What Is Gum Cancer (Gingival Cancer)?

Heavy alcohol use and tobacco may raise your risk for gum cancer. But sometimes, the cause isn't known.

What raises your risk of gum cancer?

You may have a higher risk for gum cancer if you:

• Chew tobacco or use other tobacco products
• Are 60 or older
• Use betel nut, a seed and fruit from the areca palm
• Have chronic gum trauma — sharp, hard edges from dental appliances, prosthesis, or bridges can damage your gums

“What we know is that gum cancer risks are also the ones for a lot of other cancers, like tobacco and alcohol use,” Roche says. “Another risk factor is poor oral [health].” 

And if you drink alcohol and smoke tobacco, you're 15 times more likely to get oral cancer.

Do nicotine pouches cause gum cancer?

It's unclear if nicotine pouches cause cancer. Your body absorbs other chemicals besides nicotine. One study found cancer-causing tobacco-specific nitrosamines in 26 pouch brands. 

Nicotine pouches also contain: 

• Ammonia

• Formaldehyde

• Nickel

The pouches can "irritate your gum and cheek tissue," says Roche. The irritation helps your body absorb the nicotine faster but also can act as a chronic trauma. And Roche says trauma is a "risk factor for gum cancer."

What Are the Most Common Symptoms of Gum Cancer?

You may not have symptoms for gum cancer. Without treatment, your gingival cancer can grow. But with regular dental checkups, you can catch gum cancer early. 

With gum cancer symptoms, you may have:

• A white or red patch on your gums
• A mouth sore or ulcer that doesn't heal
• A lump, thicker spot, or swelling
• Bleeding gums
• A loose tooth or teeth
• Dentures not fitting as well
• A warty lump
• Pain, tingling, or numbness
• Headaches
• Problems moving your jaw
• Weight loss

Sometimes your symptoms can happen for other reasons. If a discolored spot or mouth sore isn't going away after two weeks, see your doctor or dentist.

What Does Gum Cancer Look Like?

What your gum cancer looks like can depend on the type. 

Your gum cancer can look like:

• A red or white patch
• A darker gum area
• Cracked or bloody gums
• A thicker spot on your gums

Verrucous cancers can look like a velvety or warty bump. And spindle cell cancer can look like an ulcer that doesn't heal.

How Is Gingival Cancer Diagnosed?

Your dentist can often diagnose your gum cancer using a small mirror. They’ll shine a light to look at your gums. 

This helps your dentist see the color inside your mouth. Your dentist will check for any white or red patches, lumps, or sores.

Which tests can diagnose gum cancer?

Your doctor or dentist may diagnose you with one or more of these:

• An oral exam checks your mouth, gums, tongue, and neck. They'll feel your lymph nodes to see if there is any swelling.
• A toluidine blue test using a special dye to stain abnormal cells on a darker blue color.
• A fluorescent light test that shines a light into your mouth to reflect differently off abnormal tissue.
• A biopsy, which numbs the area before removing a small piece of gum tissue that a laboratory checks for cancer cells.
• Imaging tests to check for cancer in your soft tissues, jaw, or lymph nodes — bone, computed tomography (CT), MRI, or positron emission tomography (PET) scans.
• An endoscopy to check for cancer — the doctor inserts a small tube with a camera down your throat to see make images for your doctor to examine.

Your doctor may also do immunohistochemistry testing on your cancer cells. The test can tell if your cancer cells make a protein called PD-1.

What Are the Stages of Gum Cancer?

Your cancer stage can tell you how far your cancer has spread. Your doctor will look at how much cancer you have in your mouth.

The American Joint Committee on Cancer (AJCC) commonly uses the TNM staging system:

• Tumor is the size of your tumor

• Lymph nodes means cancer spreading into nearby nodes

• Metastasis is how far your cancer has spread

Your doctor may also use cancer stages with Roman numerals (I-IV). But many people use numbers instead (stages 1-4).

Stage 0 gum cancer

This stage is also called carcinoma in situ (Tis, N0, M0).  Cancer cells are still on the surface lining your mouth. If left untreated, the abnormal cells can turn into cancer.

Stage 1 gum cancer

This stage is also called T1, your tumor is smaller than 2 centimeters (cm). The abnormal cells are local (N0) and not in other organs (M0). 

Stage 2 gum cancer

Stage 2 gum cancer is smaller than 4 cm (T2, N0, M0) and can go up to 10 millimeters (mm) deep.

Stage 3 gum cancer

Can Surgery Treat Gingival Cancer?

Surgery often treats gum cancer depending on your cancer stage and oral health. If you use tobacco, your doctor can help you quit. 

“The first-line standard of care for gum cancer is surgery,” Roche says. “It involves removing the mucosa, the surface lining. Generally, it also removes underlying bone.” 

Depending on where you cancer is located, you may get:

• Partial-thickness mandibular resection (marginal mandibulectomy) to remove a small piece of your jawbone.
• Segmental mandibulectomy to remove a larger part of your jawbone. The surgery uses another bone, donor bone, or metal plate to replace it.
• Maxillectomy or partial maxillectomy surgery to take out the front part (maxilla) or roof of your mouth.

Your doctor may also suggest:

• Neck dissection to remove cancer in nearby lymph nodes.

• Reconstructive surgery using your own bone, muscle, or skin. The surgery restores your appearance, ability to talk, or swallow.

• Tracheostomy makes a hole (stoma) in the skin of your windpipe. 

• A nasogastric tube goes down your throat into your stomach to help you swallow.

• Gastrostomy tube (G-tube) tube goes through your belly's skin and muscle to deliver food into your stomach.

• Dental work can extract or implant teeth.

How does radiation therapy for gum cancer work?

Living With Gingival Cancer

After treatment, talk with your doctor about your survivorship care plan to stay healthy. The plan includes future follow-up visits, long-term side effects, and healthy living ideas.

“That means eating a nutritious diet, like a whole food, plant-based diet," says Roche. "It’s part of our cancer survivorship guidelines."

You may need to modify what you eat. Talk to a dietitian to design a meal plan. They can help work around your ability to eat or drink.

For an overall healthy lifestyle, you can try to:

• Eat more soft foods like smoothies

• Brush at least twice a day

• See your dentist regularly for oral care and checkups 

• Avoid alcohol

• Quit smoking or using tobacco products

• Stay physically active, take regular walks, or stretch

• Clean your dentures or oral appliances regularly

• Reach a healthy weight

Radiation and chemotherapy can cause some side effects. Ask your dentist about medication, special mouthwash, or laser therapy to soothe mouth sores. Honey can also help prevent mouth sores and lower inflammation. 

Your dentist can also suggest toothpaste or a saliva substitute for dry mouth. If you have mouth discomfort, an ulcer, or a discolored spot that isn't going away, follow up with your dentist right away.

Takeaways

Gum (gingival) cancer grows in the lining of your mouth. Alcohol, tobacco, or betel nut use can raise your risk for this rare type of head and neck cancer. If a mouth ulcer or discoloration isn't healing after two weeks, talk to your dentist or doctor about gum cancer.

Gum Cancer (Gingival Cancer) FAQs

How common is gum cancer?

Gum cancer is rare — only 10% of all head and neck cancers are gum cancer.

Is gum cancer painful?

Gum cancer can cause pain, but sometimes you may not have any symptoms. You can get head, mouth, or jaw pain. You can also get ulcers that won't heal.

Does gum cancer spread fast?

Your gum tissue is very thin. So gum cancer can quickly move into your bone underneath. 

“The tricky thing about gum cancer (alveolar ridge cancer) is the thin layer of mucosa — it doesn't take much for cancer to get into the underlying bone,” says Roche. “And staging is important because once the cancer is in the bone, it’s automatically stage 4.”

How curable is gum cancer?

Most people do well after treatment for stage 1 and stage 2 gum cancer. And prompt treatment can cure some early-stage gum cancer.

How long can you live with gum cancer?

One study looked at gum cancer including tongue tumors. About 68.5 in 100 people lived for five years after treatment.

But another study points out that many factors can change your survival. Cancer stage, tumor location, oral health, treatments, or smoking habits matter, too. Talk to your doctor about your exact risk.

How do they remove gum cancer?

Your doctor will usually remove gum cancer with surgery. If surgery isn't an option, your doctor may suggest chemoradiation or immunotherapy.

Do dentists deal with gum cancer? 

Your dentist can usually diagnose gum cancer. “We get a lot of referrals from dentists,” Roche says. Dental hygienists notice signs too. 

“Dental professionals are the ones who are really looking everywhere. They’re feeling for lumps and bumps and unusual little spots in the mouth.” 

Does gum cancer require chemo?

Chemoradiation can shrink your tumor before or after surgery. And if surgery isn't an option, you may get chemoradiation.