Mouth cancer

Published by Bupa's Health Information Team, March 2010.

This factsheet is for people who have mouth cancer, or who would like information about it.

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.

How cancer develops

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About mouth cancer

Mouth cancer is caused by an uncontrolled growth of cells in the mouth. Mouth cancer includes cancer that starts anywhere in the mouth, including:

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

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 the mouth. Other, rarer types of mouth cancer include:

• salivary gland cancer - starts in the salivary gland cells
• lymphoma - starts in lymph tissue near the base of the tongue and tonsils
• melanoma - starts in skin pigment cells around the mouth or on the lips

Symptoms of mouth cancer

Most people with mouth cancer have no early symptoms at all, but others may have:

• an ulcer in the mouth or on the lip that won't heal
• constant pain or soreness
• red or white patches in the mouth
• a lump on the lip, tongue or in the neck
• bad breath
• unexplained bleeding in the mouth
• numbness in the mouth
• loose teeth

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

Causes of mouth cancer

Doctors don't fully understand why mouth cancer develops. However, certain factors make mouth cancer more likely.

• Smoking any form of tobacco - cigarettes, cigars and pipes, as well as bidis or hand-rolled cigarettes containing cannabis.
• Chewing tobacco, such as betel quid, gutkha and paan.
• Drinking excessive alcohol, especially at the same time as smoking or chewing tobacco.
• Having already had cancer of the head and neck.
• Exposure to the sun or UV light - this increases the risk of lip cancer.
• 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.

Diagnosis of mouth cancer

The earlier mouth cancer is diagnosed, the better the 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 doctor or dentist will ask you about any symptoms, and examine you using a small mirror for harder-to-see areas. He or she will feel your neck and face for swellings. You may then be referred to an ear, nose or throat specialist for further tests.

You may have the following tests to confirm diagnosis.

• Mouth and throat examination - your doctor may use a special instrument called a laryngoscope to look inside your mouth and throat.
• Biopsy - a sample of cells or tissue is removed and sent to a laboratory for diagnosis.

Staging the cancer

If the biopsy shows that you have cancer, you will have further tests to find out how far it has spread and to help decide the type of treatment you will need. This is called staging the cancer. The tests may include the following.

• X-rays of the upper and lower jaw (Panorex X-ray), or the chest, or both.
• Barium swallow - this test involves swallowing a drink containing barium (a substance which shows up on X-rays). The X-rays will show up any unusual growths in the throat.
• Scans - these may include ultrasound, MRI or CT scans. These are done to check the 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.

Treatment of mouth cancer

Treatment depends on the type of mouth cancer, 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.

Surgery

Surgery (including the use of lasers) involves removing just the affected tissue. How much surgery is needed depends on how much tissue is affected. Surgery is sometimes followed by chemotherapy or radiotherapy treatment to make sure all the cancer cells are destroyed.

Non-surgical treatments

• Radiotherapy - radiation is used to kill cancer cells.
• Chemotherapy - anti-cancer drugs are used to destroy cancer cells. They are usually injected into a vein but sometimes may be given as tablets.
• Biological therapy - special manufactured monoclonal antibodies (cetuximab) are used to block areas on the surface of cancer cells that can trigger growth. Radiotherapy is then used to destroy the cancer cells. Cetuximab is a new treatment and is approved for use only in advanced squamous cell cancer of the head and neck.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.

Prevention of mouth cancer

Simple lifestyle changes can reduce your risk of mouth cancer.

• 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 GP.
• Don't smoke.
• Don't chew tobacco.
• Drink only in moderation.
• 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.

For common questions about Mouth cancer, see Common questions.

For sources and links to more information, see Resources.