Ask the Expert: Hidden dangers of oral cancer

Simon Young, DDS, MD, PhD | Professor and Acting Chair for Katz Department of Oral and Maxillofacial Surgery at UTHealth Houston School of Dentistry, and Oral and Maxillofacial Surgeon at UT Physicians. (Photo by UTHealth Houston)

Welcome to "Ask the Expert," a UTHealth Houston newsroom series where our leading physicians examine pressing health challenges. In this edition, we address oral cancer, symptoms, diagnosis and treatment, and the research at UTHealth Houston.

Oral Cancer Awareness Month is observed every April, and it highlights the urgent need for early detection. According to the American Cancer Society, Oral and oropharyngeal cancers still claim about one life every hour in the U.S. Below is a clear, fact-packed overview to help you understand why this month matters and what the latest data shows. This year, 59,600 Americans will be diagnosed with oral or oropharyngeal cancer. Many people are unaware of symptoms because early stages often cause no pain and may be inconspicuous. Most cases are diagnosed late, when treatment is harder and survival drops.

What are the causes of oral cancer?

Oral cancer develops in the cells lining the mouth when changes lead to uncontrolled growth. In many cases, this process occurs gradually, with normal tissue progressing through precancerous stages before becoming invasive cancer.

The most well-established risk factors remain tobacco use and alcohol consumption, particularly when used together. These exposures account for a large proportion of oral cavity cancers.

At the same time, the broader landscape of head and neck cancer is evolving. Human papillomavirus (HPV) has become a major cause of cancers in the back of the throat (often referred to as throat cancers), especially in the tonsils and base of tongue. However, HPV is associated with only a small proportion of cancers that arise in the oral cavity itself.

Other contributing factors may include chronic inflammation, sun exposure for lip cancers, and individual susceptibility. In some patients, oral cancer can still develop without any clearly identifiable risk factors, which underscores the importance of routine examinations and early detection.

Symptoms of oral cancer

Oral cancer can be difficult to detect early because it is often painless in its initial stages. Many patients do not notice symptoms until the disease has progressed.

Common symptoms include: 

•     A sore in the mouth that does not heal
•     Red or white patches on the gums, tongue, or lining of the mouth
•     A lump or thickened area in the oral tissues
•     Difficulty chewing, swallowing, or speaking
•     Numbness or persistent pain in the mouth or jaw
•     Loose teeth without a clear dental cause
•     A persistent sore throat or sensation of something stuck in the throat

Any symptom that does not resolve within two weeks should be evaluated by a dental or medical professional.

Risk factors of oral cancer 

Oral cancer risk is influenced by a combination of lifestyle, viral, and patient-specific factors.

The most significant risk factors include tobacco use in all forms and heavy alcohol consumption. HPV infection has become an increasingly important contributor, particularly in oropharyngeal cancers (the “back of the throat” as noted earlier, especially in the tonsils and base of tongue).

Additional risk factors include increasing age, male sex, and limited access to routine dental care, which can delay detection of early changes. Certain visible changes in the mouth can also signal higher risk, including persistent white patches (called leukoplakias) or red patches (called erythroplakias) on the oral tissues. These areas are sometimes referred to medically as precancerous lesions and may have a higher likelihood of developing into cancer over time.

While many patients have identifiable risk factors, it is important to recognize that oral cancer can still occur in individuals without any obvious exposures, which is why regular oral examinations remain important.

Diagnosis

Early detection plays a critical role in improving outcomes for patients with oral cancer. Diagnosis typically begins with a clinical examination, during which any suspicious lesion is identified and evaluated.

If a concerning area is found, a biopsy is performed to determine whether cancer is present. Imaging studies such as CT, MRI, or PET scans are then used to assess the extent of disease and guide treatment planning.

At UTHealth Houston, there is a strong emphasis on improving not only detection, but also the ability to identify which lesions are most likely to progress to cancer.

Research at UTHealth Houston

At UTHealth Houston, research in the Young Lab focuses on understanding how oral cancer develops and how we can better treat it by targeting both the tumor and its surrounding environment.

A key part of this work involves developing advanced experimental models that more accurately replicate human oral cancer. These models allow us to study how cancer emerges from early tissue changes, how it interacts with surrounding cells, and how the immune system responds during different stages of disease. By recreating these complex interactions in a controlled setting, we can begin to identify which lesions are more likely to progress and which biological pathways drive that progression.

Building on this foundation, our research also focuses on developing new treatment strategies, particularly in the area of cancer immunotherapy. While immunotherapy has shown promise in many cancers, its effectiveness in oral cancer has been more limited, in part due to the unique local tissue environment.

To address this, we are designing biomaterials-based therapies that can be delivered directly to the tumor site. These systems enable controlled, localized release of multiple immunotherapy agents over time, helping to coordinate a more effective immune response while reducing systemic side effects.

We are also exploring emerging approaches such as “cytokine factories,” which are engineered platforms that can continuously produce immune-stimulating signals within the tumor environment to enhance anti-tumor activity.

This work is highly collaborative and brings together clinicians, engineers, and researchers across the Texas Medical Center. By integrating expertise across disciplines, our goal is to better understand early disease, improve risk prediction, and develop more precise, targeted therapies for patients with oral cancer.

Simon Young, DDS, MD, PhD, is a professor and acting chair for the Katz Department of Oral and Maxillofacial Surgery at UTHealth Houston School of Dentistry, and an oral and maxillofacial surgeon with UT Physicians. All quotes should be attributed to him.

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