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Mouth cancer

Key points

  • Mouth cancer can start anywhere in your mouth, including lips, tongue, gums, under your tongue, inside your cheeks, the roof of your mouth, and the area behind your wisdom teeth.
  • The most common symptoms of mouth cancer are an ulcer in your mouth or on your lip that doesn’t heal after three weeks, and discomfort or pain in your mouth.
  • You are more likely to develop mouth cancer if you smoke or drink excessive alcohol.
  • Treatment depends on the type of cancer you have and how far it has progressed.

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

Animation: How cancer develops

About mouth cancer

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.

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

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.

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

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. Abiopsy 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 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.

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

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.


Reviewed by Jane McQueen, Bupa Health Information Team, March 2014.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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