Hard palate cancer is a type of cancer that starts on the roof of your mouth, known as the palate. This area has two sections: the soft part toward the back of your mouth and the hard, bony part at the front, where this type of cancer begins.
Hard palate cancer comes in different types:
Squamous cell carcinoma is the most common. It causes about 9 out of 10 cases. You’re more likely to get it if you smoke, drink heavily, or don’t take care of your teeth and gums.
Adenoid cystic carcinoma starts in the salivary glands on the roof of your mouth. Doctors aren’t sure what causes it, but it may be linked to changes in your DNA.
Mucosal melanoma is very rare. Fewer than 100 people in the U.S. are diagnosed with it each year.
What Causes Hard Palate Cancer?
Tobacco use and heavy alcohol drinking can raise your risk of getting hard palate cancer. Most oral cancers start in the lower part of your mouth, where cancer-causing substances tend to collect due to gravity. But these habits can affect the roof of your mouth, too.
“Hard palate cancers are distinctive in that they have less exposure to carcinogens," says John Cramer, MD, a surgical oncologist who specializes in head and neck cancers at Karmanos Cancer Institute in Michigan. "The lining of the hard palate is thicker, which may also make it tougher, so we have less cancer than some other areas that are more sensitive to carcinogens.”
What increases your risk for hard palate cancer?
Other activities that raise your chances of hard palate cancer include:
- Chewing betel nuts. You chew the seed of the areca palm, often mixed with tobacco or lime. This can hurt the lining of your mouth. This practice is most common in Asia and the Solomon Islands. But some people in the U.S. chew betel nuts.
- Reverse smoking, or placing the lit end of a cigarette in your mouth.
What Are the Most Common Symptoms of Hard Palate Cancer?
A common symptom of hard palate cancer is a painless bump on the roof of your mouth. Over time, it can begin to hurt. Other symptoms include:
- Bad breath (halitosis)
- Feeling like your teeth or dentures are loose
- Swallowing problems
- A lump in your neck
- Bleeding in your mouth
- Speech changes
- Trouble opening your jaw
How Is Hard Palate Cancer Diagnosed?
Hard palate cancer can be hard to catch early. Your dentist will probably be the first person to spot signs during a regular cleaning or checkup since they can easily see the roof of your mouth.
"If you have a sore or spot that doesn’t go away after three weeks, you should see a dentist or an ear, nose, and throat (ENT) doctor. Hopefully we can diagnose more of these patients at an early stage when [cancer is] much more treatable,” Cramer says.
When you visit your doctor, they’ll want to know about your symptoms, such as pain, sores on the roof of your mouth, or trouble swallowing. And they’ll ask questions about your habits, including tobacco use and how often you drink alcohol.
What tests can diagnose hard palate cancer?
Finding hard palate cancer early gives you a better chance of going into remission. Your doctor will suggest certain tests to confirm or rule out a hard palate cancer diagnosis. They include:
Biopsy: Your doctor takes a small sample of tissue and looks at it under a microscope to check for cancer cells. They may use a thin needle (called a fine needle aspiration), a tool that punches out a small piece (punch biopsy), or a scalpel to remove part of the area (incisional biopsy).
Imaging Tests: Your doctor may use one or more of these imaging tests to check the size of the tumor and see if the cancer has spread:
A CT scan or X-ray shows the size of the tumor and if it has reached nearby bone or lymph nodes.
A PET scan can show if the cancer has spread to your lymph nodes, lungs, or other areas.
Orthopantomography, also called a panorex, gives a wide view of your upper and lower jaw to see if cancer has reached your jawbone.
An MRI uses magnets to take clear pictures of the inside of your mouth and neck.
What Are the Stages of Hard Palate Cancer?
Your doctor will use information from imaging tests and biopsies to figure out the stage of your cancer, meaning how a tumor has grown or spread. They may define the stage by number (stage 1 to 4) or by tumor designation (T). To help stage the cancer, your doctor will use the TNM system. This system looks at:
- The size of the tumor (T)
- Whether it has spread to nearby lymph nodes (N)
- Whether it has reached other parts of your body (M)
Based on this information, your doctor will assign a stage number.
Stage 1 hard palate cancer
At this stage, the tumor is classified as T1. It measures 2 centimeters or less in diameter and is 5 millimeters or less in depth.
Stage 2 hard palate cancer
While the tumor has grown in size and depth, at this stage, your lymph nodes or other parts of your body aren’t affected.
Stage 3 hard palate cancer
At this stage, the tumor is at least 4 centimeters wide and more than 10 millimeters deep. It has also impacts your lymph nodes.
Stage 4 hard palate cancer
This stage has three subdivisions:
- 4A. At this stage, the tumor has spread to nearby lymph nodes but no further than your hard palate.
- 4B. At this stage, cancer affects your soft tissues, including muscles and tendons.
- 4C. Other areas of your body, besides the neck lymph nodes, have cancer cells.
Stages by tumor designation
Doctors also use the tumor’s size and depth to help stage hard palate cancer. These stages include:
- Tumor in situ (Tis). With this early stage, cancer cells appear in a single layer of tissue.
- T1. This stage includes tumors that measure 2 centimeters or less and those that have a depth of 5 millimeters or less.
- T2. At this stage, the tumor measures between 2 and 4 centimeters and has a depth of 5 to 10 millimeters.
- T3. This stage includes tumors larger than 4 centimeters that are at a depth of more than 10 millimeters.
- T4. This is when the tumor has grown into nearby bones.
How Is Hard Palate Cancer Treated?
There are different ways to treat hard palate cancer. Your treatment will depend on the stage of your cancer.
Can surgery treat hard palate cancer?
Doctors usually treat this type of cancer with surgery. A head and neck cancer surgeon will take out the tumor and any affected lymph nodes. Your doctor may recommend one of these procedures:
Maxillectomy. In this procedure, your doctor removes the tumor by making an opening in the roof of your mouth. They may take out part or all of your hard palate. To fill the gap, your doctor can place a palatal plate made of acrylic. This fits into the roof of your mouth and stays in place with an orthodontic wire. In some cases, your doctor may use soft tissue from another part of your body to close the gap.
Neck dissection. If cancer cells have spread to the lymph nodes in your neck, your doctor may take out some or all of them to stop cancer from spreading to other parts of your body.
Other treatments for hard palate cancer
For advanced hard palate cancer, your doctor will probably suggest surgery along with radiation and maybe chemotherapy or immunotherapy.
The FDA has approved the immunotherapy drug pembrolizumab (Keytruda) for adults with certain types of advanced head and neck cancer. This treatment helps your immune system find and attack cancer cells. In a large clinical trial, people who took pembrolizumab before and after surgery lived nearly twice as long without their cancer getting worse, coming back, or leading to death compared to those who didn’t take the drug.
Opdivo is another type of immunotherapy that helps your immune system find and attack cancer cells. It works by blocking a protein that stops your immune system from doing its job. Your doctor might recommend Opdivo if surgery, radiation, or chemotherapy didn’t fully work, or if your cancer returns.
What are the side effects of hard palate cancer treatment?
Treatment for hard palate cancer may cause side effects including:
Surgery:
- Trouble speaking
- Chewing and swallowing problems
- Nerve damage
Radiation:
- Extreme tiredness (fatigue)
- Changes to your skin (redness, irritation, and swelling)
- Hair loss
- Low blood counts
- Mouth or throat soreness
- Dry mouth
- Swallowing problems
- Changes in taste
- Feeling sick to your stomach (nausea)
- Jaw stiffness
Chemotherapy:
- Fatigue
- Hair loss
- Low platelet count (thrombocytopenia)
- Low white blood cell count (neutropenia)
- A higher chance of infection
- Low red blood cell count (anemia)
- Nausea and throwing up
- Changes to your hunger
- Trouble pooping (constipation)
- Loose, watery poop (diarrhea)
- Mouth sores
- Nerve problems
- Skin and nail changes (rash, dry skin, and color)
- Loss of bladder and bowel control (incontinence)
- Weight changes
- Concentration and focus issues (“chemo brain”)
- Anxiety
- Depression
- Changes to your sex drive and sexual function
- Fertility problems
Immunotherapy:
- Nausea
- Skin changes (dryness, itching, and rash)
- Shortness of breath
- A drop in thyroid hormones
- Loss of appetite
- Headache
- Diarrhea or constipation
- Pain
- Fatigue
- Fluid buildup
- Fever
Living With Hard Palate Cancer
Treatment for hard palate cancer can leave lasting effects on your breathing, swallowing, drinking, eating, and speech. This, in turn, can impact your emotional and physical health. Rehab is a crucial part of living with hard palate cancer and may involve:
Reconstructive or plastic surgery. After having a tumor removed, you could need a prosthetic device called an obturator to cover the hole left by surgery. More complex cases may call for reconstructive surgery, where doctors take tissue and sometimes bone from your thigh, arm, or another part of your body to rebuild the area.
Speech therapy. Treatment for hard palate cancer can change your voice. A speech therapist helps you get your speech back.
Dietitian. A dietitian will suggest a personalized post-treatment food plan tailored to your needs.
Emotional support. Cancer treatment can leave you feeling tired, socially isolated, depressed, and with low self-esteem. A counselor or therapist can help you work through the emotional issues surrounding cancer.
Follow-up doctor appointments. Regular checkups with your doctor will track any health changes and whether cancer has come back. Experts suggest follow-ups for at least 10 years after treatment. They’ll be more frequent at first, then taper off.
Takeaways
Hard palate cancer is a rare type of mouth cancer that starts on the roof of your mouth. You’re more likely to get it if you drink a lot of alcohol or use tobacco. Signs include a painless bump, trouble swallowing, bad breath, or changes in how you speak. Treatment often starts with surgery. You may also need radiation, chemotherapy, or immunotherapy. Side effects depend on the treatment and can affect how you eat, talk, or feel emotionally.
Hard Palate Cancer FAQs
How common is hard palate cancer?
Hard palate cancer makes up about 1% to 5% of all oral cancers and 3% of cancer cases overall. Because it’s rare, there’s not a lot of awareness about it.
How do you check for hard palate cancer?
To do a self-check at home, first check your face and the area around your head for any out-of-the-ordinary lumps. Then check the inside of your mouth for any lumps that have lasted for longer than three weeks. To inspect your hard palate, tilt your head back for better viewing, and then run your fingers along the roof of your mouth.
What does early hard palate cancer look like?
You’ll probably first notice a painless sore or bump that doesn’t heal.
What age do people get palate cancer?
Oral cancer tends to affect people around age 64, but about 20% of cases happen in those below 55.
What’s the survival rate for hard palate cancer?
Research shows the five-year survival rate for hard palate cancer is between 33% and 86%, depending on the tumor size and which treatment you have.
How fast does hard palate cancer grow?
Oral cancer can take a long time to show symptoms, but once it appears, it may spread quickly. The speed at which it grows depends on the type of cancer, where it starts, and how soon doctors spot it.
What does palate cancer feel like?
You may first notice a painless ulcer. As the cancer advances, you can have pain, bleeding, bad breath, loose teeth, speech changes, and other symptoms.
How curable is hard palate cancer?
With surgery, hard palate cancer is curable, especially for small tumors. Large tumors are harder to treat. It’s also possible for the cancer to return after treatment.
