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Mouth (Oral) Cancer

oral cancer

 

Mouth cancer can affect any part of the mouth, including the tongue and lips. The most common symptoms are having a sore or ulcer for more than three weeks. You should see your dentist or doctor if you have any symptoms in your mouth that are unusual. The outlook for people with mouth cancer is very good if it is diagnosed early.

What is mouth cancer?

Mouth cancer is a cancer that can develop in any part of the mouth, including the tongue, the gums, the palate (roof of the mouth), under the tongue, the skin lining the mouth or the lips.

What causes mouth cancer?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control.

Some people develop mouth cancer for no apparent reason. However, certain risk factors increase the chance that mouth cancer may develop. These include:

  • Smoking.
  • Alcohol. Drinking a lot of alcohol can increase your risk of developing mouth cancer.
  • Chewing tobacco or the betal leaf.
  • The human papillomavirus (HPV) may increase your risk of mouth cancer.
  • There are some conditions affecting the mouth, such as leukoplakia and erythroplakia, which can increase the risk of a cancer developing.

Mouth cancer is not hereditary, so does not run in families.

What are the symptoms of mouth cancer?

The most common symptoms of mouth cancer are a sore or ulcer in the mouth that does not heal, and pain in the mouth that does not go away. In many cases, changes are seen in the mouth before the cancer develops. This means that early treatment of these changes will actually prevent a cancer developing.

Other symptoms include:

  • White patches anywhere in your mouth (leukoplakia).
  • Red patches anywhere in your mouth (erythroplakia).
  • A lump on the lip, tongue or in the mouth or throat.
  • Unusual bleeding or numbness in the mouth.
  • Pain when chewing or swallowing.
  • A feeling that something is caught in the throat.
  • Unusual bleeding or numbness in the mouth.
  • Loose teeth or dentures feeling uncomfortable and not fitting properly.
  • A change in your voice or speech problems.
  • Weight loss.
  • A lump in the neck.

If the cancer spreads to other parts of the body, various other symptoms can develop.

Note: any ulcer in the mouth that does not heal after three weeks should be checked by your dentist or doctor.

How is mouth cancer diagnosed and assessed?

To confirm the diagnosis

It is likely that you will need a biopsy. A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then looked at under the microscope to look for abnormal cells.

Assessing the extent and spread (staging)

If you are confirmed to have mouth cancer then further tests may be done. For example, biopsy samples may be taken from the nearby lymph glands by using a fine needle.
Other tests may be arranged to see if the cancer has spread to other parts of the body. For example, a CT scan, an MRI scan, or other tests.
This assessment is called staging of the cancer. The aim of staging is to find out:

  • How much the tumour has grown in the mouth.
  • Whether the cancer has spread to local lymph nodes.
  • Whether the cancer has spread to other areas of the body (metastasised).

What are the treatment options for mouth cancer?

Treatment options which may be considered include radiotherapy, surgery, and chemotherapy. The treatment advised for each case usually depends on various factors such as the exact site and extent of the cancer, and your general health.

Surgery

The most common treatment is surgery. The type of operation depends on the size of the cancer and its site. The operation may be to remove the cancer and some of the surrounding normal tissue.

Sometimes surgery is aimed at curing the cancer by removing it all. Sometimes surgery is used to relieve symptoms if the cancer is at an advanced stage (palliative surgery). The operations are all done whilst you are asleep under a general anaesthetic.

Laser surgery may sometimes be used to remove small mouth cancers. This may be combined with a light-sensitive drug in treatment known as photodynamic therapy (PDT).
Sometimes a special type of surgery called micrographic surgery or Mohs' surgery is used for cancers on the lip. In this surgery, the surgeon removes the cancer in very thin layers and the tissue that has been removed is examined under a microscope during the operation. This technique makes sure that all the cancer cells are removed and only a very small amount of healthy tissue is removed.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying.
Two types of radiotherapy are used for mouth cancer: external and internal.

  • External radiotherapy. This is where radiation is targeted on the cancer from a machine. (This is the common type of radiotherapy which is used for many types of cancer.)
  • Internal radiotherapy (brachytherapy). This treatment involves placing small radioactive wires next to the cancer for a short time and then they are removed.

Chemotherapy

Chemotherapy is a treatment which uses anti-cancer drugs to kill cancer cells, or to stop them from multiplying. Chemotherapy may be used in conjunction with radiotherapy or surgery. Chemotherapy may also be advised if the cancer has spread to other areas of the body.


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