Lip Cancer

Lip cancer is a type of oral (mouth) cancer. It develops from the hairless and pinkish parts of the lip. The most common of these cancers are squamous cell carcinoma of the lip. Squamous cell carcinoma of the lip develops from thin, flat squamous cells.

Lip cancers are most common on the lower lip. The cause of lip cancer is unknown. In the development of lip cancer, sun exposure, tobacco use, alcohol consumption, and a weakened immune system are important risk factors. Lip cancers give signs and symptoms in the early stages. Because the lips are in a prominent position on the face. Avoiding risk factors is important in lip cancer prevention.

The diagnosis of lip cancer can be made by biopsy. Lip cancer is one of the head and neck cancers with a high survival rate. Neglected lip cancer may reduce the survival rate according to the spread of cancer. The main treatments for lip cancer are surgery, radiotherapy, and chemotherapy. Brachytherapy, targeted therapy, and immunotherapy can also take part in the lip cancer treatment process.

Signs and Symptoms

Squamous cell carcinomas of the lip occur most frequently on the lower lip. They most often develop from the pinkish parts of the lower lip. Lip cancer is less likely to occur in the corner of the mouth, upper lip, or skin-covered areas of the lip. Since lips are a very prominent organ on the face, lip cancers give signs and symptoms earlier.

Persistent ulcer or bump on the lip

Lip cancer may appear in the form of a blister, crusting, pitting, ulcer, lump or bump on the lip that has been present for more than 2-3 weeks. These formations grow over time and never go away. They can bleed easily when touched or slightly bitten.

An enlarged or swollen lip

Lip cancer can also present itself as swelling of the lip that has existed for more than 2-3 weeks. In particular, minor salivary gland tumors manifest themselves as swollen lips rather than ulcers.

Persistent patches on lips

Flat or slightly raised patches on lips that have been present for more than 2-3 weeks may be precancerous. The patches can be white, red, or dark in color. These patches on lips can turn into cancer over time.

Lip pain or sore mouth

Lip cancer can cause lip pain or pain in the skin around the mouth. Complaints of ‘lips are sore’ are common in patients.

Lip numbness and tingling

Lip cancer can cause tingling and numbness in the lip or the skin around the mouth. These may also appear as lip movement disorders.

In summary, signs and symptoms of lip cancer may include:
Persistent ulcer or bump on the lip
An enlarged or swollen lip
Persistent patches on lips
Easy bleeding when touched or bitten
Lip pain or sore mouth
Lip numbness and tingling
Tightness in the jaw due to swelling
Lump in the neck

Causes

The exact cause of lip cancer is unknown. However, there are some factors known to affect the development of lip cancer. These factors are prolonged exposure to sun and ultraviolet rays, tobacco use, alcohol consumption, and a weakened immune system. There is no definite evidence that herpes viruses that cause cold sores on the lips affect the development of lip cancer. The role of human papillomavirus (HPV), which is associated with cancers of the tonsils, base of tongue, throat, and pharynx, is not clear in the development of lip cancer.

Risk Factors

Lip cancers are more than twice as common in men than in women. Lip cancer patients are typically middle-aged and older men who work in the sun because of their profession (eg farmers). Most of these people use tobacco. Lip cancer is more common in people with light skin color. However, women and men who do not use tobacco, do not consume alcohol, and spend most of their time indoors can also get lip cancer.

Too much sun exposure and tanning bed use

Lip cancer is more common in people who have been exposed to sunlight for a long time. Sunlight, in particular, is an important risk factor in the development of lower lip cancer. Because the lower lip’s exposure to sunlight from coming above is more direct, longer, and stronger. In this respect, people who spend a long time in the sun due to their profession have a higher risk of developing lower lip cancer than other people.

In one scientific study, it was observed that farmers who work under the sun have several times more lip cancer than those working in a closed environment, regardless of tobacco use. Tanning beds also increase the risk of developing lip cancer by exposing the person to ultraviolet (UV) rays.

Tobacco use and alcohol consumption

Any forms of tobacco use, including cigarettes, cigars, pipes, hookahs, and chewing tobacco, expose the cells in the lips to dangerous chemicals that can cause cancer. If we add tobacco use to too much sun exposure, the risk of developing lip cancer increases several times. Apart from this, most of the lip cancer cases also have excess alcohol consumption. There are more cases of lip cancer among people who both smoke and drink alcohol than those who use only one of these.

Precancerous lip lesions

Cancers are common on the lip, on top of precancerous lip lesions such as radiodermatitis, chronic cheilitis, and xeroderma pigmentosum. Radiation dermatitis occurs as a result of the damage to healthy lip skin cells caused by radiation therapy, which is a standard cancer treatment. Cheilitis is an inflammation of the lips, especially the lower lip. It may be acute or chronic. Sun damage, irritants, medications, infection, allergies, etc. can cause cheilitis. Xeroderma pigmentosum is a rare, genetic disorder. It is related to DNA repair defects caused by ultraviolet (UV) radiation. In the oral cavity, xeroderma pigmentosum causes non-healing ulcers on the lips and anterior tongue.

A weakened immune system

Compromised immune system conditions such as immunodeficiency states and immunosuppressive treatments to prevent organ rejection after organ transplantation are important risk factors for the development of lip cancer. Radiation therapy, chemotherapy, and surgery also adversely affect the immune system. A weakened immune system increases the risk of all types of cancer, including lip cancer.

Oral cancer-related inherited cancer syndromes

Some inherited cancer syndromes have a high potential to form oral squamous cell carcinoma. These syndromes are among the rare risk factors in the development of lip cancer. Xeroderma pigmentosum, ataxia telangiectasia, Bloom syndrome, Fanconi’s anemia, Li-Fraumeni are some of them.

In summary, factors that can increase the risk of lip cancer include:
Too much sun exposure and tanning bed use
All forms of tobacco use
Excess alcohol consumption
Precancerous lip lesions
A weakened immune system
Having light skin tone
Being a middle-aged or elderly male
Inherited cancer syndromes
Unhealthy lifestyle
Poor oral hygiene
Infections

Types of Tumors

Lip cancers are the most commonly squamous cell carcinoma and fewer basal cell carcinomas. Apart from this, the lip may have malignant minor salivary gland tumors, rarely melanoma, sarcoma, and metastatic cancers. Carcinomas are common on the lip, on top of precancerous lip lesions such as radiodermatitis, chronic cheilitis, and xeroderma pigmentosum.

Squamous cell carcinoma

Most of the lip cancers are squamous cell carcinomas, except for a small portion. This cancer develops from thin, flat cells called squamous cells that line the surface of the lip. Squamous cell carcinomas of the lip occur most frequently on the lower lip. Typically, squamous cell carcinoma originates in the red lip. They usually present with a possibility of neck metastases. Precancerous lip lesions such as xeroderma pigmentosum can also cause squamous cell carcinoma over time. Squamous cell carcinoma is the most common cancer of the mouth, throat, larynx, and pharynx regions.

Basal cell carcinoma

Basal cell carcinoma is the second most common lip cancer after squamous cell carcinoma. Mostly, basal cell carcinomas occur on the upper lip. Typically, basal cell carcinoma originates in the white lip. Basal cell carcinomas do not usually present lymph node metastases.

Minor salivary gland tumors

Adenoid cystic carcinoma, mucoepidermoid carcinoma, and adenocarcinoma are cancers arising from the microscopic salivary glands that cover the inner surface of the lip. Minor salivary gland tumors present as a swelling in the lip. They are less often in the upper lip than the lower lip.

Melanoma

Melanomas are malignant tumors that arise from the cells that give the skin its color. Lip melanoma has a more aggressive course than squamous cell carcinoma.

Sarcoma

Sarcomas are tumors derived from connective tissue. The oral cavity is an unusual site for these tumors and they are very rare among the malignancies of the lip.

Metastatic cancers

In very rare cases, metastasis to the lip may occur from cancers of other parts of the body. Although these cancers are on the lips, they are not considered lip cancer.

Diagnosis

A patient who suspects lip cancer should first consult a dermatologist or an ear, nose, and throat doctor (otolaryngologist). To diagnose lip cancer, the doctor first examines the patient’s face, mouth, under chin, and neck. Later, the doctor takes tissue samples from the suspicious areas of the lip for examination by the pathologist. Apart from this, the doctor may need various imaging tests to aid the diagnosis.

Physical exam

The doctor examines the lip lesion by examining the patient’s face, lip, inside of the mouth, under the chin, and neck. Under strong light, the sore, lump, pitting, crusting, or patch of the lip is examined. The doctor then checks the hardness and borders of the lesion. Then, the doctor examines the condition of the lymph nodes under the jaw and neck.

Removing a tissue sample

The doctor takes tissue samples from the suspicious areas of the lip and sends them to the pathology laboratory for examination by the pathologist. Examination of these tissue samples by the pathologist is necessary for the diagnosis of lip cancer. The doctor performs the tissue sampling (biopsy) under local anesthesia, if necessary, to avoid hurting the patient. The biopsy is not a procedure that will lead to the spread of the lip tumor.

Imaging tests

The mouth, under the chin, and neck regions of the patient are examined with one or more the imaging tests such as ultrasonography (USG), computerized tomography (CT), or magnetic resonance imaging (MRI). Positron emission tomography (PET) is important in determining whether the tumor has spread far beyond the lip.

Treatment

The treatment of lip cancer may vary according to factors such as the type, stage, location, spread of cancer, and general health of the patient. One of the treatments for small, early-stage, and non-spread cancers is freezing (cryotherapy). For these situations, surgery is another option. Surgical treatment is the main choice for late-stage lip cancers that have spread to surrounding tissues. Depending on the stage of cancer, treatment includes radiation therapy and chemotherapy when necessary.

If the tumor is large or in late stages, radiation therapy and chemotherapy are used to shrink the tumor before surgery or to reduce the risk of the tumor coming back after surgery. Depending on the situation, some patients may need surgery-radiation therapy, chemotherapy-radiation therapy combinations, targeted therapy, and immunotherapy. These treatments can be alone or in combination, depending on the stage of the disease, the health status, or the preferences of the patient.

Treating doctors

Dentists are sometimes the first to notice lip cancers during regular dental examinations. Head and neck surgeons-otolaryngologists, plastic surgeons, radiation oncologists, and medical oncologists often undertake the treatment of lip cancers. Dermatologists, dentists, psychiatrists, speech, nutrition, chewing, swallowing, and pain management experts can also participate in the treatment or after treatment.

Lip cancer surgery

Surgery is the main treatment for lip cancer. Successful treatment of late-stage lip cancer that has spread to surrounding tissues requires complete removal of the tumor. In this respect, surgery is generally in the foreground in the treatment of lip cancer. Surgery is also possible for early-stage, small, and non-spread cancers. Lip cancer surgery is almost always performed under general anesthesia.

Lip tumor removal

In lip cancer surgery, the surgeon removes the cancerous tissue along with some healthy tissue surrounding it. The main purpose here is to make sure that no cancerous tissue is left behind. Larger cancers of the lip need extensive surgery. Although the surgeon removes larger tissue in large tumors of the lip, using surrounding tissues for repair can provide highly acceptable cosmetic results. In early-stage cancers, the surgeon can completely remove the cancerous tissue without leaving any scars on the lips and without deteriorating the cosmetic appearance.

Lymph node removal

Lip cancers, especially lower lip cancers, can spread to the lymph nodes under the chin and then to the neck in the early period. Therefore, during surgery, the surgeon also removes some lymph nodes in the neck. Even in small cancers of the lip, the treatment of lymph nodes under the chin and neck is important. Because although the cancer is at an early stage, it can metastasize to these lymph nodes. In these cases, the surgeon removes the scattering points of cancer cells in the neck (neck dissection) in the same surgical session while removing the tumor.

In other words, while the surgeon removes the cancerous tissue of the lip, in the same operation, he removes the suspicious lymph nodes on the same or both sides of the neck with a cut from the neck. The surgeon does this for both therapeutic and prophylactic purposes in case cancer cells spread to the lymph nodes.

Lip reconstruction

After the surgeon has removed the cancerous tissue of the lip, he takes tissue samples from the healthy tissue margins. After the pathologist examines these tissue samples and reports them as clean, the surgeon goes to the lip repair phase. There are various surgical methods for lip reconstruction after the removal of lip tumors. The surgeon chooses the reconstruction method according to the area of cancer and how far it has spread to the lip.

Lip reconstruction aims to achieve an aesthetically and functionally acceptable result for the lip. Lip can be reconstructed by carefully planning the surgery. In this way, it is possible to maintain normal lip functions and to obtain a satisfactory appearance. The reconstruction method varies according to the surgeon’s experience, personal preferences, and the patient’s needs and preferences. Generally, special surgical techniques that reduce scarring are at the forefront of lip surgery. Especially, large tumors of the lip may require plastic surgeons.

Normalization after surgery

Depending on the size of the surgery performed on the lips, the postoperative hospitalization and recovery process may take a few days. The patient may experience difficulties in feeding orally in the first postoperative days. Therefore, the patient feeds with a tube that extends from the nose to the stomach. Generally, after a few days, the patient can feed orally and get rid of this tube. After the patient can eat and talk comfortably, the hospitalization period ends.

Radiation therapy

Additional treatments may be required after surgical removal of malignant tumors of the lip. Additional therapy is usually radiation therapy. Radiation oncologists use radiation therapy to destroy cancer cells. For radiation therapy to begin, the patient must first recover after lip surgery. In lip cancers, the main target in radiation therapy is the lip, under the chin, and neck regions. Radiation therapy alone is not sufficient in the treatment of lip cancers. However, radiation therapy is really helpful in preventing the recurrence of late-stage lip cancers.

Chemotherapy

Medical oncologists administer chemotherapy. In the treatment of lip cancers, chemotherapy is often added to radiation therapy. Because chemotherapy increases the effectiveness of radiation therapy. Chemotherapy uses powerful anti-cancer drugs to kill cancer cells. These drugs enter the bloodstream and reach cancer cells that have spread throughout the body.

Targeted therapy

Targeted therapy is a cancer treatment using drugs that target mainly cancer cells and cause little damage to healthy cells. Most of the targeted therapy drugs act differently than traditional chemotherapy drugs. Also, the side effects of targeted therapy drugs are generally milder than traditional chemotherapy drugs. Medical oncologists combine targeted therapy with chemotherapy in the treatment of lip cancers.

Immunotherapy

Cancer cells produce proteins that desensitize immune system cells. In this case, the body’s disease-fighting immune system cannot see the cancer cells and attack them. Immunotherapy makes our immune system more active against cancer by strengthening it. Immunotherapy can mostly be considered when cancer has progressed and other treatments are not an option. Medical oncologists administer immunotherapy.

Scarring and appearance after surgery

The repair performed after lip cancer surgery should be in a way that leaves the least scar. Because the lip is in a very prominent position on the face. In this respect, reconstruction after lip surgery should be done under aesthetic surgery procedures. However, some scars may remain in some patients depending on the skin characteristics. Apart from this, there may be some reduction in the mouth depending on the amount of lip tissue removed. However, thanks to advanced surgical reconstruction methods, this reduction is not usually noticeable.

Speech and feeding after surgery

Lips have a very important role in nutrition and speech. The lip may be slightly affected in terms of functionality (eg speech, nutrition) in the early postoperative period. However, after recovery, there is usually no functional problem in the lips. Therefore, the reduction in the mouth after lip cancer surgery is generally not in a size that will affect the nutrition and speech of the patient.

In addition, the patient can use a mouth moisturizer for dry mouth after radiation therapy. For this, ADA approved mouthwash (eg, Biotene Dry Mouth Oral Rinse, or as a different choice: TheraBreath Dry Mouth Oral Rinse, etc.) may be beneficial.

Prognosis

Lip cancer is one of the most treatable cancers of the head and neck. The recurrence-free survival rates of the patients are very high. The main reason for this is that the lips are in a prominent position on the face. Therefore, this allows early detection of lip cancer. Neglected tumors of the lip have a worse prognosis. Because in these cases, lip cancer can gradually metastasize to the floor of the mouth, gums, jawbone, and distant parts of the body. In such cases, survival rates may decrease according to the spread of cancer. Lip cancer is often cured if treated with care at an early stage, along with the neck area.

Follow-up care

The risk of developing second cancer in the head, neck, or mouth after lip cancer treatment is higher in the patient than in other people. Accordingly, the patient comes for a check at certain intervals determined by the doctor for a certain period of time after the treatment process. This control process can take up to 5 years. During the check-ups, the doctor monitors the patient by examining whether cancer has recurred or not. Recurrence of lip cancer after the fifth year is not a recurrence. This is new cancer in the same or close area.

Recurrence of lip cancer

Lip cancer usually does not recur with adequate surgery and treatment of the neck region of the patient. However, the recurrence of cancer does not mean that everything is over. Because, with comprehensive treatment, treatment of lip cancer is often still possible.

Prevention

Avoid excessive sun exposure

Spending too much time in the sun is the most common risk factor for developing lip cancer. Light-skinned people are particularly at risk in this regard. Accordingly, avoid the sun as much as possible during the middle of the day. By protecting the face and lips with protective cream or a sun-protective hat, the risk of developing lip cancer can be reduced.

Stop tobacco use

Tobacco use affects the occurrence of lip cancer and its recurrence. Tobacco use of any kind exposes the cells of the lips to dangerous cancer-causing chemicals. With the addition of tobacco use over long-term exposure to sunlight, the risk of developing lip cancer increases exponentially.

Stop the excessive use of alcohol

One of the things that are necessary to prevent lip cancer is to limit alcohol consumption. In particular, people who have received treatment for lip cancer should definitely stop alcohol consumption. In addition, the use of alcohol-containing oral care products is also risky. Because they regularly expose the lips and mouth to alcohol. That is why, the use of alcohol-free products is safer. These products may be ADA approved mouthwash: TheraBreath Fresh Breath, CloSYS Sensitive Gentle Mint, CloSYS Ultra Sensitive Unflavored. Or as a different choice: Tom’s of Maine Natural Wicked Fresh, etc.

Avoid using tanning beds

The tanning bed emits cumulative ultraviolet (UV) light, which is likely to cause lip cancer. It is possible to greatly prevent lip cancers by avoiding or limiting exposure to ultraviolet rays.

Have regular dental checkups

People at high risk for lip cancer should not miss regular dental checkups. Because dentists are usually the first to notice the symptoms of lip cancer during regular dental checkups.

Live a healthy life

To reduce the risk of developing lip cancer, it is necessary to avoid exposure of the lip to chemicals. It is important to maintain oral health, eat a healthy diet, and keep immunity and morale high. People who have received treatment for lip cancer should end their risky lifestyle and behavior.