Gum and Inner Cheek Cancer

The gum (gingiva) and the inner cheek (buccal mucosa) are two areas of the mouth that are often overlooked. The gums are the tissue surrounding the teeth and covering the jawbone; the inner cheek is the inner surface of the cheek extending from the corner of the lips to the back molars. Cancers developing from the lining layer of these tissues are called gum cancer and inner cheek cancer.

What is gum and inner cheek cancer?

In both areas the great majority of cancers are squamous cell cancers (squamous cell carcinoma). Gum cancer may develop in the upper or lower jaw and, because of its closeness to the bone directly beneath it, may advance into the jawbone (mandible or maxilla) at an early stage. Inner cheek cancer, on the other hand, may deepen towards the muscle layer of the cheek and, when advanced, may reach as far as the skin of the cheek.

In these cancers the main risk factors are cigarettes and tobacco products, particularly smokeless tobacco placed between the cheek and the gum, alcohol use, constant irritation caused by ill-fitting dentures and broken teeth, and poor oral hygiene.

Symptoms

• A sore on the gum or inner cheek that does not heal within a few weeks
• A white (leukoplakia) or red (erythroplakia) patch that cannot be wiped away
• A raised area on the gum, a cauliflower-like growth or easy bleeding
• Unexplained loosening of teeth, or a socket that does not heal after a tooth extraction
• Dentures that no longer fit
• Firmness or thickening of the inner cheek, or difficulty opening the mouth
• Pain, numbness or swelling in the neck

Gum cancer may initially be confused with gum inflammation or a dental abscess; complaints that do not respond to dental treatment are a warning in this respect.

Diagnosis

Diagnosis begins with a careful examination of the mouth and neck; taking a tissue sample from the suspicious area (biopsy) establishes the definitive diagnosis. In gum cancers, a panoramic dental X-ray and computed tomography (CT) are used to assess bone involvement, and magnetic resonance imaging (MRI) or ultrasonography for soft-tissue spread and the neck lymph nodes. With this information the stage of the disease (stage I–IV) is determined.

Treatment

The main treatment is surgery. In inner cheek cancer the tumour is removed together with a margin of healthy tissue; if the resulting defect is small it can be closed directly, and if large it is reconstructed with tissue taken from another part of the body. In gum cancer, if there is bone involvement, part of the jawbone is removed together with the tumour; if only the upper layer of the bone is affected, a limited bone removal that preserves the continuity of the jaw may be sufficient.

The lymph nodes in the neck are removed in the same operation according to the likelihood of spread (neck dissection). Depending on the pathology result, radiation therapy (radiotherapy) and sometimes drug treatment (chemotherapy) may be added. If part of the jawbone has been removed, bone reconstruction and subsequently a dental prosthesis are planned to preserve chewing and appearance.

What to expect after surgery

After inner cheek surgery there may be some restriction of mouth opening for a time; regular jaw exercises help to prevent this. After gum and jaw surgery chewing is temporarily more difficult and a soft diet is recommended. Careful oral hygiene is an important part of healing.

When should you see a doctor?

If you have a sore, patch or raised area on your gum or inside your cheek that has not gone away for several weeks, or a complaint that has not improved despite dental treatment, you are advised to see an ear, nose and throat specialist.