Oral cancer

Oral (mouth) cancer refers to cancers of the tongue, lips, inside lining of the mouth / cheeks and the oropharynx (the portion of the throat at the back of the mouth).

Oral cancer forms part of the head and neck group of cancers. It is the sixth most common cancer in the UK – every year there are approximately 4,900 new cases reported.

Risks

In some patients the exact cause of these cancers is unknown, but there are definite risk factors. These include:

Tobacco and alcohol

These substances all contain nitrosamines, chemicals that are known to cause cancer. Over three quarters of oral cancer cases are linked to smoking, chewing tobacco (or betel quid) and alcohol.

Diet

a diet lacking in vitamins and minerals such as vitamin A and zinc increases cancer risk. Fresh fruits and vegetables act as risk reducers.

Human papilloma virus (HPV)

Some studies suggest that HPV, specifically HPV 16, is associated with oral cancer.

Excessive sunlight

Long periods of UV exposure can lead to cancer of the lip. Be sure to wear protective lip balm or sunscreen when outdoors for extended periods of time.

Age and gender

Oral cancers are more common in older people, although incidence is on the rise among those aged 40 to 50. The number of women with oral cancers is also increasing, although they are still more common in men.

Previous cancer

People who have a history of other head and neck cancers are at greater risk of developing oral cancer, particularly if they continue to smoke and drink alcohol.

Symptoms

Most oral cancers begin in the tongue and floor of the mouth. Unfortunately oral cancer can be difficult to see in its earliest stages. This makes early detection and treatment essential to improving chances of survival. Therefore be sure to ask your GP or dentist to check for signs of oral cancer during your next visit.

The common symptoms of oral cancer are:

  • red and white patches inside your mouth
  • ulcers or sores that do not heal within 14 days
  • a lump in the neck
  • pain or bleeding in the mouth
  • difficulty swallowing
  • persistent pain in the throat or ear
  • speech problems.

It is important to remember that these symptoms can mean you have a condition other than cancer.

Mortality and survival

Since they are often only caught in late stages oral cancers can have a high mortality rate (about 50% at five years from diagnosis). The survival rate jumps to over 85% when oral cancers are small, hence the importance of seeking advice early if you have concerns.

Oral cancer diagnosis

The majority of dentists look for signs of oral cancer during dental checkups (which should take place at least once a year).

If your dentist detects any signs of oral cancer you may be referred to a cancer specialist. If they suspect caner they will usually perform a biopsy (remove a tissue sample from the affected area for it to be tested in a laboratory).

If cancer is confirmed, treatment should begin as soon as possible.

Self-examination

To perform a self-examination use a mirror to check the inside of your mouth, your tongue and the space under your tongue for any abnormalities. You should also run your finger around your mouth and tongue to check for lumps, and feel your neck for anything unusual.

Be sure to report anything that concerns you to your dentist or GP.

Oral cancer treatment

Treating oral cancers usually involves professionals from a variety of disciplines: surgeons, radiation and chemotherapy oncologists, dentists, nutritionists and rehabilitation specialists. There are several oral cancer treatment options:

Surgery

Surgery is the most common form of treatment. The extent of any surgery will be dependent on the stage of the oral cancer – if the cancer has spread, the surgery will be more extensive and may involve the removal of some lymph nodes in the neck.

Radiotherapy

Radiotherapy is used after surgery to eliminate any remaining cancer cells. It is also often used to treat oral cancers that have not spread to other parts of the body.

Chemotherapy

Chemotherapy can be used in combination with radiotherapy to treat oral cancers that have spread to other parts of the body, or to treat oral cancers that have reappeared after earlier treatment.

Monoclonal antibody therapy

Monoclonal antibody therapy is a ‘targeted’ therapy and is usually used in conjunction with radiotherapy or chemotherapy. It involves the use of monoclonal antibodies which are genetically engineered to target and attack cancer cells. The specific type of monoclonal antibody used in the treatment of oral cancer is called Cetuximab.