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Mouth cancer

Mouth cancer (oral cancer) is caused by an abnormal and uncontrolled growth of cells in the mouth.

Mouth cancer includes cancer that starts anywhere in your mouth, including:

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

Over 6,500 people are diagnosed with mouth cancer every year in the UK. The risk of developing mouth cancer increases with age, and it affects more men than women.

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How cancer develops
Cells begin to grow in an uncontrolled way

Details

  • Types Types of mouth cancer

    Nine out of 10 mouth cancers are squamous cell carcinomas. They develop in the flat, skin-like cells that cover 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 in lymph tissue 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

    The most common symptoms of mouth cancer are:

    • an ulcer in your mouth or on your lip that doesn’t heal after three weeks
    • discomfort or pain in your mouth

    Other symptoms can include:

    • red or white patches in your mouth
    • a lump on your lip, tongue or in your neck
    • bad breath
    • unexplained bleeding in your mouth
    • numbness of your tongue or other part of your mouth
    • loose teeth
    • problems chewing or swallowing, difficulty moving your jaw or a feeling that something is caught in your throat
    • changes to your voice – it may sound hoarse or quieter or you may slur your words
    • weight loss because of problems swallowing

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

  • Diagnosis Diagnosis of mouth cancer

    The earlier 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 GP or dentist will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP or dentist will feel your neck and face to check for swellings and may refer you to a head and neck specialist for further tests.

    You may have the following tests to confirm a diagnosis of mouth cancer.

    • 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 is a small sample of tissue. This will be sent to a laboratory for testing to determine the type of cells and if they are benign (not cancerous) or cancerous.

    If you're found to have cancer, you may need to have other tests to assess if the cancer has spread. The process of finding out the stage of a cancer is called staging. The tests may include the following.

    • X-rays of your upper and lower jaw (Panorex X-ray), or your chest, or both.
    • Scans, which may include ultrasound, MRI or CT. These will check your muscles, organs and tissues in your face, throat and chest.
    • Further biopsies of nearby lymph nodes. Lymph nodes are glands throughout the body that are part of the immune system.
    • Endoscopy. This allows a doctor to look at the inside of the body. The test is done using a narrow, flexible, tube-like telescopic camera called an endoscope which is passed through your mouth and into your throat.
  • Treatment Treatment of mouth cancer

    Your treatment will depend on the type of mouth cancer you have, where it is and how far it has spread. Your doctor will discuss your treatment options with you. There are three main treatments for mouth cancer. These are surgery, radiotherapy and chemotherapy.

    Surgery

    Surgery (including laser surgery) involves removing the affected tissue. Your surgeon may also need to remove the lymph nodes in your neck or other affected tissues in your mouth and neck. How much surgery you need will depend on how much tissue is affected.

    If you have surgery to remove a small tumour in your mouth, it may not cause you any lasting problems. But if you have a larger tumour, your surgeon may need to remove part of your palate, tongue, or jaw. This surgery may change your ability to chew, swallow, or talk and your face may look different after surgery. You may need to have reconstructive or plastic surgery to rebuild the bones or tissues in your mouth.

    You may have chemotherapy or radiotherapy after surgery to make sure all the cancer cells are destroyed.

    Non-surgical treatments

    Non-surgical treatments include the following, which you may have alone or in combination with other treatments.

    Radiotherapy

    Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is directed at the cancerous cells, which shrinks the tumour. Sometimes a source of radioactivity will be implanted in your mouth. This is called brachytherapy. Radiotherapy can now be targeted to the area that needs treating to prevent damaging normal tissues close by.

    Chemotherapy

    Chemotherapy uses medicines to destroy cancer cells. They are usually injected into a vein. Chemotherapy may be used in combination with radiotherapy or given before surgery or radiotherapy to shrink the cancer. Radiotherapy targets the area of cancer and chemotherapy may kill cancer cells that have moved elsewhere in your body.

    Biological therapy

    Biological therapy changes the activity of cancer cells. Cetuximab is a type of biological therapy that is known as a monoclonal antibody. Cetuximab blocks areas on the surface of cancer cells that can trigger growth. You may have it together with radiotherapy and chemotherapy, if you have advanced squamous mouth or oropharyngeal cancer.

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  • Causes Causes of mouth cancer

    The exact reasons why you may develop mouth cancer aren't fully understood at present although often it is related to smoking or heavy alcohol drinking. 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, gutkha and paan
    • drink excessive alcohol
    • have already had certain types of cancer, such as skin cancer or cervical cancer
    • have other mouth conditions which affect the cells in your mouth
    • regularly expose yourself to the sun or ultraviolet (UV) light as this increases the risk of lip cancer
    • have a weakened immune system – people who have HIV/AIDS, or who are taking medicines that suppress the immune system, are more likely to develop mouth cancer
    • eat a poor diet that doesn’t include many vitamins and minerals
    • have the human papilloma virus (HPV), which can be passed on by oral sex, as this causes some cancers of the oropharynx (part of the throat at the back of your mouth), including the soft palate, the base of your tongue, and your tonsils
  • 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.
    • Don't smoke.
    • Don't chew tobacco.
    • Drink only in moderation. The UK Department of Health guidelines recommend that men drink no more than three or four units a day, and women drink no more than two or three units a day.
    • Eat a healthy diet with at least five portions of fruit and vegetables a day.
    • 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.
  • 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 having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home, this is called palliative care.

  • FAQs FAQs

    I've got an ulcer in my mouth - how can I tell if it's cancer or not?

    Answer

    Mouth cancer is relatively uncommon. However, if you have got 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.

    Explanation

    Compared with other types of cancer, mouth cancer is uncommon – two in every 100 cancers diagnosed are mouth cancer. Most mouth cancers develop in the lining (mucosa) of the mouth.

    The main symptom of mouth cancer is an ulcer that doesn't heal – eight out of 10 people with mouth cancer have this symptom.

    Other symptoms of mouth cancer include:

    • discomfort or pain in your mouth
    • red or white patches in your mouth
    • problems chewing or swallowing, difficulty moving your jaw or a feeling that something is caught in your throat
    • loose teeth
    • unexplained bleeding in your mouth
    • a feeling of numbness in your mouth
    • bad breath
    • changes to your voice – it may sound husky or quieter or you may slur your words
    • weight loss because of problems swallowing

    It's important to check the inside of your mouth and visit your dentist regularly. These symptoms aren't always caused by mouth cancer but if you have any of them, see your GP or dentist. Dentists and dental hygienists are specially trained to examine your mouth for signs of cancer. They can refer you to a surgeon if they see something unusual or concerning.

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

    Answer

    A dry mouth is a common side-effect of radiotherapy, but there are things you can do to ease your symptoms.

    Explanation

    A dry mouth can last for several months after radiotherapy and for some people it can be a permanent side-effect, making it difficult to swallow or speak. It can also put you at risk of infection and tooth decay. Some tips that may make you feel more comfortable include:

    • chewing sugar-free chewing gum
    • taking small sips of water often, especially when you're eating
    • eating moist foods with sauces or gravy
    • sucking ice chips or boiled sweets or mints
    • using artificial saliva and mouth moisteners (prescribed by your doctor)
    • having regular check-ups with your dentist to check for any infection and to keep your mouth healthy – it's important to prevent tooth decay
    • not smoking or drinking alcohol as this can make your mouth even drier

    Ask your doctor for more information and advice.

    Some foods taste odd or have no flavour to me now that I’ve had treatment for mouth cancer. What can I do to improve this?

    Answer

    If you have had treatment for mouth cancer, it's quite common for your sense of taste to be affected. This can put you off eating and cause you to lose weight.

    Explanation

    Radiotherapy and some types of chemotherapy can affect your sense of taste and make your food taste peculiar. This can have a big impact on your enjoyment of food. You might find that all foods seem to taste the same or have a metallic, salty or bitter taste. Losing either your sense of taste or smell can affect your appetite so you don't feel like eating, but it's important to try to eat a healthy balanced diet so that you don't lose weight. Some tips to help are listed below.

    • If a food tastes strange to you, don't force yourself to eat it, but you could try it every few weeks to see if your sense of taste gets better.
    • Eat foods that have a strong flavour. This might mean choosing stronger versions of the foods you like such as cheese. Cook foods using marinades and strong flavours like garlic, herbs or lemon juice. Take care with spicy foods though, as these can sometimes irritate a dry or sore mouth.
    • Try eating different foods with new textures and be creative with the foods you eat.
    • You might want to stop eating your favourite foods while you're having chemotherapy so that it doesn't put you off them for good.
    • If you're losing weight, try eating small amounts more often rather than three big meals. You could also try drinks that contain lots of calories to replace your meals, for example Complan or Fresubin. If you're losing a lot of weight, choose foods that are high in fat and have lots of calories, such as full-fat milk and yogurt.

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

    Will I have trouble eating and drinking after my treatment for mouth cancer?

    Answer

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

    Explanation

    After you have had treatment for mouth cancer, you may find that you have problems with:

    • chewing food
    • swallowing
    • your sense of taste and smell

    Things that can make swallowing difficult include:

    • any operation on your jaw, mouth, throat or tongue, as this will cause swelling and pain
    • radiotherapy to your mouth or neck as this can make your throat and mouth very sore

    Your doctor may prescribe painkillers to help relieve pain and reduce swelling. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

    Your doctor may also give you a mouthwash or gel which will form a protective coating in your mouth. It’s important to keep your mouth and teeth clean to prevent getting an infection.

    If you can't swallow properly, this can lead to aspiration. This is when small amounts of liquid or food leak into your windpipe (trachea) rather than going into your oesophagus (the pipe that goes from your mouth to your stomach). You may have a test called a video fluoroscopy to see whether or not food and drink are going into your stomach when you swallow. You may need to have a thin, plastic tube inserted through the skin of your abdomen (tummy) and into your stomach so that you get all the food you need. This can be left in for weeks if necessary and shouldn’t be too uncomfortable.

    It can take some time for the swelling to go down and for the tube to be removed. Your swallowing may not go back to the same state as before surgery. A speech and language therapist will give you exercises and advice on how to make eating and swallowing easier.

    Will I still be able to talk after treatment for mouth cancer?

    Answer

    Mouth cancer and its treatments can cause speech problems, including changes to how your voice sounds as well as how you talk and how fluent you are.

    Explanation

    The type of problems you may have will depend on where the cancer is and the kind of treatment you need. You're more likely to have difficulties if you:

    • have cancer that affects your tongue, lips or soft palate (part of the roof of your mouth towards the back)
    • you have teeth removed or have all or part of your voice box (larynx) taken out

    Mouth cancer and its treatments may cause you to:

    • slur or have problems saying certain words or sounds
    • have a different sounding voice – quieter, husky or as if you have a cold

    You may need to have a tracheostomy if your windpipe is blocked or your voice box is swollen after radiotherapy. This is when a breathing tube is inserted through the front of your neck. A tracheostomy may be temporary to relieve swelling, or permanent if your voice box is removed or your airway is seriously damaged.

    If your voice box is working, you can still talk with a tracheostomy by blocking 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 and give you exercises to help you cope with any changes. Exercises can improve the way your tongue and mouth move or help you develop new ways to make sounds and speech.

    You may have many months of therapy while you're in hospital and at home. It will take time to adjust to any changes in your speech and your ability to communicate with other people. It will help to carry a notebook and pen to communicate at first.

  • Resources Resources

    Further information

    Sources

    • Head and neck cancer. Map of Medicine. eng.mapofmedicine.com, published 5 April 2013
    • Oral cancer incidence statistics. Cancer Research UK. www.cancerresearchuk.org, published 13 October 2013
    • Cancers of the oral mucosa. Medscape. emedicine.medscape.com, published 20 April 2012
    • ENT UK. Head and Neck Cancer: Multidisciplinary Management Guidelines 4th Edition. ENT UK: London; 2011. www.bahno.org.uk/docs/head_and_neck_cancer.pdf, published September 2011
    • Pharyngeal cancer. Patient UK Professional Reference. www.patient.co.uk, published 19 January 2012
    • Malignant tumours of the palate. Medscape. emedicine.medscape.com, published 26 June 2013
    • Mouth cancer. Cancer Research UK. www.cancerresearchuk.org, published 19 March 2012
    • Cancer of the oral cavity. Patient UK Professional Reference. www.patient.co.uk, published 18 March 2011
    • Dysphagia. Medscape. emedicine.medscape.com, published 29 May2012
    • X-ray and other imaging and contrast studies. Merck Manuals. www.merckmanuals.com, published February 2013
    • Oropharyngeal cancer. Map of Medicine. eng.mapofmedicine.com, published 5 April 2013
    • Lip and Oral Cavity Cancer Treatment. National Cancer Institute. www.cancer.gov, published 16 July 2012
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 1024
    • Reducing harmful drinking. UK Department of Health. www.gov.uk, published 25 March 2013
    • Skin cancer prevention. Cancer Research UK. www.cancerresearchuk.org, published 4 March 2013
    • Mouth care guidance and support in cancer and palliative care 2012. UK Oral Mucositis in Cancer Group. www.ukomic.co.uk, accessed 24 January 2014
    • Nutritional support (artificial feeding). Macmillan cancer support. www.macmillan.org.uk, published 1 January 2013
    • Head and neck cancer. Macmillan Cancer Support. www.macmillan.org.uk, published 1 November 2012
    • Salivary Abnormalities in Dentistry. Medscape. emedicine.medscape.com, published 31 January 2013
    • General Principles of Radiation Therapy. Medscape emedicine.medscape.com, published 18 September 2013
    • Laryngectomy rehabilitation. Medscape. http://emedicine.medscape.com, published 4 December 2012
    • Personal communication. Dr Adam Dangoor, Medical Oncologist, University Hospitals Bristol, March 2014
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    Reviewed by Jane McQueen, Bupa Health Information Team, March 2014.

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