Fast facts

  • Mouth cancer occurs when cells of the mouth and the oral cavity (the cheeks, tongue, lips, gums and the roof and floor of the mouth) grow uncontrollably as a result of damage to their DNA.
  • Risk factors for mouth cancer include smoking or chewing tobacco, drinking too much alcohol, poor mouth care and diet, and infection with some types of viruses.
  • Mouth cancer can be treated by surgery and/or other types of therapy.
  • The prognosis of mouth cancer can vary widely. It depends on the specific type of cancer you have, and on the stage it has progressed to.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

DNA

The genetic material of all living cells and some viruses. The full name is deoxyribonucleic acid.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

What is mouth cancer?

Mouth cancer (also known as oral cancer) occurs when abnormal cells of the mouth and the oral cavity (the cheeks, tongue, lips, gums and the roof and floor of the mouth) grow uncontrollably.

Mouth cancers can invade local tissues and/or spread to other parts of the body (metastasise). Mouth cancers affect at least three Australians each day. [1]  

Anatomy of the oral cavity. 

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

1. Oral cancer facts. Australian Dental Association Inc. Accessed 10 June 2015 from

External link

Causes

The cause of mouth cancer, as with other cancers, is damage to cellular DNA. Within every cell in our bodies are control mechanisms that regulate the cells' growth, telling it when to multiply and when to stop multiplying. When the DNA of a healthy cell in a body changes (mutates) in such a way that these mechanisms are disrupted, the cell 'loses its brakes' and multiplies uncontrollably.The uncontrolled growth of cells leads to a tumour forming. The cancer cells can sometimes invade nearby tissues, or spread via the bloodstream or the lymphatic system to other areas of the body.

The exact cause of most mouth cancers is not well known, but certain factors can increase the risk of developing the condition.

Cell

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

DNA

The genetic material of all living cells and some viruses. The full name is deoxyribonucleic acid.

Lymphatic system

A network of vessels, lymph nodes, the spleen and other organs that transport lymph fluid between tissues and bloodstream.

Tumour

A growth caused by an abnormal and uncontrolled reproduction of cells.

1. Oral cancer facts. Australian Dental Association Inc. Accessed 10 June 2015 from

External link

Risk factors

Risk factors for mouth cancer include:

  • Smoking cigarettes and tobacco use; 
  • Drinking alcohol; 
  • Poor oral hygiene and gum disease;
  • Men are more commonly affected than women;
  • Infection with human papilloma virus (HPV), Epstein-Barr virus (EBV) or herpes simplex virus (HSV);
  • Family history: Having a sibling that has developed cancer in the head or neck almost doubles your risk;
  • Habitually chewing the lips or the cheeks, or wearing ill-fitting dentures;
  • A diet low in fruit and vegetables, and;
  • Leukoplakia and erythroplakia: Leukoplakia is a light-coloured patch that develops on the side of the tongue or the inside of the mouth. Erythroplakia is a red, raised area that bleeds easily. Only a small number of people with leukoplakia go on to develop mouth cancer, but about half of people with erythroplakia do.

Epstein-Barr virus

A virus of the herpes family that causes mononucleosis, also known as mono or glandular fever. It is also implicated in some other medical conditions.

Gum disease

A chronic, progressive disease of the gums caused mainly by bacteria and poor oral hygiene. Early stages are generally asymptomatic, with the advanced stages characterised by loss of gum tissue, supporting bone and eventual loss of teeth.

Herpes simplex virus

A highly contagious virus that gives rise to cold sores, genital infections, skin and eye lesions, and nervous system disorders. They commonly cause persisent infections.

HPV

A virus with many subtypes that cause warts, including common warts of the hands and feet, and genital warts. Some strains of HPV cause cervical cancer.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

1. Oral cancer facts. Australian Dental Association Inc. Accessed 10 June 2015 from

External link

Types

There are several types of mouth cancers, depending on the cells that give rise to the cancer.

Squamous cell carcinoma

Squamous cell carcinoma originates in the flat cells (known as squamous cells) that mainly line the insides of your mouth, nose and throat. This is the most common type of mouth cancer.

Adenocarcinoma

This is a rare type of cancer that develops in the glandular cells of the salivary glands and mouth.

Melanoma

This type of cancer originates in the cells of the skin that produce pigment. Most people think of melanoma as a disease of external skin, but it can also develop in internal areas such as the mouth and nose.

Lymphoma

Lymphomas are cancers of the lymph nodes. There are many lymph nodes in the neck. Lymphomas can cause painless swelling of affected lymph nodes.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Lymph nodes

A small organ of the lymphatic system containing many immune cells. Lymph nodes, also known as lymph glands, are the sites where many interactions between immune cells and foreign materials occur.

salivary glands

The glands in the mouth that produce saliva (spit).

1. Oral cancer facts. Australian Dental Association Inc. Accessed 10 June 2015 from

External link

Stages of mouth cancer

Treatment outcomes can vary greatly depending on the stage of cancer. Cancer is staged according to the size and location of the cancer, and whether it has spread to nearby or distant lymph nodes throughout the body.

Stage 0

Cancerous cells that have not invaded healthy tissues.

Stage I

The cancer is smaller than 2cm, and has spread deep into the lining of the tissue in the mouth, but not to nearby lymph nodes.

Stage II

The cancer is 2-4cm in size and has not spread to lymph nodes.

Stage III

The cancer is larger than 4cm, or has spread to a neighbouring lymph node.

Stage IVA

The cancer has grown through the tissue around the lip and mouth, and may have spread to lymph nodes.

Stage IVB

The cancer has spread to numerous lymph nodes.

Stage IVC

The cancer has spread throughout the body to other organs.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Lymph nodes

A small organ of the lymphatic system containing many immune cells. Lymph nodes, also known as lymph glands, are the sites where many interactions between immune cells and foreign materials occur.

1. Oral cancer facts. Australian Dental Association Inc. Accessed 10 June 2015 from

External link

Signs and symptoms

Signs and symptoms of mouth cancer include:

  • A persistent ulcer, blood blister or mass in the mouth;
  • Difficulty swallowing or moving the jaw;
  • Changes in speech, such as slurring;
  • A change in taste sensation, or the loss of feeling in the mouth, and;
  • Persistantly swollen lymph nodes in the neck.

Lymph nodes

A small organ of the lymphatic system containing many immune cells. Lymph nodes, also known as lymph glands, are the sites where many interactions between immune cells and foreign materials occur.

Ulcer

An open sore in the skin or mucous membranes such as those of the stomach lining, intestine or mouth.

1. Oral cancer facts. Australian Dental Association Inc. Accessed 10 June 2015 from

External link

Methods for diagnosis

Medical history and physical examination

Your doctor will ask you questions about your medical history and your symptoms, and examine your mouth. If you have lesions (wounds or sores) in your mouth, your doctor may refer you to an ear, nose and throat specialist for further assessment.

Scans

Your doctor may ask for scans, such as ultrasound, computerised tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to help identify the exact type and characteristics of the lesion:

Upper endoscopy

For this test, a narrow telescopic camera will be inserted into your throat in order to view it from the inside. You will be sedated during the procedure..

Biopsy

Removal of a tissue sample for examination under a microscope. A biopsy is the most accurate way of diagnosing a cancer. 

Lesions

Damage to bodily tissue.

1. Oral cancer facts. Australian Dental Association Inc. Accessed 10 June 2015 from

External link

Types of treatment

Surgery 

The cancer and affected lymph nodes may be surgically removed. There are many techniques for the surgical treatment of mouth cancers. The operation will depend on the location, size and number of lymph nodes affected by the cancer. Occasionally, after the removal of the cancer you may also benefit from plastic and reconstructive surgery that can restore your mouth's or nose's function and/or appearance. Your surgeon will discuss these surgical options with you.

Surgery is often combined with any of the following types of therapy:

Chemotherapy

Chemotherapy works by attacking cancer cells and stopping them from multiplying. Various drugs are used, which can be given intravenously or orally. They are often given in cycles: treatment for a few days, followed by a break that helps to reduce the treatment side effects.

Radiotherapy

In this type of therapy, focused X-rays from an external beam radiation source are applied to the area of the cancer. Radiotherapy helps to reduce the recurrence of cancers at their original site. It can occasionally be used on its own for the treatment of very small cancers (stages I or II).

The different types of therapies can be given either before or after surgery:

Adjuvant therapy

Adjuvant therapy is therapy that is given after surgery, with the aim of preventing the cancer from returning. It can take the form of radiotherapy, chemotherapy, or a combination of both.

Neoadjuvant therapy

Like adjuvant therapy, neoadjuvant therapy also takes the form of radiotherapy and/or chemotherapy, but is provided before surgery.

Multi-disciplinary treatment

Mouth cancers are often treated by a team of health professionals including surgeons, oncologists (cancer specialists), radiation oncologists (radiation specialists), speech therapists, dietitians, psychologists and social workers. They help to prepare for treatment, coordinate therapies and assist in your rehabilitation. They are likely to review you periodically in the years following your treatment, to look out for any signs of the cancer recurring, and to assist in your recovery.  

Other therapies 

Some people diagnosed with cancer seek out complementary and alternative therapies. None of these alternative therapies are known to cure cancer, but some can help people feel better when used together with conventional medical treatment. It is important to discuss any treatments with your doctor before starting them.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Chemotherapy

A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.

Intravenously

Within a vein.

Lymph nodes

A small organ of the lymphatic system containing many immune cells. Lymph nodes, also known as lymph glands, are the sites where many interactions between immune cells and foreign materials occur.

Radiotherapy

A treatment that uses ionising radiation to kill or control growth of malignant cancer cells.

X-rays

A scan that uses ionising radiation beams to create an image of the body’s internal structures.

1. Oral cancer facts. Australian Dental Association Inc. Accessed 10 June 2015 from

External link

Potential complications

Spread of cancer (metastasis)

Advanced mouth cancer can spread (metastasise) to other parts of the body through the bloodstream and lymphatic system.  

Difficulty swallowing

Mouth cancer can cause difficulty in swallowing of some or all types of food and drinks. This is known as dysphagia. You may experience choking or coughing when swallowing, have a sensation that something is stuck in your throat, or bring food back up through the nose.

Treatment side effects

The side effects of treatment for mouth cancer include:

  • Tooth loss - radiotherapy can destroy the jawbone (osteoradionecrosis), if decayed and loose teeth are left in place, so these need to be removed first;
  • Need for prostheses - in some cases, part of the jaw may need to be removed and replaced by a prosthetic. In extreme cases, feeding tubes may have to be used because swallowing becomes too difficult;
  • Damage to salivary glands - radiotherapy can damage the salivary glands, reducing the production of saliva, causing a dry mouth;
  • Thyroid problems - radiotherapy can cause thyroid problems (hyper- or hypothyroidism) that require management with medication;
  • Mouth infection - chemotherapy and radiotherapy of the mouth increase the risk of developing oral thrush;
  • Nausea, vomiting and fatigue can be the result of chemotherapy and radiotherapy. Whether or not the treatment makes you feel sick is not an indication of how well the treatment is working;
  • Altered bowel habits - constipation or diarrhoea can occur with chemotherapy;
  • Joint and muscle pain can occur after a treatment session and can last a few days;
  • Temporary hair loss in the head and body can occur after some forms of chemotherapy. The hair will grow back after treatment has ended, and;
  • Tingling in the hands and feet - let your doctor know if this happens and they will adjust your chemotherapy.

Chemotherapy

A medication-based treatment, usually used in the treatment of cancers. There are numerous, different types of chemotherapy drugs that can be prescribed by a specialist. These can commonly be used alongside other cancer treatments such as surgery and radiotherapy.

Fatigue

A state of exhaustion and weakness.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

Joint

A connecting surface or tissue between two bones.

Lymphatic system

A network of vessels, lymph nodes, the spleen and other organs that transport lymph fluid between tissues and bloodstream.

Nausea

A sensation of sickness and unease, typically felt in the stomach, often accompanied by the urge to vomit. Nausea is a common symptom with many possible causes.

Radiotherapy

A treatment that uses ionising radiation to kill or control growth of malignant cancer cells.

Thyroid

A large gland located in the lower front part of the neck that produces hormones that regulate metabolism, growth and development, especially during childhood.

Prosthetic

Artifical devices or tissues placed in or on the body to replace or enhance bodily tissues or parts.

salivary glands

The glands in the mouth that produce saliva (spit).

1. Oral cancer facts. Australian Dental Association Inc. Accessed 10 June 2015 from

External link

Prognosis

Your prognosis will vary according to the specific type of cancer you have, and to the stage it has progressed to.

The five-year survival rate for mouth cancer in Australia, as of 2010, is between 67-93% from the time of diagnosis. [2]

It is important to remember that survival rates are only an indication; they are based upon the averages of previously treated patients. It is not a reflection of the prognosis for an individual. It is often difficult to accurately predict an individual's chance of cure or survival. Constant advances in treatment are continually improving the odds of cure and long-term survival from mouth cancer. 

2. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Australian Government – Australian Institute of Health and Welfare. Accessed 22 September 2014 from

External link

Prevention

You can reduce your risk of getting mouth cancer by not smoking, minimising alcohol consumption, eating a healthy diet high in fruits and vegetables, and using protection during oral sex (HPV and HSV are sexually-transmitted viruses, so you can lower your risk of infection with these viruses by practising safe oral sex). Folate has been found to offer some protective effect against developing oral cancer. [3]

Folate

A type of vitamin B involved in the creation of DNA and RNA. It plays a key role in cell growth and reproduction.

HSV

A highly contagious virus that gives rise to cold sores, genital infections, skin and eye lesions, and nervous system disorders. They commonly cause persisent infections.

HPV

A virus with many subtypes that cause warts, including common warts of the hands and feet, and genital warts. Some strains of HPV cause cervical cancer.

Infection

Entry into the body of microorganisms that can reproduce and cause disease.

3. Pelucchi, C., R. Talamini, E. Negri, F. Levi, E. Conti, S. Franceschi, and C. La Vecchia. “Folate Intake and Risk of Oral and Pharyngeal Cancer.” Annals of Oncology 14, no. 11 (November 1, 2003): 1677–81. doi:10.1093/annonc/mdg448.