Oral or mouth cancer is often used to describe a type of cancer that develops in the tissues of the mouth (known as the oral cavity) or the throat area at the back of the mouth (known as the oropharynx). The oral cavity is your mouth and includes parts like the lips, teeth, gums, lining inside the lips and cheeks (called buccal mucosa), front of the tongue, bottom of the mouth, saliva glands and bony roof of the mouth. Some parts at the back of your mouth are not considered part of the oral cavity and hence they are part of the oropharynx. These include – back or base of the tongue, back of the roof of the mouth, (called the soft palate), tonsils and the sides and back of the throat. Regarded as a type of head and neck cancer, these cancers come under the category of oral and oropharyngeal cancer that starts in the cells that line your mouth and throat (classified as squamous cell carcinoma). Over 90 percent of oral cancers begin in the flat cells (squamous cells) that cover the surfaces of the mouth, tongue, and lips. According to reports from the American Cancer Society (ACS), around 53,000 Americans received a diagnosis of oral or oropharyngeal cancer in 2019. The disease is more likely to affect males than females. The average age of diagnosis is 62 years, but about 25 percent of cases occur before the age of 55 years. Early diagnosis of this type of cancer is often difficult, as patients depict no specific signs and symptoms. Billing and coding for this cancerous oral condition can be challenging, as there are several rules that go along with this condition. For precise documentation of this condition, physicians usually rely on the services of a professional medical billing outsourcing company.

Here are some frequently asked questions and answers about oral cancer –

Q: Where does oral cancer occur?

A: About two-thirds of cancer of the mouth occurs in the floor of the mouth and tongue. However, it can also occur in the upper or lower jaw, lips, gums, and cheek lining. Just behind the mouth is an area known as the orophyarnx. Oropharyngeal cancer (one-third of cases) occurs in the back of the tongue, tonsils and throat tissue.

Q: What are the main types of oral cancer?

A: It is estimated that more than 90 percent of all oral cavity tumors are squamous cell carcinomas. Squamous cells make up the lining of the oral cavity. The most common locations for cancer in the oral cavity are the tongue, tonsils, oropharynx (throat), gums and floor of the mouth. On the other hand, tumors that occur in the salivary glands are less common types of oral cancers. These include – adenoid cystic carcinoma, mucoepidermoid carcinoma and polymorphous low-grade adenocarcinoma.

Q: What are the causes of oral cancers?

A: Mouth cancers occur when cells on the lips or in the mouth develop changes (mutations) in their DNA. A cell’s DNA contains instructions that direct a cell what to do. The mutations direct the cells to continue growing and dividing when healthy cells would die. Cancer occurs when a genetic change in the body results in cells growing without control. As these continue to grow and accumulate, they form a tumor. The accumulating abnormal mouth cancer cells can form a tumor. With time, they may spread inside the mouth and migrate to other areas of the head and neck or other parts of the body.

Q: What are the factors that can increase the risk of mouth cancer?

A: Potential risk factors that can increase the chances of mouth cancer include – smoking or chewing tobacco, using snuff (which comes from tobacco), excessive alcohol consumption, human papillomavirus (HPV) infection, gastroesophageal reflux disease (GERD), a weakened immune system, excessive sun exposure to your lips and a previous history of a head and neck cancer.

Q: What are the warning signs of oral cancer?

A: Generally, in the early stages, there are often no signs or symptoms of oral cancer. Smokers and heavy drinkers need to undergo regular checkups with the dentist, as tobacco and alcohol use are serious risk factors for this type of cancer. The dentist may be able to spot any signs at an early stage. Typical symptoms include –

  • Mouth sores or ulcers that bleed easily and do not heal
  • Red or white patches in or behind the mouth
  • Visible change in mouth tissue
  • Unexplained swelling or fullness in neck
  • Unexplained lump in the neck, throat or floor of the mouth
  • Loose teeth
  • Pain and tenderness in teeth or gums
  • Diminished ability to perform normal functions such as opening jaw, chewing or swallowing
  • Difficult or painful swallowing
  • Change in the fit of dentures or partial dentures

Q: How is oral cancer diagnosed, treated and documented?

A: If a person has symptoms that could possibly indicate mouth cancer, a physician as an initial diagnosis will generally enquire about their symptoms, carry out a physical examination and review their personal and family medical history. Physician or dentist will examine the lips and mouth of the patient to check for abnormalities like – areas of irritation, such as sores and white patches (leukoplakia). If any suspicious area is diagnosed, the dentist may remove a sample of cells for lab testing in a procedure called biopsy. The sample cells are analyzed for cancer or precancerous changes that indicate a risk of future cancer.

Once the mouth cancer is diagnosed or confirmed, the physician will further work to determine the extent or stage of cancer. Endoscopy procedure may be performed to look for signs that cancer has spread beyond the mouth area. In addition, a variety of imaging tests like – X-ray, CT scan, MRI and positron emission tomography (PET) scans may be performed to determine the stage and severity of cancer. However, not every patient may need these tests. Physicians will determine which of these tests are appropriate based on individual patient condition.

Treatment for mouth cancer may directly depend on the location and specific stage of cancer. It may also depend on overall health and personal preferences of the patient. Patients may either undergo a single treatment or a combination of treatment modalities. Treatment options include surgery, radiation, chemotherapy, targeted drug therapy and immune therapy. Surgery will be done to remove the tumor that has spread and to reconstruct the mouth. Surgery for mouth cancer often affects your appearance, as well as your ability to speak, eat and swallow. Dentists, oncologists or other specialists who offer treatment for mouth cancers need to be reimbursed for the services they provide to the patients. Correct medical codes must be used to document the diagnosis, screening and other procedures performed. Medical billing and coding services offered by established companies can help physicians in using the correct codes for their medical billing process.

Q: What are the ICD-10 codes used for diagnosing mouth cancer?

A: The ICD-10 codes for mouth cancer come under the category – C00-C14 – Malignant neoplasms of lip, oral cavity and pharynx.

C00 Malignant neoplasm of lip

  • C00.0 Malignant neoplasm of external upper lip
  • C00.1 Malignant neoplasm of external lower lip
  • C00.2 Malignant neoplasm of external lip, unspecified
  • C00.3 Malignant neoplasm of upper lip, inner aspect
  • C00.4 Malignant neoplasm of lower lip, inner aspect
  • C00.5 Malignant neoplasm of lip, unspecified, inner aspect
  • C00.6 Malignant neoplasm of commissure of lip, unspecified
  • C00.8 Malignant neoplasm of overlapping sites of lip
  • C00.9 Malignant neoplasm of lip, unspecified

C01 Malignant neoplasm of base of tongue

C02 Malignant neoplasm of other and unspecified parts of tongue

  • C02.0 Malignant neoplasm of dorsal surface of tongue
  • C02.1 Malignant neoplasm of border of tongue
  • C02.2 Malignant neoplasm of ventral surface of tongue
  • C02.3 Malignant neoplasm of anterior two-thirds of tongue, part unspecified
  • C02.4 Malignant neoplasm of lingual tonsil
  • C02.8 Malignant neoplasm of overlapping sites of tongue
  • C02.9 Malignant neoplasm of tongue, unspecified

C03 Malignant neoplasm of gum

  • C03.0 Malignant neoplasm of upper gum
  • C03.1 Malignant neoplasm of lower gum
  • C03.9 Malignant neoplasm of gum, unspecified

C04 Malignant neoplasm of floor of mouth

  • C04.0 Malignant neoplasm of anterior floor of mouth
  • C04.1 Malignant neoplasm of lateral floor of mouth
  • C04.8 Malignant neoplasm of overlapping sites of floor of mouth
  • C04.9 Malignant neoplasm of floor of mouth, unspecified

C05 Malignant neoplasm of palate

  • C05.0 Malignant neoplasm of hard palate
  • C05.1 Malignant neoplasm of soft palate
  • C05.2 Malignant neoplasm of uvula
  • C05.8 Malignant neoplasm of overlapping sites of palate
  • C05.9 Malignant neoplasm of palate, unspecified

C06 Malignant neoplasm of other and unspecified parts of mouth

  • C06.0 Malignant neoplasm of cheek mucosa
  • C06.1 Malignant neoplasm of vestibule of mouth
  • C06.2 Malignant neoplasm of retromolar area
  • C06.8 Malignant neoplasm of overlapping sites of other and unspecified parts of mouth
  • C06.80 Malignant neoplasm of overlapping sites of unspecified parts of mouth
  • C06.89 Malignant neoplasm of overlapping sites of other parts of mouth
  • C06.9 Malignant neoplasm of mouth, unspecified

C07 Malignant neoplasm of parotid gland

C08 Malignant neoplasm of other and unspecified major salivary glands

  • C08.0 Malignant neoplasm of submandibular gland
  • C08.1 Malignant neoplasm of sublingual gland
  • C08.9 Malignant neoplasm of major salivary gland, unspecified

C09 Malignant neoplasm of tonsil

  • C09.0 Malignant neoplasm of tonsillar fossa
  • C09.1 Malignant neoplasm of tonsillar pillar (anterior) (posterior)
  • C09.8 Malignant neoplasm of overlapping sites of tonsil
  • C09.9 Malignant neoplasm of tonsil, unspecified

C10 Malignant neoplasm of oropharynx

  • C10.0 Malignant neoplasm of vallecula
  • C10.1 Malignant neoplasm of anterior surface of epiglottis
  • C10.2 Malignant neoplasm of lateral wall of oropharynx
  • C10.3 Malignant neoplasm of posterior wall of oropharynx
  • C10.4 Malignant neoplasm of branchial cleft
  • C10.8 Malignant neoplasm of overlapping sites of oropharynx
  • C10.9 Malignant neoplasm of oropharynx, unspecified

C11 Malignant neoplasm of nasopharynx

  • C11.0 Malignant neoplasm of superior wall of nasopharynx
  • C11.1 Malignant neoplasm of posterior wall of nasopharynx
  • C11.2 Malignant neoplasm of lateral wall of nasopharynx
  • C11.3 Malignant neoplasm of anterior wall of nasopharynx
  • C11.8 Malignant neoplasm of overlapping sites of nasopharynx
  • C11.9 Malignant neoplasm of nasopharynx, unspecified

C12 Malignant neoplasm of pyriform sinus

C13 Malignant neoplasm of hypopharynx

  • C13.0 Malignant neoplasm of postcricoid region
  • C13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
  • C13.2 Malignant neoplasm of posterior wall of hypopharynx
  • C13.8 Malignant neoplasm of overlapping sites of hypopharynx
  • C13.9 Malignant neoplasm of hypopharynx, unspecified

C14 Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx

  • C14.0 Malignant neoplasm of pharynx, unspecified
  • C14.2 Malignant neoplasm of Waldeyer’s ring
  • C14.8 Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx

Q: What lifestyle measures need to be adopted to prevent the incidence of oral cancer?

A: There is no proven way to prevent the occurrence of mouth cancer. However, it is possible to reduce the risk of mouth cancer by taking some important measures like –

  • Avoid chewing betel nut
  • Avoid excessive alcohol consumption
  • Avoid excessive sun exposure to your lips
  • Conduct regular dental check ups
  • Monitor for frequent changes in the mouth and consult a dentist (if required)
  • Stop the usage of any form of tobacco product
  • Take the vaccination to protect against HPV