Malignant oral tumours can arise in the tongue, floor of the mouth, gums, cheeks, hard palate, area behind the last molar and lips. Most are squamous cell carcinomas arising from the lining. Early diagnosis greatly improves treatment prospects, so a non-healing lesion must not be ignored. Benign tumours such as papillomas, fibromas and minor salivary-gland tumours also require removal and analysis.
Risk factors
Risk factors include tobacco, alcohol (which amplifies tobacco’s effect), potentially malignant lesions such as leukoplakia, erythroplakia and oral lichen planus, betel chewing, chronic sunlight exposure for lip cancer and reduced immunity. HPV is mainly associated with oropharyngeal cancers of the tonsils and tongue base rather than the oral cavity.
Early symptoms
Symptoms include an ulcer or white/red patch persisting for two to three weeks; a lump or firm area of the tongue, cheek or gum; bleeding, persistent pain or ear pain; unexplained loose teeth or changed denture fit; difficulty chewing, swallowing, speaking or opening the mouth; tongue/lip numbness; or a persistent enlarged neck gland.
Diagnosis and staging
Diagnosis always requires biopsy. If cancer is confirmed, MRI and/or CT of the head and neck assesses extent, with chest CT or PET-CT where indicated. TNM staging also considers depth of invasion. Treatment planning is multidisciplinary, involving surgeons, radiation and medical oncologists, radiologists and pathologists.
Treatment
Surgery is the main treatment for most oral cancers: removal with healthy-tissue margins and management of neck nodes by neck dissection or, in selected cases, sentinel-node biopsy. Reconstruction is performed where necessary. Histology may indicate further radiotherapy or chemoradiotherapy. Advanced or inoperable disease may be treated with radiotherapy, chemotherapy and immunotherapy.
After treatment
Regular follow-up is more frequent in the early years. Stopping smoking and reducing alcohol lower the risk of recurrence and second tumours. Rehabilitation of chewing, swallowing and speech, including speech and language therapy, supports quality of life.
Prevention and early diagnosis
Avoiding smoking, limiting alcohol, protecting the lips from sunlight and regular dental checks are effective preventive measures. Any mouth or tongue lesion that does not heal within two to three weeks deserves specialist assessment.
References
- Chow LQM. Head and Neck Cancer. N Engl J Med 2020;382(1):60-72. PubMed
- Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009;45(4-5):309-316. PubMed
- Warnakulasuriya S et al. Oral potentially malignant disorders: a consensus report from an international seminar on nomenclature and classification, convened by the WHO Collaborating Centre for Oral Cancer. Oral Dis 2021;27(8):1862-1880. PubMed
The information on this page is educational and does not replace medical consultation.