Causes
Cigarette, cigar, or pipe smoking; smokeless tobacco; or excessive use of alcohol. There has been a recent increase in the use of smokeless tobacco in any form, such as plug, leaf, and snuff. However, the most popular with adolescent and young adult males is the practice of "dipping snuff." This tobacco product, in the form of a moist powder, is placed between the cheek and gum. Nicotine and other carcinogens are then absorbed directly through the skin.

Incidence
More than twice as many men as women are diagnosed with oral cancers and most cases occur between 50 and 70 years of age. Although the incidence of oral cancer remains low in young adults, those who use smokeless tobacco have a higher risk of developing cancer of the cheek and gum.

Warning Signs
A red or white patch or a lump anywhere in the mouth that lasts for more than a month, or a sore that bleeds easily or doesn't heal. Difficulty in chewing, swallowing or moving the tongue and jaw are later symptoms.

Early Detection
Dentists and primary care physicians are often the first to detect these signs during regular checkups. Speech-language pathologists also make note of unusual or abnormal growths during oral examinations and provide referrals to appropriate medical professionals.

Medical Treatment

Surgery and/or radiation are the methods most often used to treat oral cancers. Five-year survival rates vary from 23% for patients with cancer of the throat to 93% for patients with lip cancer.

Effects on Speech and Swallowing

Coordinated movement of all structures in the mouth and throat is essential for the production of intelligible speech. These same abilities are also necessary for a persons to swallow normally.

The effects of a cancer on speech and swallowing depend on the location and size of the growth. For example, a sore or lump on the lips may restrict movement. This could result in unclear production of speech sounds made with the lips (labial sounds) such as /p/, /b/, and /m/. Restricted movement of the lips might also reduce people' s ability to hold food in their mouth when eating. A lesion on the tongue may affect the intelligibility of some lingual sounds, such as /l/ and /r/, and limit the ability to move food around the mouth or push food back toward the throat during swallowing. A growth on the roof of the mouth (soft palate) or in the throat may change the nasal quality of the voice.

Postsurgical outcomes on speech and swallowing abilities also depend on the location and size of the cancerous growth. However, other important factors include the amount of tissue removed in surgery, the availability and frequency of speech/swallowing treatment, and the motivation of the patient.

In some cases, reconstructive plastic surgery or the use of prosthetic devices can restore oral functioning to near normal levels.

Role of the Speech-Language Pathologist

Evaluation and treatment by a speech-language pathologist is essential to restore speech intelligibility and swallowing skills. Speech-language pathologists are integral parts of the hospital-based cancer team and perform both pre- and postsurgical assessments in addition to treatment.

Standard articulation tests are used to assess intelligibility of speech, along with analysis of tape-recorded conversational speech samples. To assess nasal air escape, the speech-language pathologist uses critical listening skills to analyze and describe resonance patterns. Sometimes X-rays and special instrumentation are used to evaluate nasality problems. If a swallowing problem exists, an X-ray called a "modified barium swallow" is generally recommended. Sometimes, the swallowing process is viewed through a small fiberoptic tube inserted in the nose and passed down to the back of the throat.

The speech-language pathologist can teach modifications in oral movements

Treatment often includes helping clients adapt to the differences in the size, shape, and feel of their mouth. The speech-language pathologist will also teach a client how to make specific modifications in oral movement to produce the most intelligible speech sounds. Oral exercises help the client develop better control over weakened muscles in the throat or palate and to correct nasality problems. Treatment for swallowing problems varies from simple changes in food consistency to exercises for weak oral muscles to learning totally new ways to swallow. In many cases, improvement is evident within several months.

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