Oral Cavity Cancer Is Rising—And It’s No Longer Just About Smoking
What Radiologists and Clinicians Need to Know in 2025
Oral cavity cancer was once strongly linked to tobacco and alcohol use. But new evidence shows a worrying shift: cases are increasing even as smoking rates decline, especially among younger, non-smoking women. A recent review published in Radiology: Imaging Cancer highlights why this trend matters—and how medical imaging plays a crucial role in diagnosis, staging, and treatment planning.
A Changing Landscape of Oral Cancer
Oral cavity carcinomas account for about 3% of all cancers worldwide, but their incidence has been steadily rising. Large population studies, including data from the United States and Europe, reveal a particularly sharp increase among women aged 18–44. Unlike oropharyngeal cancers, where human papillomavirus (HPV) is a well-established cause, HPV explains only a small proportion of oral cavity cancers.
This leaves researchers with an important question: what is driving this increase?
Beyond Tobacco and HPV: Searching for New Explanations
The authors summarize several emerging hypotheses. Genetic susceptibility, immune dysregulation, and chronic inflammation are all under investigation. Certain conditions—such as oral lichen planus, Fanconi anemia, and exposure to betel nut or betel quid—are known to raise cancer risk.
Another growing area of interest is the oral microbiome. Changes in the balance of bacteria, viruses, and fungi—known as oral dysbiosis—may promote chronic inflammation, DNA damage, and tumor development. Poor dental health and periodontal disease may not only increase cancer risk, but also worsen outcomes during radiation or chemotherapy.
Why Imaging Matters More Than Ever
While oral cavity lesions are often detected through clinical examination, imaging is essential for understanding what lies beneath the surface. The oral cavity has complex anatomy, and small or superficial tumors can be difficult to detect, especially in the presence of dental artifacts.
The review emphasizes the role of CT, MRI, and PET imaging in:
Identifying subtle tumors that are not clinically obvious
Measuring tumor thickness and estimating depth of invasion
Detecting bone involvement and spread to adjacent spaces
Assessing lymph node metastases and extranodal extension
Advanced techniques such as PET/CT and PET/MRI are particularly helpful in revealing tumors that standard imaging might miss.
Not All Oral Cancers Are the Same
Oral cavity cancer can arise in multiple subsites, each with distinct patterns of spread. The most common location is the oral tongue, followed by the floor of the mouth, gingiva, hard palate, and retromolar trigone.
Understanding these subsites matters because even small differences in tumor location or depth can significantly change cancer staging—and, ultimately, surgical planning. Tumors that invade the mandible, tongue muscles, or nearby neurovascular structures are more advanced and require more extensive treatment.
The Importance of Accurate Staging
Modern staging systems now emphasize depth of invasion, not just surface size. A tumor that looks small on inspection may already carry a higher risk of lymph node spread if it extends deeply into surrounding tissues.
The authors stress that radiology reports should clearly describe:
Tumor size and thickness
Involvement of bone, muscles, or nerves
Number and laterality of suspicious lymph nodes
Signs of extranodal extension
This information directly guides decisions about surgery, reconstruction, and radiation therapy.
Looking Ahead
Despite declining smoking rates, oral cavity cancer is becoming more common, and its causes remain only partially understood. The review underscores the need for heightened awareness, careful imaging interpretation, and structured reporting—especially in younger patients without traditional risk factors.
As imaging technology advances and new PET tracers emerge, radiologists will continue to play a central role in improving early detection, staging accuracy, and patient outcomes.
Conclusion
Oral cavity cancer is no longer a disease defined solely by tobacco use. Its rising incidence, particularly among younger women, signals a shift in risk factors and challenges long-held assumptions. Through detailed imaging and multidisciplinary collaboration, clinicians can better understand tumor behavior and deliver more precise, effective care.
Original Article Reference
Mosier KM, Graner BD, Gray BR.
Trends in Head and Neck Cancer: Oral Cavity Carcinoma and What Radiologists Need to Know. Radiology: Imaging Cancer. 2025;7(6):e250154.
DOI: https://doi.org/10.1148/rycan.250154