Overview
Mouth cancer, also called oral cancer, starts in the lips, the tongue, the gums, the lining of the cheeks, the roof of the mouth or the floor of the mouth under the tongue. Most of these cancers begin in the flat cells that line the mouth.
It is common across South Asia, where chewing habits are widespread, and it is more common in men and in older people. Mouth cancer is one of the few cancers that can be seen. Most of it shows up in a mirror or is spotted by a dentist, which is why a change that does not heal is worth acting on.
Symptoms
The warning signs are usually ordinary-looking things that simply do not go away.
- An ulcer or sore in the mouth that has not healed after three weeks
- A white patch or a red patch inside the mouth
- A lump in the mouth, on the lip, in the neck or in the throat
- Pain in the mouth that does not settle
- Difficulty swallowing or speaking, or a hoarse voice that lasts
- Loose teeth, or dentures that suddenly stop fitting
- Numbness in the mouth or lip, or bleeding with no clear cause
- Losing weight without trying
A mouth that opens less widely than it used to, often with a burning feeling when eating spicy food, points to oral submucous fibrosis, a stiffening of the lining caused by areca nut. That is not cancer, but it can turn into cancer, so it needs treatment and regular follow-up.
When to see a doctor
See a doctor or a dentist within a few days for an ulcer that has lasted more than three weeks, a white or red patch, a lump in the mouth, lip, neck or throat, mouth pain that does not settle, a hoarse voice or trouble swallowing that does not go away, or a mouth that opens less than before. These signs are common and usually turn out to be something else, but when cancer is the cause, finding it early makes it easier to treat.
Causes
Mouth cancer begins when cells in the lining of the mouth are damaged so often that they start to grow out of control. In this part of the body the damage is usually done by something held against the lining again and again.
- Chewing tobacco in any form, including gutkha, khaini, zarda, mawa and paan with tobacco
- Areca nut, or supari, with or without tobacco added
- Smoking
- Drinking a lot of alcohol, which acts together with tobacco
- Some types of human papillomavirus () infection in the mouth
- A lot of sunlight on the lips
Risk factors
- Using tobacco or areca nut, and using both together
- Older age, and being male
- A white patch called leukoplakia, or oral submucous fibrosis
- Having had cancer before
- A weakened immune system, from HIV or from medicines that suppress it
- Changes in genes that run in a family
Complications
Left alone, mouth cancer grows into nearby tissue and can spread to the lymph glands in the neck and further. Eating, swallowing and speaking become harder, and weight falls.
Treatment itself can leave lasting effects. Surgery may change the shape of the jaw, the tongue or the face, and can cause a dry mouth, mouth ulcers and stiff jaw muscles. A specialist team, including speech and swallowing therapists and dietitians, helps with these.
Prevention
- Stopping all forms of tobacco, smoked and chewed
- Stopping areca nut, including plain supari and pan masala
- Drinking less alcohol, or none
- Eating plenty of vegetables and fruit, and staying active
- Protecting the lips from strong sun
- Having a dental check when anything in the mouth has not healed in three weeks
Diagnosis
A doctor or dentist looks inside the mouth and feels the neck. If something looks suspicious, a is taken, which means removing a small sample of the affected area so it can be examined under a microscope. This is the test that gives the answer.
If cancer is found, scans such as an X-ray, , CT, MRI or PET scan, along with blood tests and sometimes a biopsy of a neck gland, show how far it has spread. The results decide the treatment plan.
Treatment
Surgery removes the cancer, and sometimes the lymph glands in the neck as well. If a large piece of tissue has to be taken out, reconstructive surgery uses skin or bone from another part of the body to rebuild the area.
uses radiation to kill cancer cells. It can be the only treatment for an early cancer, or it can be given after surgery, or instead of it. , which is medicine that kills cancer cells, is often combined with radiotherapy or given before or after surgery. Targeted medicines and immunotherapy are used mainly for cancer that is advanced or has come back.
When a cure is not possible, treatment is aimed at slowing the cancer, easing symptoms and helping the person live longer and more comfortably, with support from a palliative care team.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Supari is only a mouth freshener, so plain supari without tobacco is safe.”What is true?
Fact
Areca nut, which is what supari is, is classed as a cause of cancer in its own right. Chewed with or without tobacco it can stiffen the lining of the mouth, a condition called oral submucous fibrosis, which slowly reduces how wide the mouth opens and can turn into cancer.
Myth“Every mouth ulcer heals by itself, so there is no point showing it to anyone.”What is true?
Fact
Most ulcers do heal within about two weeks. An ulcer that is still there after three weeks is different, and it should be looked at by a doctor or a dentist even if it does not hurt.
Myth“Only people who smoke get mouth cancer.”What is true?
Fact
Smoking is one cause, but chewing tobacco, betel quid and paan, areca nut, drinking a lot of alcohol, some HPV infections in the mouth and long sun exposure on the lips all raise the risk as well.
Myth“Taking a biopsy makes the cancer spread.”What is true?
Fact
This is a common belief and it is mistaken. A biopsy is simply how doctors find out what a lump or patch actually is, and the answer decides the treatment. Putting the test off lets a cancer grow quietly and become harder to treat.
Myth“Cancer can pass from one person to another, so a patient should eat and sleep separately.”What is true?
Fact
Cancer does not spread from person to person. Sharing food, a room or a bed with someone who has mouth cancer is safe. Keeping the person apart adds loneliness to an illness that is already hard.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
I only chew plain supari, never tobacco. Am I still at risk?
Yes. Areca nut is a cause of cancer on its own, and it is also the ingredient behind oral submucous fibrosis, the stiffening of the mouth that makes it open less widely. Adding tobacco makes matters worse, but plain supari is not a safe option.
My mouth ulcer does not hurt. Does that mean it is nothing?
Pain is not a good guide. An early mouth cancer can be painless, and a harmless ulcer from a sharp tooth can be very sore. What matters is how long it lasts. Anything still present after three weeks should be examined.
Will treatment leave me unable to speak or eat normally?
It depends on where the cancer is and how large it is. Small early cancers often need only limited surgery or radiotherapy. Larger ones can affect speech and swallowing, and reconstructive surgery, speech therapy and dietitian support are used to recover as much function as possible. Ask the team what to expect in your case.
Does stopping tobacco help once cancer has already been found?
It does. Stopping tobacco and areca nut lowers the chance of a second cancer developing elsewhere in the mouth or throat, and people who stop tend to cope better with surgery and radiotherapy. It is worth asking for help with quitting rather than trying alone.
