What is it?
Oral cancer is a malignant condition arising from the cells that line surfaces such as the lip, tongue, floor of the mouth, inside of the cheek, gums and palate. The great majority of cases are of the squamous cell type. It is seen most often along the side of the tongue and on the floor of the mouth. These two areas are also the hardest for a person to see in the mirror.
The hardest thing about the early stage is that it is silent. A small lesion most often causes no pain, does not bleed and does not get in the way of eating; so even when it is noticed, it gets put off. Pain, numbness, difficulty swallowing and teeth becoming loose are usually findings of a later stage. Part of the delay in seeking help comes not from the disease but from the sign being treated as something ordinary.
What noticing it early changes is clear: while the lesion is small and confined, the treatment planned is narrower in scope, the effect on speech and swallowing is less, and follow-up is easier. Even so, no single finding on its own means cancer. The great majority of sores and patches seen in the mouth have a benign cause; what tells them apart is examination and, where needed, tissue examination.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
Tobacco use
Cigarettes, pipes, waterpipes and tobacco products held in the mouth are the best defined risk factor. The effect is accepted to be related both to how long they are used and to how much. After stopping, the risk has been reported to fall over the years.
- 02
Alcohol and tobacco used together
Alcohol is a risk factor on its own as well. When it is used together with tobacco, the two are accepted to create a risk greater than the sum of them. This combination makes up one of the settings in which the disease is most often reported.
- 03
The form linked to human papillomavirus
Some types of the virus have been linked with cancers in the tonsil and base of tongue area in particular. Because this form can also be seen in younger people who use neither tobacco nor alcohol, it is kept in mind during assessment.
- 04
Sun, precursor lesions and ongoing irritation
Disease on the lip is linked with long-term exposure to the sun. White or red patches that do not rub off, long-standing conditions of the lining of the mouth and a sharp tooth edge that has damaged the same spot for years are also taken into account.
How does it progress?
- Precursor
Changes that are not yet cancer
There is a white patch that does not rub off, or a velvety red area. Neither of these is cancer, and they are dealt with under separate headings; what is being talked about at this stage is not a disease but a change that needs examining.
- Early
A small, confined lesion
The lesion is small and limited to the area it is in, and no involvement has been found in the lymph nodes. The narrowest version of the treatment plan is discussed at this stage.
- Regional
Spread to the lymph nodes in the neck
The lesion has grown, or involvement has been found in the lymph nodes of the neck. A firm, painless lump in the neck that does not move is a common finding at this stage. Treatment may call for more than one method to be planned together.
- Advanced
The stage at which neighbouring structures are involved
The lesion has advanced into the surrounding muscle, bone or deeper tissues. At this stage the scope of treatment widens and preserving function becomes a heading of its own. Staging is carried out by the relevant specialist from the examination and imaging findings.
How is it treated?
Diagnosing and treating oral cancer is not the field of dentistry. When a suspicious finding is picked up, the departments to go to are oral and maxillofacial surgery and the head and neck surgery carried out within ear, nose and throat services. The diagnosis is made by tissue examination alone; it is not made by looking, by photographs or by dyes applied inside the mouth. Where they see fit, these departments request imaging to establish the stage of the disease.
The treatment decision is not made by one clinician but by several departments assessing together. Surgery, the radiotherapy carried out by clinical oncology and the drug treatments carried out by medical oncology are planned on their own or together, according to the site, type and stage of the lesion. Which method is used, in what order and for how long is decided by that team. The dentist is not the party carrying out treatment in this process.
The dentist's role is at the start of the process and alongside it. At a routine examination the side of the tongue, the floor of the mouth, the lip and the neck are assessed; a suspicious finding is recorded and referred on without delay. In people for whom radiotherapy to the head and neck is planned, sources of infection in the mouth are asked to be cleared before treatment starts, because extractions carried out after radiotherapy can lead to healing problems in the jawbone. During and after treatment, dry mouth, sores on the lining of the mouth and the increased risk of decay are headings that dentistry follows.
- If you have a sore in your mouth or on your lip that has not healed for two weeks
- If you have a firm, painless lump in your neck that has not gone away for three weeks
- If unexplained numbness has started in your lip, your jaw or your tongue
- If you have difficulty swallowing, hoarseness lasting more than three weeks, or teeth loosening with no cause found
How is it prevented?
- Give up tobacco products and stay away from the kinds held in the mouth.
- Cut down on alcohol; when it is used together with tobacco, the risk rises further.
- Protect your lips from the sun; use a lip product with sun protection during long hours outdoors.
- Keep up your mouth check-ups; show a sore that has not healed in two weeks without waiting.
Frequently asked questions
- Is the sore in my mouth cancer?
- This question cannot be answered without an examination, and no judgement is made from a single appearance. The great majority of sores inside the mouth come from benign causes such as an aphthous ulcer, pressure from a denture or a bite, and they heal within one to two weeks. What sets one apart is not how the sore looks but that it does not go: a sore that has not healed in two weeks should be assessed whatever the cause.
- Does a biopsy spread the disease?
- This is a common worry, but no basis has been shown for the idea that taking a tissue sample spreads the disease. A delay in diagnosis, on the other hand, affects the course directly. Tissue examination is the only method that can establish whether an area is benign or something else; the decision and its timing are made by the clinician carrying out the assessment.
- I do not smoke or drink alcohol, can I still get it?
- The absence of risk factors lowers the likelihood, but it does not remove it. The disease has also been reported in people who use neither tobacco nor alcohol, particularly in forms sited along the side of the tongue and in those linked to the virus. For that reason, findings such as a sore that does not heal or a patch that does not rub off are assessed regardless of habits.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.