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Mouth cancer

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This factsheet is for people who have mouth cancer, or who would like information about it.
 
About 5,300 people get mouth cancer each year in the UK. It mostly affects people over 50 and is more common in men. Mouth cancer is usually treated with surgery, radiotherapy or chemotherapy.
 

How cancer develops
About mouth cancer
Symptoms of mouth cancer
Causes of mouth cancer
Diagnosis of mouth cancer
Treatment of mouth cancer
Prevention of mouth cancer

 

How cancer develops

The information on the video provided does not constitute advice on diagnosis or the treatment for heart disease and such advice should always be sought from a doctor or another suitably qualified health professional.

About mouth cancer

Mouth cancer is caused by an uncontrolled growth of cells in the mouth. Mouth cancer includes cancer that starts anywhere in the mouth, including:

  • lips
  • tongue
  • gums
  • floor of the mouth or under the tongue
  • inside the cheeks and lips
  • roof of the mouth (the palate)
  • area behind the wisdom teeth

Types of mouth cancer

Nine out of 10 mouth cancers are squamous cell carcinomas. They develop in the flat, skin-like cells that cover the inside of the mouth.
Other, rarer types of mouth cancer include:

  • salivary gland cancer – starts in the salivary gland cells
  • lymphoma – starts in lymph tissue near the base of the tongue and tonsils
  • melanoma – starts in skin pigment cells around the mouth or on the lips

Symptoms of mouth cancer

Most people with mouth cancer have no early symptoms at all, but others may have:

  • an ulcer in the mouth or on the lip that won’t heal
  • constant pain or soreness
  • red or white patches in the mouth
  • a lump on the lip, tongue or in the neck
  • bad breath
  • unexplained bleeding in the mouth
  • numbness in the mouth
  • loose teeth

These symptoms aren’t always caused by mouth cancer but if you have them, visit your GP or dentist.

Causes of mouth cancer

Doctors don’t fully understand why mouth cancer develops. However, certain factors make mouth cancer more likely.

  • Smoking any form of tobacco – cigarettes, cigars and pipes, as well as bidis or hand-rolled cigarettes containing cannabis.
  • Chewing tobacco, such as betel quid, gutkha and paan.
  • Drinking excessive alcohol, especially at the same time as smoking or chewing tobacco.
  • Having already had cancer of the head and neck.
  • Exposure to the sun or UV light – this increases the risk of lip cancer.
  • A weakened immune system – people who have HIV/AIDS, or who are taking medicines that suppress the immune system, are more likely to develop mouth cancer.

Diagnosis of mouth cancer

The earlier mouth cancer is diagnosed, the better the chances of recovery. Your dentist may spot mouth cancer in its early stages during a routine check-up, so it’s important to visit your dentist regularly.
Your doctor or dentist will ask you about any symptoms, and examine you using a small mirror for harder-to-see areas. He or she will feel your neck and face for swellings. You may then be referred to an ear, nose or throat specialist for further tests.
You may have the following tests to confirm diagnosis.

  • Mouth and throat examination – your doctor may use a special instrument called a laryngoscope to look inside your mouth and throat.
  • Biopsy – a sample of cells or tissue is removed and sent to a laboratory for diagnosis.

Staging the cancer

If the biopsy shows that you have cancer, you will have further tests to find out how far it has spread and to help decide the type of treatment you will need. This is called staging the cancer. The tests may include the following.

  • X-rays of the upper and lower jaw (Panorex X-ray), or the chest, or both.
  • Barium swallow – this test involves swallowing a drink containing barium (a substance which shows up on X-rays). The X-rays will show up any unusual growths in the throat.
  • Scans – these may include ultrasound, MRI or CT scans. These are done to check the muscles, organs and tissues in your face, throat and chest.
  • Further biopsies of nearby lymph nodes. Lymph nodes are glands throughout the body that are part of the immune system.

Treatment of mouth cancer

Treatment depends on the type of mouth cancer, where it is and how far it has spread. Your doctor will discuss your treatment options with you. There are three main treatments for mouth cancer.

Surgery

Surgery (including the use of lasers) involves removing just the affected tissue. How much surgery is needed depends on how much tissue is affected. Surgery is sometimes followed by chemotherapy or radiotherapy treatment to make sure all the cancer cells are destroyed.

Non-surgical treatments

  • Radiotherapy – radiation is used to kill cancer cells.
  • Chemotherapy – anti-cancer drugs are used to destroy cancer cells. They are usually injected into a vein but sometimes may be given as tablets.
  • Biological therapy – special manufactured monoclonal antibodies (cetuximab) are used to block areas on the surface of cancer cells that can trigger growth. Radiotherapy is then used to destroy the cancer cells. Cetuximab is a new treatment and is approved for use only in advanced squamous cell cancer of the head and neck.

Prevention of mouth cancer

Simple lifestyle changes can reduce your risk of mouth cancer.

  • Visit your dentist for regular check-ups.
  • Look for any changes in your mouth such as, sore patches or ulcers that don’t heal and report them to your GP.
  • Don’t smoke.
  • Don’t chew tobacco.
  • Drink only in moderation.
  • Eat a healthy diet with at least five portions of fruit and vegetables a day.
  • Protect your skin from sunlight and other UV exposure such as sunbeds. Wear sunblock on your lips, stay out of the sun between 11am and 3pm and wear a wide-brimmed hat to protect your face.
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Will I have trouble eating and drinking after my treatment?
Since having treatment for mouth cancer, I’ve had a really dry mouth. Is there anything I can do to make this better?
Lots of the foods that I used to enjoy eating taste odd or have no flavour to me now. What can I do to improve this?
Will I still be able to talk after treatment?
I’ve got an ulcer in my mouth. How can I tell if it’s cancer or not?

Will I have trouble eating and drinking after my treatment?

Yes, you may do. All treatments for mouth cancer can affect your ability to eat and drink and have an impact on your enjoyment of food, causing you to lose weight. Your doctor and nurse can advise you on ways to help ease the symptoms and get the food and fluids you need.

Explanation

After treatment, you may find that you have problems with:

  • chewing  food
  • swallowing
  • your sense of taste and smell

Things that can make swallowing difficult include:

  • any operation on your jaw, mouth, throat or tongue as this will cause swelling and pain
  • radiotherapy to your mouth or neck can make your throat and mouth very sore

Painkillers can relieve any pain and reduce redness and swelling. This may be in the form of a liquid, or gel which forms a protective coating. Keeping your mouth and teeth clean can ease your symptoms and also help to prevent infection. Don’t eat spicy foods, smoke or drink alcohol as this can make your mouth more painful.

If you can’t swallow properly, this can lead to aspiration – small amounts of liquid or food leak into your windpipe (trachea) rather than going into your oesophagus (the pipe that goes from your mouth to your stomach). You may have a test called a videoflouroscopy to see whether or not food and drink are going into your stomach when you swallow. You may need to have a thin, plastic tube inserted through the skin of your abdomen and into your stomach so that you get all the food you need.

It can take some time for the swelling to go down and for the tube to be removed. Your swallowing may not recover to the same state as before surgery. Your speech and language therapist will give you exercises and advice on how to make eating and swallowing easier.

Further information

Macmillan Cancer Support
0808 808 0000
www.macmillan.org.uk
Mouth Cancer Foundation
01924 950 950
www.mouthcancerfoundation.org

Sources

  • Eating after mouth cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 13 January 2010
  • Changes to eating after treatment for head and neck cancer. Macmillan Cancer Support. www.macmillan.org.uk, accessed 13 January 2010

 

Since having treatment for mouth cancer, I've had a really dry mouth. Is there anything I can do to make this better?

Dry mouth can often be caused by radiotherapy. There are things you can do to ease your symptoms.

Explanation

Dry mouth can last longer than six months after radiotherapy and for some people it can be a permanent side-effect, making it difficult to swallow or speak. It can also put you at risk of infection and tooth decay. Some tips that may make you feel more comfortable include:

  • chewing sugar-free chewing gum
  • taking small sips of water often, especially when you’re eating
  • eating moist foods with sauces or gravy
  • sucking ice chips or boiled sweets or mints
  • artificial saliva and mouth moisteners prescribed by your doctor
  • having regular check-ups at the dentist to check for infection and to keep your mouth healthy – it’s important to prevent tooth decay
  • not smoking or drinking alcohol as this can make your mouth even drier
  • using acupuncture to ease the symptoms

Further information

Macmillan Cancer Support
0808 808 0000
www.macmillan.org.uk
Mouth Cancer Foundation
01924 950 950
www.mouthcancerfoundation.org

Sources

Lots of the foods that I used to enjoy eating taste odd or have no flavour to me now. What can I do to improve this?

If you have had treatment for mouth cancer, it’s quite common for your sense of taste to be affected. This can put you off eating and cause you to lose weight.

Explanation

Radiotherapy and some types of chemotherapy can affect your sense of taste and make your food taste peculiar. This can have a big impact on your enjoyment of food. You might find that all foods seem to taste the same or have a metallic, salty or bitter taste. Losing either your sense of taste or smell can affect your appetite so you don't feel like eating, but it's important to try to eat a healthy balanced diet so that you don't lose weight. Some tips to help are listed below.

  • If a food tastes strange to you, don’t eat it but keep trying it every few weeks to see if your sense of taste gets better.
  • Eat foods that have a strong flavour. This might mean choosing stronger versions of the foods you like such as cheese. Cook foods using marinades and strong flavours like garlic, herbs or lemon juice. Take care with spicy foods though, as these can sometimes irritate a dry or sore mouth.
  • Try eating different foods with new textures and be creative with the foods you eat.
  • You might want to stop eating your favourite foods while you're having chemotherapy so that it doesn't put you off them for good.
  • If you’re losing weight, try eating little and often rather than having big meals. You could also try drinks that contain lots of calories to replace your meals, for example Complan or Fresubin. If you’re losing a lot of weight, choose foods that are high in fat and have lots of calories, such as full-fat milk and yogurt.
  • Get advice from your dietician if you're worried about your weight or the foods you’re able to eat.

Further information

Macmillan Cancer Support
0808 808 0000
www.macmillan.org.uk
Mouth Cancer Foundation
01924 950 950
www.mouthcancerfoundation.org

Sources

  • Eating after mouth cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 13 January 2010
  • Changes to eating after treatment for head and neck cancer. Macmillan Cancer Support. www.macmillan.org.uk, accessed 13 January 2010
  • Mouth cancer – coping with taste changes. Cancer Research UK. www.cancerhelp.org.uk, accessed 13 January 2010

 

Will I still be able to talk after treatment?

Cancer of the mouth and its treatments can cause speech problems, including changes to how your voice sounds as well as how you talk and how fluent you are.

Explanation

The type of problems depends on where the cancer is and the kind of treatment you need. You're more likely to have difficulties if you:

  • have cancer that affects your tongue, lips or soft palate (part of the roof of your mouth towards the back)
  • you have teeth removed or have all or part of your voice box (larynx) taken out

Mouth cancer and its treatments may cause you to:

  • slur or have problems saying certain words or sounds
  • have a different sounding voice – quieter, husky or as if you have a cold

You may need to have a tracheostomy if your windpipe is blocked or your voice box is swollen after radiotherapy. This is when a breathing tube is inserted through the front of your neck. A tracheostomy may be temporary to relieve swelling, or permanent if your voice box is removed or your airway is seriously damaged.

If your voice box is working, you can still talk with a tracheostomy by blocking the hole in your neck with your finger, allowing air to pass through your voice box so you can speak.

If your voice box has been removed, you will need to have a tracheostomy with a speech valve inserted or learn to speak from your oesophagus (the pipe that goes from your mouth to your stomach).

A speech and language therapist will give you exercises to help you cope with any changes. Exercises can improve the way your tongue and mouth move or help you develop new ways to make sounds and speech.
You may have many months of therapy while you’re in hospital and at home. It takes time to adjust to any changes in your speech and your ability to communicate with other people. Carry a notebook and pen to tell people about your operation at first.

Further information

Macmillan Cancer Support
0808 808 0000
www.macmillan.org.uk

Sources

I’ve got an ulcer in my mouth. How can I tell if it’s cancer or not?

Cancer of the mouth is relatively uncommon. However, if you’ve got an ulcer in your mouth that isn’t healing after several weeks, see your dentist. The sooner any cancer is found and treated, the better your chances of a full recovery.

Explanation

Compared with other types of cancer, cancer of the mouth is uncommon – two in every 100 cancers diagnosed are mouth cancer. Most mouth cancers develop in the lining (mucosa) of the mouth.

The main symptom of mouth cancer is an ulcer that doesn’t heal - eight out of 10 people with mouth cancer have this symptom. Mouth cancer usually isn't painful so if you have any symptoms you're worried about, see your dentist or GP.

Other symptoms of mouth cancer include the following.

  • Red or white patches on the lining of your mouth for more than three weeks.
  • Problems chewing or swallowing, difficulty moving your jaw or a feeling that something is caught in your throat.
  • Loose teeth for no specific reason.
  • Unusual bleeding in your mouth or a feeling of numbness.
  • Bad breath – if you have mouth cancer, bad breath may be worse or happen more often.
  • Voice changes – husky or quieter or slurring your words.
  • Weight loss because of problems swallowing.

It’s important to check the inside of your mouth and visit your dentist regularly. Dentists and dental hygienists are specially trained to examine your mouth for signs of cancer. He or she can refer you to a surgeon if they see something unusual or concerning.

Further information

Macmillan Cancer Support
0808 808 0000
www.macmillan.org.uk
Mouth Cancer Foundation
01924 950 950
www.mouthcancerfoundation.org

Sources

 

Mouth cancer factsheet
Visit the mouth cancer health factsheet for more information

Related topics

Further information

Macmillan Cancer Support
0808 808 0000
www.macmillan.org.uk
Mouth Cancer Foundation
01924 950 950
www.mouthcancerfoundation.org

Sources

  • About mouth and oropharyngeal cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 11 January 2010
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005: 910
  • Cancer of the mouth. Macmillan Cancer Support. www.macmillan.org.uk, accessed 11 January 2010
  • Types of mouth and oropharyngeal cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 11 January 2010
  • Oral cancer prevention. National Cancer Institute. www.cancer.gov, accessed 11 January 2010
  • Improving outcomes in head and neck cancers – The manual. The National Centre for Clinical Excellence (NICE), 2004. www.nice.org.uk
  • Staging of oral cancer. British Association of Oral and Maxillofacial Surgeons, 2007. www.baoms.org.uk
  • Fruit and veg. Food Standards Agency. www.eatwell.gov.uk, accessed 11 January 2010
  • Covering up. Cancer Research UK. www.sunsmart.org.uk, accessed 11 January 2010
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