Mouth cancer

Mouth cancer, also known as oral cancer or cancer of the oral cavity, describes cancer that starts in the region of the mouth. It begins in the cells lining the mouth, where damaged cells can grow uncontrollably to form a tumour.

The two main risk factors are alcohol and tobacco, and the combined effect of drinking and smoking is far greater than either alone. The risk rises as you get older, and men are about three times more likely than women to develop the disease.

Mouth cancer can be treated if it is found early, so it is important to see your dentist or doctor promptly if you notice any changes in your mouth. The most common sites are the lips, tongue and floor of the mouth, but it can also develop in the gums, the inside lining of the cheeks, the roof of the mouth, the hard and soft palate, the tonsils and the salivary glands.

Symptoms of mouth cancer#

Symptoms can include:

• A visible mass or lump that may or may not be painful
• An ulcer that will not heal
• White or red patches on the mouth, tongue or gums
• Loss of sensation anywhere in the mouth
• Trouble swallowing
• Reduced tongue movement
• Difficulty moving your jaw
• Loose teeth or sore gums
• Altered taste
• Swollen lymph glands

Having these symptoms does not mean you have mouth cancer, but if you notice any of them you should speak to your dentist or doctor, especially if a lump or mouth ulcer lasts more than two weeks.

Risk factors#

If you smoke and drink, your risk is much higher. Alcohol may make it easier for other carcinogens, including tobacco, to enter and damage cells.

Tobacco use includes cigarettes, cigars, pipes and chewing tobacco. If you smoke or chew tobacco or “paan”, you are about twice as likely to develop mouth cancer as a non-smoker. Chewing or smoking areca nut, betel quid, pan or gutka also increases your risk. The location of the cancer often relates to how the product is used – for example, if you habitually chew tobacco against your left cheek, you may be more prone to cancer of that cheek.

Mouth cancer is around six times more common in people who drink alcohol than in those who do not, and the more you drink, the greater the risk.

Other risk factors include:

• Being over 40 years of age
• Being male – men are about three times as likely as women to develop mouth cancer
• Sun exposure – ultraviolet (UV) radiation can lead to skin cancer on the lips
• Being overweight or obese

How mouth cancer can spread#

The skin of the mouth, nose and throat is lined with flat, firm cells called squamous cells, and most mouth cancers begin in these surface cells. Without treatment, squamous cell carcinoma can spread deeper into muscle and bone, or into the throat or the lymph glands in the neck. It can also spread to other parts of the body if it reaches the bloodstream or lymphatic system, which is why early diagnosis and treatment matter.

Diagnosis#

Mouth cancer is diagnosed using a number of tests, which may include:

• A physical examination of the mouth by your dentist or doctor
• A biopsy (taking a small sample of tissue from the mouth for laboratory examination)
• X-ray
• Ultrasound
• CT scan
• MRI (magnetic resonance imaging) scan
• PET (positron emission tomography) scan

Test results can take a few days to come back, and it is natural to feel anxious while you wait. It can help to talk to a close friend or relative about how you are feeling.

Treatment for mouth cancer#

Treatment depends on the size, type and location of the cancer and whether it has spread. It may include:

• Surgery – the tumour is surgically removed if it is small. The lymph glands on the affected side may also be removed if the tumour extends into them.
• Radiation therapy – small, precise doses of ionising radiation target and destroy cancer cells. This is often all that is needed for small, localised cancers.
• Chemotherapy – cancer-killing drugs, often combined with surgery and/or radiotherapy. Chemotherapy may sometimes be used to shrink a tumour before surgery.
• Combined (multi-modal) treatment – surgery on larger tumours may be followed by radiation therapy, and chemo-radiotherapy may also be used.
• Long-term monitoring and ongoing care – this may include regular oral examinations and occasional X-rays to make sure the cancer has not returned.

All treatments have side effects, which vary with the type of treatment. Many are temporary, but some may be permanent. Your doctor will explain the possible side effects before treatment begins.

If mouth cancer has spread and cannot be cured by surgery, your doctor may still recommend treatment to control the cancer, which can include chemotherapy, radiotherapy, surgery, immunotherapy or pain-relieving medications, or a combination of these. This treatment may relieve symptoms, help you feel better and allow you to live longer. You may hear your doctor call this kind of treatment “palliative”, meaning it is designed to relieve symptoms rather than cure the cancer.

Reducing your risk#

Following this advice does not guarantee you will never get mouth cancer, but it can reduce your risk and has other health benefits too:

• Stop smoking or chewing tobacco
• Reduce the amount of alcohol you drink
• Eat a healthy diet, including plenty of non-starchy vegetables and fruit, which are thought to help lower the risk
• Keep a healthy body weight
• Use sun protection on your lips

Having regular check-ups with your oral health professional, and telling them about any changes in your mouth, is an important part of catching problems early.

Key points#

• The risk of mouth cancer increases as you get older, and men are about three times more likely than women to develop it.
• If you smoke and drink, your risk of developing mouth cancer is much higher.
• Chewing or smoking areca nut, betel quid, pan or gutka also increases your risk.
• Mouth cancer is around six times more common in people who drink alcohol than in those who do not.
• The more you drink, the greater the risk.

Where to get help#