Mouth cancer, which is also known as lip and oral cavity cancer, is a type of cancer that may begin in any area of the mouth. This includes the gums, the lining of the cheeks and lips, oral/mobile tongue (the front two-thirds of the tongue), the floor of the mouth under the tongue, hard palate (the bony roof of the mouth) and the retromolar trigone (area behind the wisdom teeth).
In adults, the most common form of mouth cancer is a squamous cell carcinoma, which arises from the squamous cells that line the inside of the mouth. Rarer forms of mouth cancer in adults are lymphomas (cancer that begins in the lymphatic system) and melanomas (cancer that begins in melanocytes). In children, mouth cancers usually take the form of a lymphoma or a sarcoma (cancer arising from bone or soft tissue). Rarely, children mouth cancers may appear as squamous cell carcinomas.
Mouth cancer is more common in males, and is generally diagnosed after the age of 55. However, anyone can develop this disease.
Treatment
If mouth cancer is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Treatment is dependent on several factors, including location, stage of disease and overall health. In adult patients, your tumour will be staged and graded to help determine the best treatment option for you. There is currently no standard staging system for children with mouth cancer.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
The treatment options for adults and children with mouth cancer are similar. These options may include:
- Surgery, potentially including:
- Glossectomy (removal of part or all of the tongue).
- Mandibulectomy (removal of part or all of the jaw bone (mandible)).
- Maxillectomy (removal of part or all of the upper jaw bone (maxilla)).
- Radiation therapy.
- Chemotherapy.
- Clinical trials.
- Palliative care.
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
Risk factors
Some of the risk factors for mouth cancer include:
- Excessive alcohol consumption.
- Smoking and/or tobacco usage.
- Poor oral hygiene.
- Being infected with the Human Papillomavirus (HPV).
- Having a family history of mouth cancer.
- Certain conditions, such as Fanconi anaemia, Li-Fraumeni syndrome and/or bloom syndrome.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Early symptoms
Symptoms of mouth cancer are similar in adults and children. Some of the potential symptoms include:
- Pain in the mouth.
- Difficulty or pain when swallowing.
- Persistent sore throat.
- A persistent sore or swelling in the mouth that doesn’t heal over time.
- Unusual bleeding and/or numbness in the mouth.
- Red and/or white patches on the tongue, lips, mouth or gums.
- Unexplained bad breath.
- Changes and/or difficulties with speech.
- Pain when moving the tongue.
- Unexplained weight loss.
- Loose or ill-fitting dentures.
- Pain in the ear.
- Swelling of the jaw.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have mouth cancer, they will order a range of diagnostic tests to confirm the diagnosis, and refer you to a specialist for treatment.
Physical examination
Your doctor will collect your overall medical history, as well as your current symptoms. Following this, they may examine your body to check for any abnormalities. More specifically, they will examine the oral cavity and observe any abnormalities with a small mirror with lights attached.
Imaging & blood tests
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), x-ray and/or ultrasound, depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis. Additionally, a blood test may be taken to assess your overall health and help guide treatment decisions.
Biopsy
Once the location of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. Once a sample has been removed, it will be sent to a lab and analysed for cancer cells.
Prognosis (Certain factors affect the prognosis and treatment options)
While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage mouth cancers have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
References
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.