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Mouth cancer

Nearly 5,000 people are diagnosed with mouth (oral) cancer every year in the UK. Most of these people are over the age of 40, and it affects more men than women. In recent years there has been a rise in the number of people affected in the UK.

  • About mouth cancer
  • Symptoms
  • Causes
  • Diagnosis
  • Treatment
  • Prevention
  • Further information
  • Sources
  • Related topics

About mouth cancer

Mouth cancer is a type of head and neck cancer. It can occur in many different areas of your mouth, including your lips, tongue, gums, floor of the mouth (under the tongue), inside the cheeks and on the palate (roof of the mouth). The floor of the mouth is the most commonly affected area.

Types of mouth cancer

The most common type of mouth cancer is squamous cell carcinoma. It develops from squamous cells - the flat, skin-like cells that cover the lining of the mouth. At least nine out of 10 mouth cancers are squamous cell carcinomas.

Rarer types of mouth cancer include:

  • salivary gland cancer - this type of cancer starts in the salivary gland cells, which are in the lining of the mouth and throat
  • lymphoma - this type of cancer starts in lymph tissue, which is around the base of the tongue and tonsils
  • melanoma - this is a type of skin cancer that starts in skin pigment cells around the mouth or on the lips

Symptoms

There is usually no pain in the early stages of mouth cancer, and you may not notice any symptoms. If you do have symptoms, they can include:

  • a painless ulcer in your mouth or on your lip that doesn't heal
  • pain or soreness that doesn't go away when you move your jaw or tongue, for example when you are speaking, swallowing or eating
  • a red or white patch in your mouth or throat that doesn't go away
  • a lump or thickening of a small area on the lip, tongue or in the mouth
  • unexplained bleeding in your mouth
  • numbness in your mouth
  • loose teeth
  • a lump in your neck

Visit your doctor or dentist as soon as you can if you notice any of these symptoms. Although not necessarily a result of mouth cancer, if you have these symptoms you should visit your GP.

Causes

No one knows why some people develop mouth cancer and others don't. However there are certain factors that make mouth cancer more likely. These are listed below.

  • Smoking tobacco - any form of smoking can increase your risk of getting mouth cancer including cigarettes, cigars and pipes, as well as bidis or hand-rolled cigarettes containing cannabis.
  • Chewing tobacco, such as betel quid, gutkha and paan - this tobacco accounts for the high level of mouth cancer found in countries such as India.
  • Drinking excessive alcohol, especially at the same time as smoking or chewing tobacco.
  • Having already had cancer of the head and neck - if you have already had this type of cancer, you are at risk of developing it again.
  • Spending a long time in the sun or under UV light is a risk factor for lip cancer, particularly if you have pale skin.

Other possible risk factors may include:

  • poor diet, lacking vitamins A, C and E and iron, selenium and zinc
  • infection with some strains of the wart virus human papilloma virus (HPV), some strains of which are also linked to cancer of the vulva, cervix and vagina

Mouth cancer can also develop if you have a type of cancer called Kaposi's sarcoma, which can affect any part of the skin. Kaposi's sarcoma is associated with AIDS, a disease that weakens the immune system. It is also associated with a weakened immune system - for example if you are taking medicines to suppress the immune system after a transplant.

Diagnosis

The earlier mouth cancer is diagnosed, the better your chances are of recovery. Your dentist may spot it in its early stages during a routine check-up, so it's important to visit your dentist regularly.

If you have visited your doctor or dentist with symptoms, he or she will ask you about how and when you noticed it, and examine you. If you visit your doctor, he or she may ask you to see your dentist. Your dentist will look at all areas of your mouth, using a small mirror for harder-to-see areas. He or she will also feel your neck and face for swellings.

If your doctor or dentist suspects that you might have mouth cancer, you may be referred to an oncologist - a doctor specialising in cancer. The specialist will look at your mouth and throat carefully. He or she may take a small sample of some of the affected tissue to be tested at a laboratory. This is called a biopsy. You will usually have a local anaesthetic injection to numb the area so that you don't feel any pain when the sample is taken.

Alternatively, your dentist may do a biopsy and may then refer you to a specialist. Your biopsy results will be passed on to your specialist.

Staging the cancer

If the biopsy shows that cancer is present, your doctor will need to know how far it has spread. This is called staging the cancer. To do this, you will need to have more tests, including:

  • endoscopy - a thin, flexible tube with a light at the end is inserted through your mouth and into your throat, and sometimes lungs, so that your doctor can examine the lining of your throat, windpipe and lungs - this may be carried out under general anaesthetic
  • X-rays - you may have a dental or chest X-ray, or both
  • scans - these might include magnetic resonance imaging (MRI) or computerised tomography (CT) scans, which can give detailed images of any part of the body

Treatment

Treatment depends on the exact type of cancer, where it is and how far it has spread. Your doctor will discuss your treatment options with you.

Surgery

Surgery is a common way of managing mouth cancer. The aim is to remove the cancer completely. The part of your mouth that the specialist may remove depends on where the cancer is and where it has spread. If the cancer has been found early then it may be very small. This means that it may be possible to have treatment as a day case, with no need to stay overnight in hospital. You may have a local or a general anaesthetic. If the cancer is larger and the surgery is more extensive, you will need to stay in hospital to be treated.

Radiotherapy

Radiotherapy involves using radiation to destroy the cancer cells, while trying to cause as little damage as possible to nearby healthy tissue. It's carried out using a machine to deliver a narrow beam of radiation to the affected area, or by surgically implanting small radioactive pellets next to the cancerous tissue.

Radiotherapy can have side-effects such as causing painful inflammation of the lining of your mouth. This can be painful and you may need painkillers for a few weeks until your mouth begins to heal.

You might have radiotherapy after surgery to make sure all the cancer cells have been killed off.

Chemotherapy

This involves taking medicines that disrupt the growth of cancer cells. Chemotherapy can also have side-effects such as making you feel sick or tired.

Chemotherapy is sometimes used in combination with radiotherapy. It's usually given as an intravenous injection or drip. Some drugs can be given as tablets.

You will need to visit hospital a number of times to receive your radiotherapy or chemotherapy.

Prevention

There are a number of lifestyle changes you can make to reduce your risk of mouth cancer:

  • visit your dentist for regular check-ups
  • look for any changes in your mouth, sore patches or ulcers that don't heal
  • don't smoke
  • don't chew tobacco
  • drink only in moderation (up to two to three units a day for women and up to three to four units a day for men)
  • eat a healthy diet with plenty of fruit and vegetables (at least five different portions per day)
  • take care to protect your skin from sunlight and other UV exposure such as sunbeds - wear sunblock on your lips, stay out of the sun between 11am and 3pm and wear a wide-brimmed hat to protect your face

Further information

Cancerbackup

Mouth Cancer Foundation

Sources

  • Opportunistic oral cancer screening. British Dental Association. Occasional paper, 2000(6). www.bda.org
  • About mouth cancer. Cancer Research UK. www.cancerresearchuk.org, accessed 26 June 2007
  • Mitchell, DA and Mitchell L, Oxford Handbook of Clinical Dentistry. Oxford: Oxford University Press, 2005: 452
  • Simon C, Everitt H, and Kendrick T, Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005: 910
  • Scully C, Porter S. ABC of Oral Health - Oral Cancer. BMJ 2000;321: 97-100
  • Oral Cancer Prevention. National Cancer Institute. www.cancer.gov, accessed 27 June 2007
  • Critchley, JA, Unal, B. Health Effects Associated with Smokeless Tobacco: A Systematic Review. Thorax 2003; 58: 435-443
  • Signs and Symptoms of Kaposi's Sarcoma. Cancerbackup. www.cancerbackup.org.uk, accessed 27 June 2007
  • Staging of oral cancer. British Association of Oral and Maxillofacial Surgeons. www.baoms.org.uk, accessed 27 June 2007
  • Alcohol and health. Department of Health. www.dh.gov.uk, accessed 27 June 2007
  • Fruit and veg. Food Standards Agency. www.eatwell.gov.uk, accessed 27 June 2007

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