Recently, you've noticed a pale lump inside your mouth that doesn't seem to be healing. It's not like anything you've seen before. What you may have encountered is an early sign of oral or throat cancer.

The American Cancer Society estimates more than 28,000 new cases of oral and throat (oropharyngeal) cancer occur annually in the United States. Oral cancer includes cancer of the lips, mouth, tongue, gums and salivary glands. Throat cancer involves cancer of the part of the throat just behind the mouth. An estimated more than 7,000 Americans die of these cancers annually.

Periodic self-examination of your mouth is the best way to detect the early signs of oral cancer. And, when detected early, oral cancer is almost always successfully treated. Unfortunately, many oral and upper throat cancers are far advanced by the time a doctor is made aware of the situation. This is because oral and throat cancers are usually painless in their early stages.

An early indication of oral and throat cancer is one or more changes in the way the soft tissues of your mouth usually look or feel. Signs and symptoms may include:

• A sore in your mouth that doesn't heal or increases in size
• Persistent pain in your mouth
• Lumps or white, red or dark patches inside your mouth
• Thickening of your cheek
• Difficulty chewing or swallowing or moving your tongue
• Difficulty moving your jaw, or swelling or pain in your jaw
• Soreness in your throat or feeling that something is caught in your throat
• Pain around your teeth, or loosening of your teeth
• Numbness of your tongue or elsewhere in your mouth
• Changes in your voice
• A lump in your neck
• Severe pain in one ear with a normal eardrum

Most oral cancers arise on the tongue or on the floor of the mouth. They also may occur inside your cheeks, on your gums or on the roof of your mouth.

Oral and throat cancer appears to occur as a result of situations that damage the cells in your mouth and throat. Using tobacco and excessive alcohol consumption can damage these tissues. The combination of smoking or chewing tobacco and excessive drinking creates a much higher risk of oral and throat cancer. Excessive exposure to ultraviolet light, chewing your lips and the inside of your mouth and wearing loosefitting dentures can damage and result in irritation to cells inside your mouth. Damage to cells may cause them to malfunction and to reproduce rapidly as cancer cells.

A variety of factors that you can control increase your risk of oral cancer. These include:

• Use of tobacco. Tobacco can damage cells in the lining of the oral cavity and upper throat. Smokers are six times more likely to develop oral or upper throat cancers than nonsmokers are. About 90 percent of people who develop these cancers use some form of tobacco. Tobacco use is more prevalent among men, and oral cancer is twice as common in men as in women.

  People who use smokeless or chewing tobacco are at even higher risk of cancers of the cheek and inner surface of the lips. Aside from oral and throat cancers, using smokeless tobacco can cause other serious health problems, including cancer of the esophagus, larynx, stomach and pancreas, and gum disease, high blood pressure and cardiovascular disease. When you use smokeless tobacco, your body absorbs more than just nicotine. It absorbs a number of cancer-causing substances, including arsenic and formaldehyde.

• Excessive alcohol consumption. Alcohol also can damage cells inside your mouth and upper throat. About 75 percent to 80 percent of people with oral and upper throat cancers are frequent drinkers of alcohol. The combination of alcohol and tobacco use significantly increases the risk.
• Chronic irritation from jagged tooth surfaces or poorly fitting dentures. Irritation caused by the dentures doesn't appear to be a factor in oral cancer. However, poorly fitting dentures can trap particles of tobacco and alcohol, which may irritate the lining of your mouth.
• Prolonged exposure to ultraviolet light. Too much ultraviolet light can damage the cells on your lips and increase your risk of lip cancer.
• White patches on the tongue or inside of the cheek (leukoplakia). Most of the time leukoplakia is not dangerous. But leukoplakia can be serious, as some of the patches may show early signs of cancer, and a large percentage of cancers of the mouth occur in areas in which leukoplakia is adjacent. Leukoplakia may result from a variety of causes, including smoking or chewing tobacco products, ill-fitting dentures, a rough spot on an adjacent tooth, or cheek-biting.

Diagnosis initially involves you and your dentist or doctor discussing the history of your signs and symptoms and your doctor performing an examination of your mouth. To determine whether cells within your mouth are cancerous, your doctor will need to take a small tissue sample (biopsy) to be examined in the laboratory.

Almost all oral and throat cancers are of the squamous cell type (squamous cell cancer or carcinoma). Squamous cells are firm and flat, and they form the lining of the oral cavity and upper throat as well as the surface of your skin. Squamous cell cancer begins with abnormal cells located only on the surface. As it progresses, the malignant cells invade deeper layers of the oral cavity and upper throat and may spread to your lymph nodes as well as to other parts of your body.

For your doctor to determine how far oral or throat cancer may have spread, you'll need to undergo imaging procedures, which may include:

• X-ray. Your doctor may want to see dental X-rays as well as X-rays of your head and chest.
• Computerized tomography (CT) or magnetic resonance imaging (MRI) scan. A CT scan allows your doctor to see your organs in two-dimensional slices. Split-second computer processing creates these images as a series of very thin X-ray beams are passed through your body. An MRI scanner uses no X-rays. Instead, a computer creates tissue slice images from data generated by a powerful magnetic field and radio waves. These images can be viewed from any direction or plane. These images help determine the extent of the mass and whether there is lymph node involvement.
• Ultrasound. This imaging technique uses no radiation. Instead, it combines high-frequency sound waves and computer processing. Ultrasound is especially good for providing information about the shape, texture and makeup of tumors and cysts. While you relax on a bed or examining table, a wand-like device (transducer) is placed next to your head. It emits inaudible sound waves that are reflected back to the transducer (similar to sonar). Those reflected sound waves are then translated into a moving image by a computer.

Many oral and throat cancers aren't detected until they're far advanced. When detected early, squamous cell cancer can almost always be successfully treated.

You may not have any major side effects from surgery to remove a small tumor from your mouth. However, extensive surgery may require major adjustments in the way you chew, swallow, breathe and speak. You may need a prosthetic device in your mouth to replace removed portions of your teeth, gums and jaw. In more advanced cases, you may need to use tubes for feeding and breathing and an artificial voice aid for speaking.

Doctors use surgery and radiation therapy to treat oral and throat cancer in the earliest stages. For cancer in more advanced stages, doctors use surgery combined with radiation therapy or radiation therapy combined with chemotherapy. Your treatment plan should be developed for you specifically based on multiple factors by an integrated team of physicians including surgeons, cancer specialists (oncologists) and oncologists who specialize in treating cancer with radiation (radiation oncologists).

• Surgery. The type of surgery you may need depends on the size and location of the tumor. Tumors that haven't grown into nearby tissues can be surgically removed with relatively few side effects. However, if the tumor has invaded nearby tissues, the surgery is more extensive. Sometimes surgeons need to remove bone tissue from the jaw or the roof of the mouth. To treat a cancer of your tongue or the upper part of your throat, your surgeon may need to remove tissues that you use to swallow and in some cases your voice box (larynx). If the cancer has spread beyond your mouth, your surgeon may also need to remove lymph nodes in your neck.
• Radiation therapy. Radiation therapy uses X-rays to kill cancer cells. Doctors may use it alone to treat small tumors or combined with chemotherapy to treat large tumors. Radiation therapy may also be used along with surgery to destroy small amounts of cancer cells that can't be removed during surgery.
• Chemotherapy. Chemotherapy uses drugs to destroy cancer cells. You take these drugs either through your veins (intravenously) or orally. The type of drugs and the length of treatment depend on the size and location of the tumor. In the case of a large and invasive tumor, chemotherapy may be used in combination with radiation therapy and in place of surgery.

Following removal of an extensive tumor, reconstructive surgery or speech pathology may enhance your recovery and rehabilitation.

Reconstructive surgery
The goal of reconstructive surgery is to improve your appearance and to help you adjust to difficulties you may have with chewing, swallowing, speaking or breathing. Sometimes you'll need grafts of skin or tissue from other parts of your body to rebuild areas in your mouth, throat or jaw. You also may need to have a dental prosthesis implanted to replace a part of your jaw removed during surgery. If you've had extensive surgery in your neck, you may also undergo surgery to create a hole in your neck (tracheostomy) to help you breathe more easily. If muscles you need for swallowing have been removed, you'll need surgery to create a hole in your abdomen (gastrostomy) in order to receive food directly into your stomach through a feeding tube.

Rehabilitation
Adjusting to life after surgery may mean working with a speech therapist and dietitian. A speech therapist can help you overcome problems with speech and swallowing. If you've lost the ability to speak, you can learn to speak by forcing air up through your esophagus (esophageal speech). Artificial devices also are available to help you speak or speak more loudly. A dietitian can help you choose foods that are suitable for you if you've lost some of your ability to chew and swallow. In addition, you may benefit from sessions with a physical therapist and occupational therapist to help you make adjustments in your personal life and work life.

Tobacco and alcohol are by far the most important risk factors for oral and throat cancer. You can greatly reduce your risk by not smoking and limiting the amount of alcohol you drink. Other steps you can take to help prevent oral and throat cancer or its progression include:

• Use well-fitting dentures. If you wear dentures, be sure they fit properly and are well cleaned and rinsed. Oral irritation increases your risk of oral cancer.
• Don't chew on the tissues on the inside of your mouth (inner cheek). Doing so irritates your oral tissues. This frequently occurs during sleep, along with teeth grinding (bruxism). Talk with your dentist if this is a problem for you.
• Limit your exposure to the sun. Ultraviolet light damages the skin on your lips and increases your risk of oral cancer. When you're out in the sun, use lip balm that contains sunscreen and wear a wide-brimmed hat to protect your face and lips.
• Check your mouth and tongue periodically. Standing in front of a mirror, use your forefinger and thumb to pull facial tissue aside to get a good view and feel of the tissue on the inside of your lips, your cheeks and elsewhere inside your mouth, especially under your tongue. Look for bumps and for changes in color. Use your thumbs and fingers to check for lumps and tender spots. If you notice changes, talk to your dentist or doctor. Oral and throat cancer can be successfully treated, but success depends on early detection.
• Visit your dentist twice a year. Most dentists perform a thorough examination of your mouth during each visit. He or she should conduct a direct as well as indirect (mirrored) observation of all the tissues inside your mouth.

A diagnosis of cancer can be extremely challenging. Remember that no matter what your concerns or prognosis, you're not alone. Here are some strategies and resources that may make dealing with cancer easier:

• Know what to expect. Find out everything you can about your cancer — the type, stage, your treatment options and their side effects. The more you know, the more active you can be in your own care. In addition to talking with your doctor, look for information in your local library and on the Internet. The National Cancer Institute will answer questions from the public. You can reach them at (800) 4-CANCER, or (800) 422-6237. Or contact the American Cancer Society at (800) ACS-2345, or (800) 227-2345.
• Be proactive. Although you may feel tired and discouraged, don't let others — including your family or your doctor — make important decisions for you. It's vital that you take an active role in your treatment.
• Maintain a strong support system. Having a support system can help you cope with any issues, pain and anxieties that might occur. Although friends and family can be your best allies, they may sometimes have trouble dealing with your illness. If so, the concern and understanding of a formal support group or others coping with cancer can be especially helpful. Although support groups aren't for everyone, they can be a good source for practical information. You may also find you develop deep and lasting bonds with people who are going through the same things you are.
• Set reasonable goals. Having goals may help you feel in control and can give you a sense of purpose. But don't choose goals you can't possibly reach. You may not be able work a 40-hour week, for example, but you may be able work at least half time. In fact, many people find that continuing to work can be helpful.
• Take time for yourself. Eating well, relaxing and getting enough rest can help combat the stress and fatigue of cancer. Also, plan ahead for the downtimes, when you may need to rest more or limit what you do.
• Stay active. Receiving a diagnosis of cancer doesn't mean you have to stop doing the things you enjoy or normally do. For the most part, if you feel well enough to do something, go ahead and do it. It's important to stay involved as much as you can.
• Look for a connection to something beyond yourself. Having a strong faith or a sense of something greater than yourself seems to be a key factor in successfully coping with cancer.