Mouth cancer

About mouth cancer

Mouth cancer can start anywhere in your mouth, including:

• the lining of your cheek and the inside of your lip
• the floor and roof of your mouth and underneath your tongue
• the edges of your tongue
• your gums

Most cancers of the mouth are squamous cell carcinomas. This is when the cancer grows in the flat, skin-like cells that line the inside of your mouth. There are other, rarer, types of mouth cancer including cancer of the salivary gland and skin cancer on the lips.

Men are more likely to develop mouth cancer than women and it’s more common in people over 50. Around 80,000 people in the India are diagnosed with mouth cancer each year. The number of people getting mouth cancer is increasing.

Symptoms of mouth cancer

Mouth cancer is often diagnosed quite late on because the early signs can be difficult to spot. Early signs of mouth cancer include:

• changes to the lining of your mouth or tongue – for example, white, red, or red and white patches
• mouth ulcers that don’t heal after two to three weeks 

Other symptoms include:

• a lump on your lip or in your neck or mouth
• bleeding in your mouth
• loose teeth or problems wearing your dentures
• problems swallowing
• problems with your speech

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

Causes of mouth cancer

The most common causes of mouth cancer are smoking and drinking more alcohol than recommended.

Some health problems and conditions – for example, dysplasia (abnormal cells developing) and leukoplakia (white patch or lump in your mouth) – may increase the risk of mouth cancer. These conditions can affect people who smoke and those who do not. So, it’s important to have regular mouth checks if you have either condition and to get checked if you notice any potential symptoms. 

There is some suggestion that a condition called lichen planus (a white rash in your mouth) may lead to mouth cancer in a very small number of people. But the evidence for this is not certain.

Chewing betel nuts can also increase your risk of mouth cancer.

Infection with some types of human papillomavirus (HPV) can cause mouth cancer in some people. You can catch an HPV infection by having oral sex with someone who has it.

Diagnosis of mouth cancer

Your dentist might spot the early signs of mouth cancer during a routine check-up. If so, they can refer you straight to a specialist for further tests.

If you see your doctor with symptoms of mouth cancer, they’ll ask you about your symptoms and examine your mouth and neck. If your doctor thinks your symptoms could be due to mouth cancer, they will refer you to a specialist.

You’ll be asked to have some tests to find out what type of cancer it is and if it has spread. These tests may include:

• blood tests
• a biopsy – this involves taking a small sample of tissue that is then examined in a laboratory
• a CT scan,MRI scan or ultrasound
• an endoscopy – this involves a narrow, flexible tube with a camera that your doctor uses to look at the inside of your mouth and

Treatment of mouth cancer

What treatment you’re offered will depend on what type of mouth cancer you have, where it is and if it’s spread. Some treatments can cure the cancer whereas others control it. There are lots of combinations of treatments and your doctor will talk to you about your options.

If you smoke, you’ll be asked to smoking before you start any treatment. This is because smoking can increase your risk of complications and reduce the chance that treatment will work.

Treatments include surgery, radiotherapy, chemotherapy, targeted cancer drugs and immunotherapy.

Surgery

The aim of surgery is to remove all the cancer or as much of it as possible. Exactly what type of surgery you’ll need will depend on where your cancer is, how big it is and if it’s spread. Your surgeon will explain what they’re planning and what to expect afterwards.

Sometimes, this type of surgery can be quite major and, depending on where the cancer is and how big it is, it can affect:

• how you look
• how you breathe
• your speech
• how you chew and swallow
• your sense of smell 

You may need to have reconstructive surgery to repair the bones and soft tissues of your mouth and face. Before you have your operation, you’ll probably be asked to see a dentist. They will check your teeth and do any dental work that’s needed. You may also be asked to see a speech and language therapist and a dietitian to help you recover well. 

Radiotherapy

If the cancer is small, you may have radiotherapy instead of surgery. Or you may have radiotherapy after surgery to make sure all the cancer cells have been destroyed. Radiotherapy works by damaging cancer cells so they can’t work.

Radiotherapy for mouth cancer can be given in two different ways:

• external radiation – a beam of radiation is directed at the cancerous cells
• brachytherapy – a radioactive implant that gives out radiotherapy is placed inside your body 

If you’re having external radiotherapy, you’ll probably need to have it five days a week for several weeks. Implants can be taken out after a short time or left in. If they are left in, the radiation they give off gradually decreases over a period of a few weeks or months.

As with other types of treatment for cancer, radiotherapy can cause side-effects. These include a sore or dry mouth, tiredness, sickness and changes in how your food tastes and smells. Most side-effects start to improve within a few weeks following your treatment.

Medicines

There are two main kinds of medicine used to treat mouth cancer.

• Chemotherapy: You may have this before or alongside radiotherapy instead of surgery. You might also have it to ease the symptoms of cancer that’s spread to other parts of your body, and to slow down its growth. The side-effects include tiredness, sickness and being more likely to get infections.
• Targeted cancer drugs. These are medicines that interfere with how cancer cells grow. They can stimulate your body to control the growth of cancer cells or destroy them. The main targeted cancer drug used to treat mouth cancer is called Cetuximab.

Immunotherapy

Immunotherapy is a type of treatment that uses your own immune system to kill cancer cells. This type of treatment may be offered for advanced mouth cancer or mouth cancer that comes back.Immunotherapy is used when the cancer has not responded to other treatments. It can be effective for some people.  

Prevention of mouth cancer

Making some lifestyle changes can reduce your risk of mouth cancer. These include:

• – there is support available to help you do this
• and cleaning them regularly
• eating a diet that includes lots of fruit, vegetables and fish, and few high-fat foods
• drinking  within the recommended weekly limits

You should have regular mouth checks if you have known dysplasia, leukoplakia or lichen planus. Speak to your doctor or dentist if you have any questions.   

Help and support

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

Specialist doctors and nurses are experts at giving support and they may also visit you at home. If you have more advanced cancer, support is available in hospices, hospital or at home. This is called palliative . For links to further support and information, see the section: Other helpful websites.