Cancer in the mouth
Cancer of the lip, tongue, gums and floor of the mouth are the most common types of mouth cancer. Less often it involves the inside of the cheeks or the palate. It may also start in one of the salivary glands, or spread to the mouth from surrounding areas such as the throat or nose.
As with many forms of cancer, early diagnosis is important to maximize the benefits of any treatment, to reduce the chances of the cancer spreading to other parts of the body, and to avoid facial disfigurements and speech difficulties.
According to statistics gathered by Cancer Research USA, mouth cancers are twice as common in men as women. It is also more likely to affected people over the age of 40. However, recent research shows that it is becoming more common in younger patients and woman.
In the USA there are over 4.300 new cases of mouth cancer diagnosed, and more than 1700 people die from the condition, every year.
Symptoms of mouth cancer
Any spots or lumps in the mouth that remain for a long time and show no sign of going away should be checked out by a healthcare practitioner (GP, dentist or specialist). Similarly, any crack, ulcer or lump on the lips or inside the mouth that does not heal, even if painless, should be examined.
A developing tumor may cause no pain, but can extend and form ulcers, which may bleed. Cancers of the tongue tend to be painful and cause the tongue to feel unnaturally stiff and inflexible.
There may be difficulty in speaking properly or in swallowing, and a feeling of numbness may occur.
If persistent white patches (leukoplakia) or red patches (erythroplakia) appear inside the mouth, these should be brought to the attention of your GP or dentist, as they can be recognized pre-cancerous conditions (conditions that are likely to be followed by the development of cancer).
Why does cancer in a mouth occur?
Cancer of the mouth is often related to tobacco use. Switching from cigarettes to a pipe or cigars, or using snuff or oral tobacco (chewing tobacco), does not reduce the risk. Using low tar or ‘light’ brands will not help either. Keeping a quantity of tobacco in one place in the mouth for long periods is particularly dangerous.
It often causes leukoplakia (see Symptoms), a recognized pre-cancerous condition. Other factors that may encourage the development of mouth cancer include:
- over-consumption of alcohol, especially spirits,
- the combination of alcohol and smoking,
- badly-fitting dentures,
- poor care of teeth, especially if they are rough or jagged,
- constant irritation to the tongue from a sharp edge on a tooth, and
- chewing the areca (betel) nut or betel leaf (pahn) – this is a common practice among certain cultural groups such as those with Bangledeshi heritage.
The combination of alcohol and cigarette smoke is a major cause because the absorption of the cancer-producing substances (carcinogens) in cigarette smoke is enhanced by alcohol.
Any lump, or tissue change in the mouth that does not clear up within a month should be reported to a doctor.
Dentists can also inspect for oral cancers during routine dental check-ups.
A visual examination is usually the first step, followed by touching of the affected area, to feel for lumps or other unusual signs such as fissures or ulcers. It may also be helpful to discuss the oral health history of the patient, for example how long any lumps or ulcers have been present, whether there has been a history of pain or bleeding, and whether they have had difficulty swallowing or talking.
A small biopsy (taking a small amount of tissue for analysis) can confirm the diagnosis.
X-rays and CT scans may also be necessary, to determine the extent of the cancer and to find out if it has affected bones or other areas.
Mouth cancer treatment
Treatment usually consists of surgical removal of all cancerous tissue, radiotherapy (using radiation to destroy cancer cells), chemotherapy (using drugs that attack the cancer, or a combination of these.
A new treatment called Photodynamic therapy (PDT) is also being used on some types of cancer of the mouth. This uses laser light and a light-sensitive drug to destroy cancer cells.
When oral cancer is treated early the outlook for recovery is good. After surgery, it may be necessary to carry out some reconstructive surgery on the soft tissue or skin, or to replace bones with prosthetics (artificial replacements). Restorative dentistry, speech therapy and dietary counseling may be required for those whose mouths have been altered by the treatment.
Psychological support may also be required for those whose appearance or speech has altered or who find the treatment particularly distressing.