Gum cancer, also known as gingival cancer, is a relatively rare type of oral cavity cancer. It is more commonly seen in people who smoke or use chewing tobacco.

What is gum cancer? 

Gum cancer is usually a type of squamous cell carcinoma. It is considered a head and neck cancer, and it is often described by its location:

• Maxillary gum cancer is found in the upper jaw.
• Mandibular gum cancer is found in the lower jaw and is more common than maxillary gum cancer.

Gum cancer is rare in the United States. Because of its rarity, reports of the disease are usually grouped together with those of other oral cancers. Overall, about 11.5 out of every 100,000 adults develop oral cavity cancer each year. Gum cancer accounts for less than 10% of oral cavity cancer cases in the United States.

What causes gum cancer? 

Gum cancer most often affects people over age 60. People who have a condition called proliferative verrucous leukoplakia (PVL) are more likely to develop gum cancer. PVL causes patches of thickened white lining (leukoplakia) to develop on the gums and in the mouth. Sometimes, the cause of leukoplakia is associated with irritation and inflammation. In other cases, the cause is unknown.

Some research has found a link between gum cancer and Porphyromonas gingivalis, the most common bacteria associated with periodontal disease. This suggests that poor oral hygiene might increase the risk of gum cancer, but more research is needed to fully understand the link between gum disease and cancer.

Other factors that increase the risk of gum cancer include:

• Use of tobacco, including chewing tobacco
• Heavy alcohol use
• Betel nut use

However, some people develop gum cancer without any known risk factors.

What are the signs and symptoms of gum cancer?

Gum cancer symptoms include:

• A lump, swelling or irregular ulcer
• A sore that does not heal
• A white or red patch around the gumline or teeth
• Loose teeth or changes to the fit of dentures
• Pain, tingling or numbness
• Tooth extraction wounds that don’t heal
• Unusual bleeding of the gums

Early symptoms of gum cancer can mimic those of periodontal diseases such as gingivitis.

How is gum cancer diagnosed?

Dentists are often the first providers to notice signs of gum cancer. After seeing something suspicious, a dentist usually refers the patient to a medical doctor for diagnosis. If gum cancer is suspected, a doctor will perform tests including the following.

• Physical exam: The doctor examines the mouth, gums, tongue and neck. The doctor also discusses the patient’s health history and asks about risk factors such as tobacco and alcohol use.
• Biopsy: During a biopsy, the doctor removes a small amount of tissue from the gums. A pathologist examines the cells under a microscope to look for signs of cancer.
• Imaging: Tests such as CT (computed tomography) scans and MRI (magnetic resonance imaging scans may be used to assess the cancer. They can also determine whether cancerous cells have spread beyond the gums and into surrounding soft tissues, bones and lymph nodes.
• Endoscopy: A doctor uses a small scope to see if cancer has spread beyond the mouth.

How Gum Cancer Can Spread

Using these tests, doctors determine how advanced the cancer is. As gum cancer progresses, it can spread into other structures such as the sinuses or jawbone. It can also spread to lymph nodes in the neck and possibly other parts of the body. The size of the tumor does not always predict how aggressively it will spread.

When oral cavity cancer is diagnosed, it is classified by stage. The following stages indicate how advanced the cancer is.

• Stage 0: In this stage, abnormal cells are present on the gums. Stage 0 cancer is sometimes referred to as carcinoma in situ. Untreated, the abnormal cells can develop into cancer.
• Stage I: At this stage, cancer has developed but has not spread beyond the gums. Stage I oral cavity cancer is usually less than 2 centimeters wide and does not extend deeper than 5 millimeters into the tissue.
• Stage II: Stage II tumors are 4 centimeters or smaller and extend 5 millimeters to 10 millimeters deep.
• Stage III: Stage III cancers may have the following characteristics.
• Stage IV: In this stage, the cancer has extensively spread in the mouth and surrounding areas such as the sinuses, soft tissues or deep tongue muscles. It could also spread into several lymph nodes or other parts of the body. Typically, the cancer first reaches areas such as the tongue, floor of the mouth, sinuses or facial soft tissues. Later, it may spread beyond the oral cavity to areas such as the lungs, liver or bones.

Gum Cancer Treatment

People with gum cancer may be treated with one or more therapies.

Surgery

Surgery for gum cancer may include the following.

• Tumor resection: Surgery is usually the primary treatment for gum cancer. In some cases, people may not need additional treatments. The extent of the surgery depends on how far the tumor has spread. When the cancer is advanced, it may be necessary to remove parts of the jawbone or tongue and other soft tissues.
• Reconstructive surgery: Some people have reconstructive surgery to repair the damage caused by tumor removal. In such cases, plastic and reconstructive surgeons may use bone grafts, skin grafts or advanced techniques that use muscle flaps from surrounding areas (free flap surgery or reconstructive microsurgery) to restore form and function to the jaw, mouth and face.

Radiation Therapy

Radiation therapy is often used as a secondary treatment after the tumor is removed during surgery. Gum cancer may be treated with external beam radiation.

Chemotherapy

Chemotherapy is used less often than surgery and radiation for treating gum cancer. In some cases, though, chemotherapy is used in combination with radiation therapy to increase treatment effectiveness.

Immunotherapy

Immunotherapy works by training a person’s immune cells to fight cancer. Researchers are studying immunotherapy for oral cancers and whether it can be used before surgery or radiation. For cancer that returns after treatment, immunotherapy may be used if chemotherapy stops working.

What is the outlook for people with gum cancer?

The success of gum cancer treatment depends on many factors, including how advanced the cancer is. Survival rates are higher if the cancer is treated completely, before it spreads to the lymph nodes.

If gum cancer has spread into nearby bone, treatment can result in significant side effects, including:

• Cosmetic impacts
• Difficulty chewing
• Nasal leakage
• Speech changes
• Trismus (lockjaw)

While these side effects can be challenging, some people have success using prosthetic coverings to restore function and cosmetic appearance. People who use a prosthesis are often able to chew and speak normally.