What Is Hard Palate Cancer?

Overview

The oral or buccal cavity, also known as the mouth, is a simple yet essential structure responsible for digestion, communication and breathing! Unfortunately, it is also home to a detrimental disease, Oral Cancer.¹

But “Oral Cancer or Mouth Cancer” is a very broad term applied to all the cancers of the mouth and back throat.² Oral tumours are an abnormal increase in the growth of cells leading to malignant or cancerous formations that can occur on the lips, tongue, lining of the mouth, and the soft and hard palate of the roof of the mouth.² When these tumours grow on the posterior, hard palate of the mouth, separating our mouth from our nose (nasal cavity); they are called “Hard palate cancers/tumours”.^1,2 Tumours can arise from any of the tissue that makes up the hard palate i.e. the epithelium (skin), or salivary glands under the skin.³

There can be two types of hard palate tumours:

• Benign tumours – These are commonly slow-growing tumours, that are not cancerous or harmful and treatment is only necessary depending on the individual characteristics of each lesion⁴ 
• Malignant tumours – Commonly known as “Hard Palate Cancers”, generally grow faster (within the span of even a few months) and are life-threatening for patients if left untreated.³ A common example of hard palate cancer is oral squamous cell carcinoma

Oral cavity cancer/mouth cancer is one of the leading causes of death and the 13^th most common cancer worldwide according to the WHO. Oral cancers are also included under the broad umbrella of head and neck cancer which is the 8^th most common cancer in the UK and makes up 3% of all new cancer cases. Although rare, awareness of hard palate cancer is important as it is included in all the former discussed cancer groups and may have an overall 10-year survival rate of just 19-59%.

Stages of hard palate cancer

Staging in cancer patients is carried out by following the TNM classification for malignant tumours, which is an internationally recognised standard unifying system for staging the spread of cancers by the Union for International Cancer Control. Following are the staging criteria:^3,5

• Tumour – Stages the physical size of the tumour in the patient’s mouth. The stages include T1, T2, T3, T4 (sizes increasing from 1-4), Tx (cannot be assessed), T0 (cancer not present) and Tis (cancer very local with minimal spread)⁵
• Node – This stages the tumour based on the lymph nodes involved. Stages include Nx (nodes cannot be checked), N0 (no lymph nodes involved), N1, N2, N2a, N2b, N3, N3a, N3b, & N3c (involvement increasing from N1 to N3c being highest)^3,5
• Metastasis – Stages the spread of the cancer to other organs of the body. Stages include Mx (cannot be checked), M0 (no spread), M1, M2, & M3 (the spread increasing from 1-3)^3,5

This criterion is used for staging cancers worldwide by dentists, surgeons, clinical oncologists (cancer doctors) etc.⁵ These numbered stages help to map out the treatment required and the chances of survival for cancer patients.^3,5

Causes of hard palate cancer

These are risk factors that could potentially cause hard palate cancer in the future.^1,3 Following are the most important and commonly presented causes of hard palate cancer:

Tobacco

One of the major risk factors of soft tissue oral cancer around the globe.⁶ Most forms of tobacco consumption (e.g., smoking or chewing tobacco) have been 

established as a causative agent/risk factor for oral squamous cell carcinoma (a cancer type with a very low survival rate).⁶

Alcohol

While less harmful in the short term than tobacco, long-term alcohol consumption has been associated with a high death rate in oral cancer.⁷ Over time, it has been established that alcohol is still one of the major risk factors for oral cancer.⁷  Alcohol consumption when coupled with tobacco consumption has been proven to multiplicate the risk of developing oral cancers (instead of twice there is a 4 times increase in the chances of developing cancer when consumed together).⁸

Potentially malignant conditions

Certain lesions inside the mouth such as white or red patches or certain oral cavity disorders such as lichen planus, or syndromes like Plummer-Vinson syndrome also carry a risk of progressing into oral cancer.³ Furthermore, infections inside the mouth such as Human Papilloma Virus (HPV)  infections, and Candida (fungal) infections may also progress to cancer.³ Patients with compromised immune systems can also be at an increased risk of developing hard palate cancers like Kaposi Sarcoma.³

Genetic

Through decades of research, it has been identified that specific inherited genes or genetic mutations increase the risk of oral cancer amongst certain individuals.⁹

Signs and symptoms of hard palate cancer

Some common signs and symptoms of hard palate cancer are:³

• Soreness and hoarseness around the hard palate or the back of the throat
• Lump(s) in neck
• Difficulty swallowing (dysphagia)
• Cranial nerve palsy
• Changes in speech
• Unexplained weight loss

If any of the above signs or symptoms last longer than around 2-3 weeks, it is important to consult a dentist or a GP as soon as possible.

Management and treatment for hard palate cancer

Treatment and management is a complex procedure given the various factors affecting it and requires a combination of the expertise of doctors from various fields.³

• Head and neck surgery: This is the most recommended treatment for hard palate cancer. Surgical plans differ based on the individual condition of the patient, some surgeries that might be performed include maxillectomy (removing part of the upper jaw) and neck dissection (removing any affected areas of the head and neck)^3,10
• Radiation therapy: This may be a sole treatment option or can be combined with other treatments(i.e., chemotherapy)^3,10
• Rehabilitation: A huge portion of hard palate cancer care is focused on rehabilitation.³ Patients who undergo surgery also need reconstructive surgery followed by aesthetic and functional rehabilitation with artificial appliances to help perform daily activities such as swallowing, speaking, etc. Patients may also often require support from various specialties such as occupational therapy, and mental health professionals to aid in their rehabilitation^3,10
• Chemotherapy: Not frequently indicated in hard palate cancer patients but may be used sometimes to supplement other treatment methods³

Like most cancers, hard palate cancer care is also a long and tedious process spanning over a long time, hence care counseling and good communication between patients, their caregivers, and healthcare professionals through all the stages of the treatment is important.³

Diagnosis

1. History and examination: Doctors often ask for any family history of oral cancer or other cancers or any numbness, pain, trauma etc. that the patient might have noted.³ They also ask patients about any habits such as tobacco or alcohol use to establish risk factors within the history.³ In examinations, professionals will check inside the mouth, nose (if necessary) and will generally check the neck for swollen lymph nodes³
2. Biopsies and histopathological examination: The standard method of establishing a diagnosis of cancer is by surgically taking a small piece of tissue (a biopsy) in and around the affected area for further examination under a microscope (histopathological examination) by a trained professional.³ Different types of biopsies include fine-needle aspiration biopsy, punch biopsy, or incisional biopsy³
3. Radiological examination: Radiological examination helps to know the exact size, spread, and staging of cancers. Different scans that may be used include MRIs, CT scans, or PET scans¹¹

Furthermore, various other tests may be needed and this will strongly vary based on individual patient’s conditions.³

Complications

Complications from the treatment of hard palate cancer highly vary and individual complications are best discussed with treating physicians. Some common complications maybe:

• Difficulty eating, speaking, or swallowing.
• Local or widespread nerve damage
• Compromised immune system³

FAQs

How can I prevent hard palate cancer

While the most influential genetic risk cannot be prevented, discontinuing any use of tobacco products, and limiting or removing alcohol intake will reduce the risk of developing hard palate cancer  (Cleveland Clinic).

How common is hard palate cancer

Hard palate cancer is a rare type of oral cancer included in the group of head and   neck cancer which is 8^th most common cancer in the UK making up 3% of all new cancer cases (Cancer Research UK).  Oral Cancer Foundation and American Cancer Society estimated that 54,000-54,500 new cases of oral cancer may be diagnosed in the United States alone this year with approximately 9750-11,580 estimated death.

Who is at risk of hard palate cancer

Patients with a family history of oral or any other cancer or patients in whom different risk factors such as tobacco/alcohol use or potentially malignant conditions/disorders might be present are at high risk of developing hard palate cancer.³

When should I see a doctor

Regular dental and health check-ups may help in diagnosing any probable lesions early. But if you notice any of the above signs and symptoms and they last longer than 3 weeks, it is advisable to make an appointment with a dentist or a GP at the earliest (NHS). 

Summary

Hard palate cancer is a rare type of oral cancer affecting the hard part of the roof of the mouth separating the mouth and nose.^1,2 Its causes can be internal (genetic) or external (risk factors such as tobacco or alcohol use).^3,6,8,9 Some signs and symptoms are bad breath, swelling inside the mouth, difficulty eating, drinking, or speaking, and a non-healing ulcer or wound over several weeks (NHS). Diagnosis is established by a trained dental/medical professional through examination and biopsy and it is staged using the TNM classification.³ The overall 10-year survival rate may be anywhere between 19-59% (Cancer Research UK). The most recommended treatment option is head and neck surgery followed by rehabilitative management.³ Complications following treatment may seriously impact the patient’s overall quality of life (Cleveland Clinic).