Oral Cavity Cancer

Oral cavity cancers are the collective name for cancers arising from the tissues lining the mouth. The tongue, the floor of the mouth, the gums, the inner cheek, the hard palate and the inner surface of the lips all belong to this region. Because the inside of the mouth is an easily visible area, these cancers can often be noticed at an early stage with a careful examination.

What is oral cavity cancer?

The oral cavity extends from the inner surface of the lips to the point where the throat (pharynx) begins. The thin lining tissue covering this area (mucosa) consists of constantly renewing flat cells. The great majority of oral cavity cancers are squamous cell cancers arising from these cells (squamous cell carcinoma). Less commonly, cancers developing from the minor salivary glands may also be seen.

The cancer is named according to the part of the mouth in which it begins: tongue cancer, floor of the mouth cancer, gum cancer, inner cheek cancer or palate cancer. The site directly affects the symptoms and how treatment is planned.

Risk factors and precancerous lesions

• Cigarettes, pipes, cigars and smokeless tobacco products
• Regular alcohol use; the risk rises further when combined with tobacco
• Constant irritation caused by broken teeth, sharp-edged fillings or ill-fitting dentures
• Poor oral hygiene
• Infection with human papillomavirus (HPV)

White (leukoplakia) or red (erythroplakia) patches in the mouth that cannot be wiped away may be precancerous lesions with the potential to turn into cancer. It is important that such patches are monitored at regular intervals and sampled when necessary.

Symptoms

• A sore or ulcer that does not heal within a few weeks
• A white or red patch in the mouth that does not go away
• Firmness, thickening or a lump in the tissue
• Easy bleeding, unexplained pain or numbness
• Difficulty chewing, swallowing or speaking
• Dentures that no longer fit, loosening of teeth
• A palpable swelling in the neck

Diagnosis

For diagnosis, the mouth and neck are carefully examined; a tissue sample is taken from the suspicious area (biopsy) and examined under the microscope. To assess how deep the cancer has reached and whether it has spread to the jaw or the neck lymph nodes, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) or PET imaging may be used. This information is brought together to determine the stage of the disease (stage I–IV).

Treatment

The main treatment for oral cavity cancers is surgery: the tumour is removed together with a margin of healthy tissue around it. When necessary, the lymph nodes in the neck are removed in the same session (neck dissection). After extensive resections, tissue reconstruction may be performed to preserve speech and swallowing. Depending on the pathology result and the stage, radiation therapy (radiotherapy) and sometimes drug treatment (chemotherapy) may be added to surgery. The diagnostic and treatment process is described in more detail on a separate page.

When should you see a doctor?

If you notice a sore, patch, firm area or swelling in your mouth that has not gone away for several weeks, you are advised to be examined by an ear, nose and throat specialist. Dental check-ups also help these changes to be noticed early, so it is worth keeping to yours.