Lip cancer

A persistent sore or lump on your lip may be an early symptom of lip cancer, a type of oral cancer.

What is lip cancer?

As with other oral cancers, this type typically results when the squamous cells on the surface layer of the mouth and lips begin to grow abnormally. Most new cases are diagnosed in patients in their late 60s or early 70s, and it often occurs on the lower lip.

How common is it?

Oral (mouth) cancers represent about 3 percent of all cancers diagnosed annually in the United States, according to the U.S. Centers for Disease Control and Prevention, and lip cancer is just one form of oral cancer.

The National Cancer Institute’s (NCI) Surveillance, Epidemiology, and End Results (SEER) Program estimates the chance of developing lip cancer over your entire lifetime at about 0.1 percent, or one chance in a thousand. Newly diagnosed cases of lip cancer amounted to six per 1 million American adults annually from 2014 to 2018.

What causes lip cancer?

Too much exposure to sun or ultraviolet (UV) light from tanning equipment is a risk factor that’s specific to lip cancer, as is having fair skin. Although it shares these risk factors with skin cancer, health experts group lip cancer with oral cavity and oropharyngeal (throat) cancers.

Risk factors for this group of cancers include:

• Tobacco use, whether it be cigarette, pipe or cigar smoking, or chewing tobacco
• Heavy alcohol consumption
• HPV (human papillomavirus) infection, since strains of this sexually transmitted virus have been linked to genital warts and cancers of the genitals, anus, mouth and throat
• Being male, as men develop oral cavity and oropharyngeal cancers at double the rate of women, which may also be tied to alcohol and tobacco use
• Age, as people older than 55 make up most oral and oropharyngeal cases, though most HPV-related head and neck cancers tend to be found in people younger than 50
• Diet lacking in vegetables and fruit
• Certain genetic syndromes

While you can’t change your age, you can take steps to limit other risk factors, including:

• Eating a healthy diet
• Avoiding tobacco and excessive alcohol consumption
• Limiting exposure to sunlight and artificial tanning light
• Reducing exposure to various HPV strains by restricting the number of your sex partners

Lip cancer symptoms and signs

You, your dentist or dental hygienist, or your doctor may suspect lip cancer if any of these signs are present:

• Lesion, blister, lump or sore that doesn't heal
• Discolored patch on the lip that’s red or white, or a dark spot
• Persistent lip pain or numbness
• Thickening of the lip
• Bleeding from the lip
• Neck mass or growth

How is lip cancer diagnosed?

After a physical and visual examination of your lips and mouth, a biopsy or tissue sample is typically taken to verify that what you have is cancer.

Your doctor may initially perform a quick and simple method called exfoliative cytology. The surface of the suspected tumor is scraped and the sample placed on a glass slide, stained with a dye and examined under a microscope. Evidence of abnormal cells may lead to removal of a small amount of tissue for further testing. This is called an incisional biopsy and can be done in your doctor’s office after your lip has been numbed with an anesthetic.

If you have a mass growing in your neck, a fine needle aspiration (FNA) biopsy may be done to see if it contains cancer cells. Not all growths are cancerous; some are harmless cysts or lymph nodes enlarged by infection.

If you have a history of tobacco and/or heavy alcohol use, it’s possible to simultaneously develop cancer in more than one area of your body. Tobacco and alcohol are risk factors for many cancers, including oral, throat, lung and esophageal. People who smoke and drink heavily are about 30 times more likely to develop any oral cavity and oropharyngeal cancer, according to the American Cancer Society.

Your doctor may decide to perform a panendoscopy, in which a variety of endoscopes (thin, flexible tube-like instruments) are used to look at your throat, esophagus, windpipe (trachea) and the bronchi that branch off into the lungs. General anesthesia is usually administered for this procedure.

Lip cancer treatment

Your lip cancer treatment depends upon several factors, such as:

• Age and state of health
• Size and location of the tumor
• Stage, or point in progression, of the cancer
• How treatment may affect appearance and the ability to eat, drink and speak

Progression for lip and oral cavity cancers range from stage 0, also called carcinoma in situ, which is when abnormal cells exist on the surface but have not grown into neighboring tissue, all the way to stage 4C, which is when cancer has spread to distant parts of your body. Standard treatment begins with surgical removal of the tumor and some surrounding tissue (called wide local excision) or radiation therapy.

• For stages 1 and 2 lip cancer, doctors may use excision of the tumor and surrounding tissue along with internal radiation therapy. This therapy inserts radioactive material in or near the tumor. It may be employed alongside standard external radiation.
• For stages 3 and 4, clinical trials of chemotherapy, chemotherapy with radiation, or hyperfractionated radiation therapy (in which radiation is given in small doses) may be added to surgery and radiation therapy.

If cancer has spread from the lips, doctors may perform a procedure called a neck dissection, which removes lymph nodes and tissue in the neck. Plastic surgery to restore the use and appearance of affected areas may be necessary.

After initial treatment, your medical team will follow up to see how you’re recovering and if there’s any sign of cancer returning.

A clinical trial of hyperthermia, another therapeutic approach, may be used for recurrent lip cancer. During this technique, tumor cells are heated to kill them or impede their growth or make them more susceptible to radiation and chemotherapy.

Lip cancer survival rates

Lip cancer isn’t usually as deadly as some other cancers. According to the NCI’s SEER database, the death rate was two per 10 million annually for the years 2015 to 2019.

The overall five-year relative survival rate, the percentage of people expected to be alive five years after diagnosis, is compared with other cancers below. All are for the time period 2011 to 2017.

• Lip cancer: 90.9 percent
• Female breast cancer: 90.3 percent
• Lung and bronchus cancer: 21.7 percent
• Liver cancer and intrahepatic bile duct cancer: 20.3 percent

Five-year relative survival rates in SEER are also broken down into three stages:

• Localized, when the cancer appears not to have spread from its original site
• Regional, when cancer has infiltrated neighboring tissues and lymph nodes
• Distant, when it has spread to sites far from the original tumor location

For lip cancer, SEER gives the five-year relative survival rates per stage for the years 2011-2017 as:

• Local: 93.2 percent
• Regional: 64.9 percent
• Distant: 32.6 percent
• All stages combined: 90.9 percent

The five-year survival rate for all oral and oropharyngeal cancers is 66 percent, which rises to 85 percent if diagnosed in an early stage, according to the American Society of Clinical Oncology.

Prognosis varies depending on how far your cancer has advanced. Generally, a disease that’s caught and treated early, or when a tumor is small, has better outcomes than cancer that has grown and spread.