After diagnosing a patient with hard palate cancer (cancer involving the hard palate and the maxilla, or upper jaw), a doctor will need to determine what type of cancer it is, the grade of the tumor, and the stage of the cancer based on a biopsy or more often by the pathology after surgery. It is important to note that oral cancers can sometimes be difficult to diagnose. If a doctor is having a hard time determining what type of cancer it is, he or she might ask for a second opinion and send some pieces of the tumor off to a specialist in head and neck pathology who deals more frequently with these types of tumors.
Type
The most common type of hard palate cancer is squamous cell carcinoma. More than 90% of mouth cancers are squamous cell carcinoma. Squamous cell carcinoma is a cancer that starts from abnormal cells on the surface layer of the lips or the lining of the mouth. If the cancer is discovered at an early stage, before invading past the deepest layer of the mouth lining, then it is called carcinoma in situ and has a good prognosis when removed. Another subtype is called verrucous carcinoma. This subtype usually has a slow growth pattern and is less likely to spread to lymph nodes in the neck or other parts of the body.
Less common types of hard palate cancer
Cancer Type | Description |
---|---|
Salivary gland cancers | There are minor salivary glands located under the lining of the mouth. This is why cancers in this region can be glandular malignancies referred to as adenocarcinomas, including mucoepidermoid carcinomas, and adenoid cystic carcinomas. |
Lymphoma | The mouth also has lymphoid cells under the surface. This is why lymphoma could, in rare cases, appear as a lump in the mouth. |
Mucosal melanoma | These cancers come from skin cells (melanocytes). In rare cases, melanoma can be found in the lining of the mouth, nose and/or throat. |
Kaposi’s sarcoma | This cancerous tumor is usually associated with AIDS. While it usually presents on the skin, it can be found with a similar appearance in the mouth. It looks like a purple lesion in the mouth filled with blood vessels. |
Grade
A doctor will rely on the final pathology of the tumor to determine the grade and stage of cancer. The grade is usually only determined after the tumor has been removed. The grade of cancer relates to how healthy or unhealthy cells look under a microscope. In other words, a pathologist will determine the grade of cancer by comparing the amount of the healthy-looking tissue to the amount of cancerous tissue. If most of the tumor cells look like normal tissue then the cancer is “well differentiated” or “low-grade.” However, if the tumor cells look very different from normal tissue then the cancer is “poorly differentiated” or “high-grade.” The grade of cancer may help to determine how quickly the cancer is likely to spread.
Oral cancer grading is described as the following:
Grade Definition GX The grade cannot be evaluated. G1 The cells look more like normal tissue and are well differentiated. G2 The cells are only moderately differentiated. G3 and G4 The cells don’t look like normal tissue and are poorly differentiated.
Stage
The stage of a cancer is determined by the TNM staging system:
- The ‘T’ stands for tumor size.
- The ‘N’ stands for lymph node involvement.
- The ‘M’ stands for distant metastases, or cancer spread to other areas of the body.
Staging helps doctors determine how serious the cancer is and how best to treat it. Staging systems often reference very specific anatomical structures. Please reference the anatomy page to learn more about these terms.
Staging is generally based on the American Joint Committee on Cancer (AJCC) 8th edition guidelines. To learn more, see the AJCC TNM Staging Table and the TNM Staging Tool below.
TNM Staging Table, from the American Joint Committee on Cancer (AJCC)
Staging
T N M Stage T1 N0 M0 I T2 N0 M0 II T3 N0 M0 III T1,2,3 N1 M0 III T4a N0,1 M0 IVA T1,2,3,4a N2 M0 IVA Any T N3 M0 IVB T4b Any N M0 IVB Any T Any N M1 IVC