Mouth cancer can affect any part of the mouth, including the tongue and lips. The most common symptoms are having a sore or ulcer for more than three weeks. You should see your dentist or doctor if you have any symptoms in your mouth that are unusual. The outlook for people with mouth cancer is very good if it is diagnosed early.
What is cancer?
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply 'out of control'.
A cancerous (malignant) tumour is a lump or growth of tissue made up from cancer cells which continue to multiply. As they grow, malignant tumours invade into nearby tissues and organs, which can cause damage.
Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form secondary tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues and spread again.
Some cancers are more serious than others, some are more easily treated than others, some have a better outlook (prognosis) than others.
So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become and whether it has spread. This will enable you to obtain reliable information on treatment options and outlook. See separate leaflet called What is Cancer? for more details.
What is mouth cancer?
Mouth cancer is a cancer that can develop in any part of the mouth, including the tongue, the gums, the palate (roof of the mouth), under the tongue, the skin lining the mouth or the lips.
Mouth cancer is also sometimes called oral cancer. Although mouth cancer is uncommon in the UK, it seems to be getting more common. There are around 4,700 cases that are diagnosed each year. It is twice as common in men as it is in women and is rare in people aged under 40. Many cases are diagnosed by dentists rather than doctors.
What causes mouth cancer?
A cancerous (malignant) tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control. See separate leaflet called What Causes Cancer? for more details.
Some people develop mouth cancer for no apparent reason. However, certain risk factors increase the chance that mouth cancer may develop. These include:
- Smoking. Mouth cancer is just one cancer which has a much higher incidence in smokers than in non-smokers.
- Alcohol. Drinking a lot of alcohol can increase your risk of developing mouth cancer.
- Chewing tobacco or the betal leaf.
- Poor dental hygiene.
- Dietary factors (eating a well-balanced diet - high in fruits, vegetables and fish and low in high-fat and cholesterol meats, rice and refined grains - can reduce the risk of oral cancer).
- The human papillomavirus (HPV) may increase your risk of mouth cancer.
- There are some conditions affecting the mouth, such as leukoplakia and erythroplakia, which can increase the risk of a cancer developing.
What are the symptoms of mouth cancer?
The most common symptoms of mouth cancer are a sore or ulcer in the mouth that does not heal and pain in the mouth that does not go away.
In many cases, changes are seen in the mouth before the cancer develops. This means that early treatment of these changes will actually prevent a cancer developing.
Other symptoms include:
- White patches anywhere in your mouth (leukoplakia).
- Red patches anywhere in your mouth (erythroplakia).
- A lump on the lip, tongue or in the mouth or throat.
- Unusual bleeding or numbness in the mouth.
- Pain when chewing or swallowing.
- A feeling that something is caught in the throat.
- Unusual bleeding or numbness in the mouth.
- Loose teeth or dentures feeling uncomfortable and not fitting properly.
- A change in your voice, or speech problems.
- Weight loss.
- A lump in the neck.
- If the cancer spreads to other parts of the body, various other symptoms can develop.
All of these symptoms can be due to other conditions, so tests are needed to confirm the diagnosis.
Note: any ulcer in the mouth that does not heal after three weeks should be checked by your dentist or doctor.
How is mouth cancer diagnosed and assessed?
To confirm the diagnosis
It is likely that you will need a biopsy. A biopsy is a procedure involving a small sample of tissue being removed from a part of the body. The sample is then looked at under the microscope to look for abnormal cells. Results of a biopsy can take two weeks.
Assessing the extent and spread (staging)
If you are confirmed to have mouth cancer then further tests may be done. For example, biopsy samples may be taken from the nearby lymph glands (lymph nodes) by using a fine needle. This is to assess if any cancer cells have spread to the lymph glands.
Other tests may be arranged to see if the cancer has spread to other parts of the body. For example, a CT scan, an MRI scan, or other tests.
This assessment is called staging of the cancer. The aim of staging is to find out:
- How much the tumour has grown in the mouth.
- Whether the cancer has spread to local lymph nodes.
- Whether the cancer has spread to other areas of the body (metastasised).
What are the treatment options for mouth cancer?
Treatment options which may be considered include radiotherapy, surgery and chemotherapy. The treatment advised for each case usually depends on various factors such as the exact site and extent of the cancer and your general health.
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects and other details about the possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
- In many cases, treatment aims to cure the cancer. There is a good chance of a cure if it is treated in the early stages. Many cases are diagnosed at an early stage. This is because early mouth cancers are more easily detected than cancers deeper inside the body. (Doctors tend to use the word remission rather than the word cured. Remission means there is no evidence of cancer following treatment. If you are in remission, you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.)
- In some cases, treatment aims to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.
- In some cases, treatment aims to ease symptoms. For example, if a cancer is advanced then you may require painkillers or other treatments to help keep you free of pain or other symptoms. Some treatments may be used to reduce the size of a cancer, which may ease symptoms such as pain or difficulty with swallowing.
The most common treatment is surgery. The type of operation depends on the size of the cancer and its site. The operation may be to remove the cancer and some of the surrounding normal tissue.
Sometimes surgery is aimed at curing the cancer by removing it all. Sometimes surgery is used to relieve symptoms if the cancer is at an advanced stage (palliative surgery). The operations are all done whilst you are asleep under a general anaesthetic.
Laser surgery may sometimes be used to remove small mouth cancers. This may be combined with a light-sensitive medicine in treatment known as photodynamic therapy (PDT).
Sometimes a special type of surgery called micrographic surgery, or Mohs' surgery, is used for cancers on the lip. In this surgery, the surgeon removes the cancer in very thin layers and the tissue that has been removed is examined under a microscope during the operation. This technique makes sure that all the cancer cells are removed and only a very small amount of healthy tissue is removed.
Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on malignant (cancerous) tissue. This kills cancer cells, or stops cancer cells from multiplying. See separate leaflet called Radiotherapy for more details.
Two types of radiotherapy are used for mouth cancer: external and internal.
- External radiotherapy. Radiation is targeted on the cancer from a machine. (This is the common type of radiotherapy which is used for many types of cancer.)
- Internal radiotherapy (brachytherapy). This treatment involves placing small radioactive wires next to the cancer for a short time and then they are removed.
Chemotherapy is a treatment which uses anti-cancer medicines to kill cancer cells, or to stop them from multiplying. Chemotherapy may be used in conjunction with radiotherapy or surgery. Chemotherapy may also be advised if the cancer has spread to other areas of the body. See separate leaflet called Chemotherapy with Cytotoxic Medicines for more details.
What is the outlook (prognosis)?
If a mouth cancer is diagnosed and treated at an early stage then there is a good chance of a cure. A cure is less likely if the cancer has spread.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook and how well your type and stage of cancer is likely to respond to treatment.
Further help & information
Dr Louise Newson
Dr Colin Tidy
Dr John Cox