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Mouth cancer

Mouth cancer (oral cancer) is the 14th most common cancer in the UK. If you have mouth cancer, cells in your mouth start to grow abnormally and out of control. Around 7,300 people are diagnosed with mouth cancer every year in the UK. You’re more likely to develop mouth cancer if you’re over 40. Mouth cancer affects more men than women.

“If you notice any unusual lumps or ulcers in your mouth or jaw, you should see your GP or dentist. The earlier mouth cancer is diagnosed, the easier it is to treat.”

Amanda Squire, Bupa Oncology Nurse Advisor

How cancer develops
Cells begin to grow in an uncontrolled way

Details

  • Types Types of mouth cancer

    Mouth cancer can start anywhere in your mouth, such as:

    • inside your lips
    • in or under your tongue
    • in your gums
    • inside your cheeks
    • in the roof of your mouth (your hard palate)
    • in the area behind your wisdom teeth

    Nine out of 10 mouth cancers are a specific type of cancer called squamous cell carcinoma. They grow in the flat, skin-like cells that line the inside of your mouth. 

    Other, rarer types of mouth cancer include:

    • salivary gland cancer, which starts in your salivary gland cells
    • lymphoma, which can start near the base of your tongue and tonsils
    • melanoma, which can start in skin pigment cells in your mouth or on your lips

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  • Symptoms Symptoms of mouth cancer

    In the early stages of mouth cancer, you don’t always have symptoms. But sometimes you may notice:

    • a lump in your mouth or on your lip that doesn’t disappear after two weeks
    • an ulcer in your mouth that doesn’t heal after three weeks
    • a neck lump for no known reason that doesn’t go away on its own
    • red or red-and-white patches in your mouth

    If you have any of these symptoms, you should see your dentist or GP straightaway. 

    Other symptoms of mouth cancer can include:

    • discomfort or pain in your mouth
    • unexplained bleeding in your mouth
    • numbness of your lip or another part of your mouth
    • loose teeth or dentures that no longer fit you properly
    • difficult or painful chewing or swallowing
    • difficulty moving your jaw
    • changes to your voice – it may sound hoarse or quieter, or you may slur your words
    • unexplained weight loss
    • swollen lymph glands in your neck

    These symptoms aren't necessarily signs of mouth cancer, but if you have any of them, see your dentist or GP.

  • Diagnosis Diagnosis of mouth cancer

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

    Your dentist or GP will ask about your symptoms and examine you. They may also ask you about your medical history and will feel your neck and face to check for swellings. If mouth cancer is suspected, they will refer you to a head and neck specialist for further tests. These may include the following.

    • A mouth and throat examination. Your doctor may use a special instrument called a flexible laryngoscope to look inside your mouth and throat.
    • Biopsy. A biopsy involves taking a small sample of tissue from your lip. This will be sent to a laboratory for testing to determine the type of cells and if they’re benign (not cancerous) or cancerous. 

    If you're found to have cancer, you may need to have other tests to see if your cancer has spread. This is called staging. Staging can help doctors estimate how your cancer is likely to progress, and what’s the best course of treatment for you.

    The tests may include the following.

    • Scans. These may include an ultrasound, magnetic resonance imaging (MRI) or CT scan. These check your muscles, organs and tissues in your face, throat and chest.
    • X-rays of your upper and lower jaw, or your chest, or both.
    • Further biopsies of nearby lymph nodes. Lymph nodes are glands found in various parts of your body. They are part of your immune system and may swell up if you have an infection or cancer.
    • Endoscopy. This allows a doctor to look at the inside of your mouth and throat in detail. The doctors uses a narrow, flexible, tube-like telescopic camera called an endoscope.
  • Treatment Treatment of mouth cancer

    Your treatment will depend on which type of mouth cancer you have, where it is and how far it’s spread. Your doctor will discuss your treatment options with you. If you smoke, they will suggest you stop smoking before you start any treatment. This is because smoking can affect how well the treatments work.

    You will usually be offered surgery or radiotherapy first. Your doctor may also suggest other non-surgical treatments, such as chemotherapy and biological therapy.

    Surgery

    The aim of surgery (including laser surgery) is to remove all of the cancer. Your surgeon may need to remove the lymph nodes in your neck too. The type of surgery you have will depend on how much the cancer has grown and spread. Your surgeon will explain to you what needs to be done, and can then give you more details about your aftercare and recovery.

    If your surgeon removes a small tumour in your mouth, this may not cause you any lasting problems. But if you have a larger tumour, the surgery may change how you chew, swallow or talk, and your face may look different afterwards. You may need to have reconstructive or plastic surgery to rebuild the bones or tissues in your mouth. You might also need to have speech and swallowing therapy to help you speak and eat. You will have a dedicated team to help you through both your treatment and aftercare.

    Radiotherapy

    You may have radiotherapy instead of surgery, or after surgery to make sure all of the cancer cells have been destroyed. 

    If you have radiotherapy, a beam of radiation is directed at the cancerous cells. This can shrink or destroy the tumour. The radiation is targeted using computers and scans to try and reduce any damage to normal tissue around the cancer. Radiotherapy does have some side-effects, but these usually settle down a few days or weeks after your treatment has finished. You will be given information about these side-effects and how to manage them by the team treating you.

    Radiotherapy doesn’t change how you look, eat or talk afterwards. But you may still notice some side-effects, such as a sore or dry mouth, or difficulty tasting foods. Your sense of taste will usually come back within a few months, but sometimes, tasting difficulties can be permanent. Losing your sense of taste can affect your appetite, but it’s important to eat a healthy, balanced diet so that you don’t lose weight. If some foods taste odd or have no flavour, there are some things you can do to improve this. Choose foods with strong flavours and add garlic, lemon juice, herbs and spices to your food. Your doctor can refer you to a dietitian who specialises in helping people who’ve been treated for head or neck cancer.

    Get advice from your dietitian if you're worried about your weight or the foods you're able to eat. 

    Chemotherapy

    You may be offered chemotherapy alongside radiotherapy. Chemotherapy is a treatment for cancer that uses medicines to destroy cancer cells. Side-effects of chemotherapy might include sickness, but this can usually be controlled with medicine. Also, chemotherapy can make you more susceptible to infections. The team treating you will tell you what to look out for and how to manage this.

    Biological therapy

    Biological therapy changes how cancer cells grow and spread. Cetuximab is a type of monoclonal antibody given as an injection. It blocks areas on the surface of cancer cells that usually trigger growth. Your doctor may recommend you have cetuximab with radiotherapy and chemotherapy. It has a few side-effects, such as skin rash.

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  • Causes Causes of mouth cancer

    It’s not fully understood why some people develop mouth cancer, although certain factors can make you more prone to the disease. You may be more likely to develop mouth cancer if you:

    • smoke any form of tobacco – cigarettes, cigars and pipes, as well as bidis (Indian cigarettes) or hand-rolled cigarettes that contain cannabis
    • chew tobacco, such as betel quid and paan
    • drink large quantities of alcohol
    • have other mouth conditions that affect the cells in your mouth
    • regularly expose yourself to the sun or ultraviolet (UV) light, as this increases the risk of cancer developing on your lips
    • have a weakened immune system – people who have HIV/AIDS, or who are taking medicines that weaken their immune system, are more likely to develop mouth cancer
    • eat a poor diet containing few fruits and vegetables or limited amounts of vitamins A or C
    • eat a lot of salty fish, often found in Chinese food
    • have the human papilloma virus (HPV) – this virus can cause cancer in a part of your throat at the back of your mouth (called your oropharynx)
  • Prevention Prevention of mouth cancer

    Making some simple lifestyle changes can reduce your risk of mouth cancer. These include the following.

    • Look after your teeth and visit your dentist for regular check-ups.
    • Look for any changes in your mouth, such as sore patches or ulcers that don't heal, and report them to your dentist or GP.
    • Don't smoke.
    • Don't chew tobacco.
    • Drink only in moderation. The Department of Health recommends that men and women shouldn’t drink more than 14 units of alcohol a week.
    • Eat a healthy, balanced diet, with at least five portions of fruit and vegetables a day.
    • Protect your skin from sunlight. Wear sunblock on your lips, stay out of the sun between 11am and 3pm, and wear a wide-brimmed hat to protect your face.
  • Help and support Help and support

    Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is being given support to deal with the emotional aspects as well as the physical symptoms. 

    It’s important to discuss your feelings with your GP or specialist cancer nurse as they can talk through any concerns you have. Visit the cancer charity websites to find local support groups.

    If you have more advanced cancer, further support is available to you in hospices or at home. This is called palliative care.

  • FAQ: Spotting the signs of mouth cancer I've got an ulcer in my mouth – how can I tell if it's cancer?

    Mouth cancer is relatively uncommon. Only two in every 100 cancers diagnosed in the UK are mouth cancer. But if you notice an ulcer in your mouth that hasn't healed after three weeks, see your dentist or GP. The sooner any cancer is found and treated, the better your chances of a full recovery.

    More information

    Mouth cancer usually grows in the lining of your mouth. In its early stages, it often doesn’t cause any symptoms. But the first sign may be an ulcer that doesn't heal after three weeks. One in three mouth cancers affect the inside of the mouth, and another one in three affect the tongue.

    A persistent ulcer isn’t necessarily a sign of mouth cancer, but it’s important to ask your dentist or GP to examine you to make sure. Dentists are specially trained to check your mouth for signs of cancer. If they think you may have mouth cancer, they can refer you to an oral surgeon for further tests.

  • FAQ: A dry mouth after radiotherapy Since having treatment for mouth cancer, I've had a really dry mouth. Is there anything I can do to make this better?

    Sometimes, radiotherapy can damage your salivary glands, which reduces your saliva production. This can make your mouth feel dry and may last for several months. Occasionally, a dry mouth can be permanent. Your mouth may feel uncomfortable and you may find it difficult to swallow or speak. A dry mouth can also make you more likely to develop mouth infections and tooth decay.

    There are several things you can do to make your mouth feel more comfortable. These include:

    • chewing sugar-free chewing gum
    • taking small sips of water often, especially when you're eating
    • keep a glass of water by your bed
    • eating moist foods with sauces or gravy
    • sucking ice chips
    • using artificial saliva and mouth moisteners (prescribed by your doctor)
    • having regular check-ups with your dentist to look for any infections
    • brushing and flossing your teeth every day to keep your mouth healthy and prevent tooth decay

    Ask your doctor or dentist for more information and advice.

  • FAQ: Eating and drinking problems Will I have trouble eating and drinking after my treatment for mouth cancer?

    Yes, you may do. All treatments for mouth cancer can affect your ability to eat and drink. This may affect your enjoyment of food and can cause you to lose weight. Your doctor and nurse can advise you on ways to help ease your symptoms and get the food and fluids you need. 

    More information

    After surgery or radiotherapy for mouth cancer, you may have problems with chewing and swallowing food, and with your sense of taste and smell.

    Your doctor may prescribe painkillers to help relieve any pain and reduce swelling. They may also give you a mouthwash or gel that will form a protective coating in your mouth. It’s important to keep your mouth and teeth clean to stop you getting an infection. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine. 

    If some of your teeth were removed during surgery, your dentist can insert dental implants into your mouth. This will help you chew. Your doctor may also recommend some exercises to loosen tight jaw muscles.

    If you can’t eat at all during treatments such as radiotherapy, your surgeon may insert a feeding tube through the skin of your abdomen (tummy) and into your stomach. It’s a simple procedure and will make sure you get all the food and nutrition you need. The feeding tube can be removed when you’re able to eat again.

  • FAQ: Speech problems after treatment Will I still be able to talk after treatment for mouth cancer?

    After treatment for mouth cancer, your voice may sound different or you may find it more difficult to talk. Your voice may be quieter or huskier, or you may slur some of your words. How your speech is affected will depend on where your cancer is and which treatment you need.

    More information

    If your windpipe is blocked or your voice box is swollen after radiotherapy, you may need to have a tracheostomy. This is when a breathing tube is inserted through the front of your neck.

    If your voice box is working, you can still talk with a tracheostomy. You block the hole in your neck with your finger, allowing air to pass through your voice box so you can speak. 

    If your voice box has been removed, you will have a tracheostomy with a speech valve inserted or learn to speak from your oesophagus. A speech and language therapist will help you with this.

    It will take time to adjust to any changes in your speech and your ability to communicate. You may find it helpful to carry a notebook and pen to communicate at first.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Oral cancer statistics. Cancer Research UK. www.cancerresearchuk.org, accessed 19 January 2016
    • Head and neck cancers. Oxford Handbook of Oncology (online). 4th ed. Oxford Medicine Online. www.oxfordmedicine.com, published online September 2015
    • Cancers of the oral cavity. PatientPlus. www.patient.info/patientplus, last checked 27 July 2015
    • Dental public health. Oxford Handbook of Global Public Health (online). 6th ed. Oxford Medicine Online. www.oxfordmedicine.com, published online February 2015
    • Mouth anatomy. Medscape. www.emedicine.medscape.com, reviewed 11 September 2015
    • Multidisciplinary management guidelines for head and neck cancer. British Association of Head and Neck Oncologists. www.bahno.org.uk, published September 2011
    • Oral squamous cell carcinoma. The MSD Manuals. www.msdmanuals.com, reviewed July 2013
    • Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), June 2015. www.nice.org.uk
    • Head and neck cancers. Clinical Knowledge Summaries. www.cks.nice.org.uk, reviewed November 2015
    • Lip biopsy. Medscape. www.emedicine.medscape.com, reviewed 21 July 2015
    • Lymph node disorders. Medscape. www.emedicine.medscape.com, reviewed 29 May 2014
    • Endoscopy. The MSD Manuals. www.msdmanuals.com, reviewed February 2013
    • Cancers of the oral mucosa. Medscape. www.emedicine.medscape.com, reviewed 20 February 2014
    • Principles of radiation oncology. Oxford Handbook of Oncology (online) 4th ed. www.oxfordmedicine.com, published online September 2015
    • Mouth care. Cancer Research UK. www.cancerresearchuk.org, accessed 18 January 2016
    • General aspects of chemotherapy. PatientPlus. www.patient.info/patientplus, reviewed 13 June 2014
    • Cancer epidemiology and public health. Oxford Textbook of Global Public Health (online). 6th ed. Oxford Mediicne Online. www.oxfordmedicine.com, published online February 2015
    • Alcohol Guidelines Review. Report from the Guidelines Development Group to the UK Chief Medical Officers. Department of Health. www.gov.uk, published December 2015
    • Sunburn. PatientPlus. www.patient.info/patientplus, last checked May 2015
    • Oncology and palliative care. Oxford Handbook of Clinical Medicine (online). 9th ed. Oxford Medicine Online. www.oxfordmedicine.com, published online January 2014
    • Eating after mouth cancer. Cancer Research UK. www.cancerresearchuk.org, accessed 19 January 2016
    • Oral mucositis. BMJ Best practice. www.bestpractice.bmj.com, reviewed 2 February 2015
    • Enteral feeding. PatientPlus. www.patient.info/patientplus, last checked 21 May 2015
    • Changes in your speech due to mouth cancer. Cancer Research UK. www.cancerresearchuk.org, accessed 19 January 2016
    • Head and neck cancers. PatientPlus. www.patient.info/patientplus, last checked 27 July 2015
    • Head and neck surgery. OSH Operative Surgery (online). 2nd ed. Oxford Medicine Online. www.oxfordmedicine.com, published online October 2011
    • Laryngeal cancer. The MSD Manuals. www.msdmanuals.com, reviewed July 2013
    • Laryngectomy rehabilitation. Medscape. www.emedicine.medscape.com, reviewed 19 March 2014
    • Tracheostomy. PatientPlus. www.patient.info/patientplus, last checked 10 December 2015
     

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