Jaw cancer

Jaw cancer is a general term for cancer that affects the upper or lower jaw. It isn't one specific type of cancer. Some cancers start in the jawbone or in tissues in or around the jaw, including tissues involved in forming the teeth.

Cancers also can start nearby, such as in the gums, tongue or lining of the mouth, and grow into the jaw. Jaw cancer may spread to lymph nodes or other parts of the body.

The exact type of cancer is important. Different cancers that affect the jaw can grow, spread and respond to treatment in different ways. Your care team will determine the type of cancer, where it started and how far it has spread when planning treatment.

Not all jaw tumors and cysts are cancer. Many are benign, which means they are not cancer. Even so, some can grow into or push against nearby bone, tissue or teeth and cause damage. Treatment may still be needed.

Types

Types of cancer that can affect the jaw include:

• Squamous cell carcinoma involving the jaw. This cancer usually doesn't start in the jawbone. It often starts in another part of the mouth such as the gums, tongue or floor of the mouth. It can then grow into the upper or lower jaw. Rarely, squamous cell carcinoma can begin directly within the bone.

• Jaw sarcoma. Jaw sarcomas are rare cancers that start in the bone, muscle, cartilage or other supporting tissues. The most common type of jaw sarcoma is osteosarcoma. This is a cancer that forms in bone.

  Other rare sarcomas also can affect the jaw. These include chondrosarcoma, rhabdomyosarcoma, Ewing sarcoma and synovial sarcoma. Sarcomas of the jaw are rare.

• Malignant odontogenic tumors. These very rare cancers start in tissues involved in forming the teeth. Most odontogenic tumors aren't cancer. Cancerous forms are sometimes called odontogenic carcinomas.

Sometimes a cyst develops in tissues involved in forming teeth. A cyst is a sac that contains fluid or soft material. Rarely, these cysts may develop into tumors. In very rare situations they can lead to jaw cancers.

Because several different cancers can affect the jaw, there isn't one set of jaw cancer symptoms. Symptoms depend on where the cancer starts, what type it is and how it affects nearby tissues.

Symptoms can vary depending on the type of cancer and where it starts. Possible symptoms include:

• A sore in the mouth that doesn't heal.
• A lump or thickening in the mouth or gums.
• Pain in the jaw or mouth.
• Numbness in the mouth.
• Numbness or tingling in the jaw or face.
• Loose teeth or dentures that no longer fit well.
• Trouble chewing, swallowing or moving the jaw.

Other symptoms include:

• Swelling or a growing lump in the jaw.
• Swelling in front of the ear.
• Ear pain.
• Pain when swallowing.
• Difficulty opening the mouth.

Some types of jaw cancer cause certain symptoms more often than do others.

The symptoms listed can have many causes besides cancer. Having one or many of these symptoms doesn't mean you have cancer. But it is important to see a healthcare professional to help find the cause of these symptoms.

Some noncancerous jaw tumors also can cause similar symptoms. For example, some may cause swelling or pain and grow into surrounding tissue.

Many noncancerous jaw tumors don't cause any symptoms. They may be found on X-rays or other scans during a routine dental visit.

When to seek care

Make an appointment with a healthcare professional or dentist if these symptoms don't go away:

• Jaw swelling.
• Ongoing jaw pain.
• Numbness in your mouth, tongue, cheek, lips or chin.
• A sore in your mouth.

These symptoms can have many causes. Having one doesn't mean you have cancer. An exam and testing can help to find the cause.

There isn't one cause of jaw cancer because several different cancers can affect the jaw. What causes or raises the risk of one type may not apply to another.

• Jaw sarcoma. Experts don't know exactly what causes most jaw sarcomas.
• Squamous cell carcinoma. Squamous cell carcinoma that grows into the jaw usually starts somewhere else in the mouth, not in the jawbone. Tobacco raises the risk of mouth cancer and other head and neck cancers that can affect the jaw. Using tobacco and alcohol together raises the risk even more.
• Malignant odontogenic tumors. Experts don't know what causes most of these rare cancers. Some develop from an existing, benign odontogenic tumor or cyst. Others develop without an earlier tumor or cyst.

Risk factors depend on the type of cancer affecting the jaw. Having a risk factor doesn't mean that you'll develop cancer.

The risk factors below apply mainly to cancers of the mouth that can grow into the jaw. There aren't known risk factors for every type of cancer that starts in the jaw.

For mouth cancer that may grow into the jaw, risk factors include:

• Tobacco use. Cigarettes, cigars, pipes and smokeless tobacco increase the risk of mouth and other head and neck cancers. Chewing tobacco also raises the risk of cancers of the mouth, some of which can grow into the jaw.
• Alcohol use. Alcohol use increases the risk of mouth and other head and neck cancers. Using tobacco and alcohol together raises the risk even more.
• Betel quid use. Chewing betel quid, with or without tobacco, increases the risk of mouth cancer.
• A history of head and neck cancer. Someone who has had a head and neck cancer has a higher risk of developing another head and neck cancer.

Diagnosis usually starts with an exam. Your healthcare professional may examine your mouth and jaw and feel your neck for enlarged lymph nodes. Imaging tests and a biopsy help find out whether a growth is cancer. If it is cancer, these same tests can help find out what type it is.

Imaging tests

CT scans and MRI scans can show a tumor's size, where it is and whether it has grown into nearby areas. They also can help show whether cancer may have spread to lymph nodes in the neck.

If jaw sarcoma is suspected, CT scans and MRI scans of the head and neck can show the tumor and nearby areas. A chest CT can check whether cancer has spread to the lungs. A whole-body scan, such as a PET-CT scan, may be used to look for cancer that has spread to other parts of the body.

For squamous cell carcinoma in the mouth, CT scans or MRI scans may be used to look at the tumor and nearby areas. These tests also can help your care team check lymph nodes and look for signs that the cancer has spread.

Imaging tests also can help show how a jaw tumor affects bone. But imaging tests, including X-ray, CT or MRI, cannot alone determine what type of tumor it is. A biopsy is always required to confirm the diagnosis of cancer.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. A pathologist is a doctor who examines tissue for signs of disease. The pathologist checks the sample to find out whether it is cancer and, if so, what type.

The type and location of the tumor help determine how the biopsy is done. A surgical team may help plan the biopsy. The way the biopsy is done can affect later surgery.

Options for biopsy can include:

• Surgical biopsy. A surgeon makes an incision to reach the suspicious area and remove a tissue sample for testing.
• Image-guided needle biopsy. A healthcare professional uses imaging, such as a CT scan or MRI scan, to guide a thin needle into the suspicious area and collect a sample.
• Core biopsy. This is a type of needle biopsy. A healthcare professional uses a hollow needle to remove a small column of tissue for testing.

The type of biopsy used depends on the tumor and where it's located. Your surgical team will recommend the approach that's right for you.

Treatment depends on the type of cancer affecting the jaw, where it started, how far it has spread and whether surgery can remove it completely.

Your healthcare team may include:

• Head and neck surgeons, such as oral and maxillofacial surgeons or ear, nose and throat surgeons.
• Medical oncologists, who use medicines to treat cancer.
• Radiation oncologists, who treat cancer with radiation therapy.
• Reconstructive surgeons, who rebuild areas affected by cancer surgery.

Your care team also considers how treatment may affect eating, speaking, swallowing and your appearance.

Surgery is an important treatment for both squamous cell carcinoma that involves the jaw and jaw sarcomas that affect the jawbone. Surgery may be combined with radiation therapy or chemotherapy depending on the stage of the cancer and the type of the cancer. Some people may receive other treatment as well.

Chemotherapy

Chemotherapy treats cancer with strong medicines. It may be part of treatment for some jaw cancers. Some advanced jaw cancers may be treated with both surgery and chemotherapy.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. It may be used after surgery for some jaw cancers that have a higher risk of coming back.

Radiation therapy isn't usually the main treatment for jaw cancers that can be completely removed by surgery. Radiation may be considered when surgery isn't possible. It also may be used when cancer cells are found at the edge of the tissue removed during surgery.

Surgery

The goal of surgery is to remove the cancer along with a small amount of cancer-free tissue around it. If no cancer cells are found at the edges of the removed tissue, this is called a clear margin. It also is called a negative margin. The amount of jawbone that needs to be removed depends on where the cancer is and how deeply it has grown into the bone.

Surgery in the lower jaw may include:

Marginal mandibulectomy. A marginal mandibulectomy may be used when cancer is close to the lower jaw but hasn't grown deeply into the bone itself. In this procedure, the surgeon removes part of the upper edge of the lower jawbone while keeping the jawbone connected. This allows the jaw to remain connected. Only a portion of the upper half of the lower jaw is removed.

Segmental mandibulectomy. The surgeon removes a section of the lower jaw from top to bottom. This may be needed when cancer has grown more deeply into the bone. Often that part of the jaw needs to be rebuilt.

To rebuild the jaw, the surgeon may use bone, soft tissue and blood vessels from another part of the body. The tissue is shaped to replace the part of the jaw that was removed. The blood vessels in the tissue are connected to blood vessels in the neck. This is called a free-flap or microvascular reconstruction.

Maxillectomy. This surgery removes part or all of the upper jawbone. Reconstruction is often needed afterward. Depending on how much tissue was removed, the surgeon may rebuild the area using tissue from another part of the body, implants or both.

If jaw cancer has spread to lymph nodes in the neck, surgery may include removing the lymph nodes. This is called a neck dissection.

Immunotherapy

Immunotherapy helps the immune system recognize and attack cancer. One type of immunotherapy uses medicines called checkpoint inhibitors. They may be considered as part of the treatment for mouth and jaw cancers.

If you have jaw cancer, one of the next steps is to find out how much cancer is present and whether it has spread. This is called staging. The result is the cancer's stage. Your healthcare team uses your cancer's stage to help create your treatment plan.

The staging system depends on the type of cancer. Generally, to find the stage of cancer, a healthcare team considers:

• The cancer's location.
• The size of the cancer.
• How fast the cancer is growing.
• How deeply the cancer has grown into nearby tissue.
• Whether there is more than one area of tumor in the same bone.
• Whether the cancer has spread to the lymph nodes or to other parts of the body.

Staging tests

A physical exam, biopsy and imaging tests provide information used to determine the cancer's stage. Imaging can show the tumor and nearby lymph nodes. It also can show whether the cancer may have spread to other areas of the head and neck or other parts of the body.

Staging varies depending on tumor type and location. The stages of some jaw cancers range from 1 to 4. In general, a higher stage means the cancer is more advanced. It may be larger, have grown more deeply into nearby tissue, or have spread to lymph nodes or other parts of the body.

Many cancers that affect the jaw use a staging system called TNM:

• T stands for tumor. It describes the size of the main tumor and how far it has grown into nearby tissue.
• N stands for lymph nodes. It describes whether cancer has spread to lymph nodes in the neck.
• M stands for metastasis. Metastasis means cancer has spread to a distant part of the body.

Some jaw cancers, including jaw sarcomas, also are given a grade.

• G stands for grade. Grade describes how the cancer cells look under a microscope and gives clues about how quickly the cancer may grow.

There isn't one survival rate for jaw cancer. Different cancers can affect the jaw. The outlook for each one can be very different. Survival also depends on factors such as where the cancer started, its stage, and whether it can be completely removed. It also depends on the unique situation of the person who has the cancer.

The survival rates for jaw cancers depend on:

• The type of cancer affecting the jaw.
• Where it started.
• Its stage and grade.
• Whether it has spread.
• Whether surgery can completely remove it.
• Other factors unique to each person.

Your care team can tell you which factors apply to you and what they may mean for your outlook.

Survival statistics

Squamous cell carcinoma involving the mouth. The outlook for this type of cancer varies by where the cancer started and its stage. Cancers found at an earlier stage generally have a better outlook than cancers found at a later stage. The outlook may be worse if the cancer has spread to lymph nodes or grown more deeply into nearby tissue.

Jaw sarcoma. One study found that about 67% of people with the most common type of jaw sarcoma, called jaw osteosarcoma, were still alive five years after diagnosis. In that same study, about 59% of people with jaw osteosarcoma were still alive 10 years after diagnosis. However, a single survival statistic shouldn't be used to describe every person with jaw osteosarcoma. The outlook also varies among different types of jaw sarcoma.

Malignant odontogenic tumors. There isn't one survival rate for these tumors. These cancers are very rare. The outlook varies by tumor type, whether the cancer has spread or come back, and some other factors. Because so few people have these cancers, survival estimates are based mainly on small studies and reports of individual cases.

What you can do

Ask your care team which survival statistics may be most useful in your situation. Many factors affect your outlook. These include the type and size of the cancer, its stage and grade, whether it has spread, and whether surgery was able to remove all of it.

Survival statistics describe groups of people treated in the past. They can't tell exactly what will happen to one person.