians, 66: 203-239. doi:10.3322/caac.21343