Mouth cancer has the same meaning as oral cancer – it is cancer that occurs in any part of the mouth; on the tongue’s surface, in the lips, inside the cheek, in the gums, in the roof and floor of the mouth, in the tonsils, and also the salivary glands.
Mouth cancer is a type of head and neck cancer, and is often treated similarly to other head and neck cancers.
34,000 Americans are diagnosed with oral or pharyngeal cancer each year, 23% with fatal cases. Most oral cancer cases occur when the patient is at least 40 years old. It affects more men than women.
What are the signs and symptoms of oral cancer?
Most patients have no detectable symptoms during the early stages of oral cancer. Smokers, heavy drinkers should have regular checkups at the dentists’ – dentists are often able to identify signs of oral cancer.
When signs and symptoms do appear, the typically include:
- Patches on the lining of the mouth or tongue, usually red or red and white in color.
- Mouth ulcers that do not go away.
- A sore that does not heal.
- A swelling in the mouth that persists for over three weeks.
- A lump or thickening of the skin or lining of the mouth.
- Pain when swallowing.
- Loosening teeth (tooth) for no clear reason.
- Dentures don’t fit properly.
- Jaw pain.
- Jaw stiffness.
- Sore throat.
- A sensation that something is stuck in your throat.
- Painful tongue.
- A hoarse voice.
- Pain in the neck that does not go away.
If you have some of these symptoms you should see our doctor. There are many other conditions and diseases with similar symptoms.
What are the risk factors for mouth cancer?
A risk factor is anything that increases that likelihood of developing a disease or condition. For example, regular smoking increases the risk of developing lung cancer; therefore smoking is a risk factor for lung cancer. The risk factors for mouth cancer include:
- Smoking – studies indicate that a 40-per-day smoker has a risk five times great than a lifetime non-smoker of developing oral cancer.
- Taking snuff (snorting tobacco).
- Both heavy and regular alcohol consumption – somebody who consumes an average of 30 pints of beer per week has a risk five times greater than a teetotaler or somebody who drinks moderately.
- Heavy smoking combined with heavy drinking – as tobacco and alcohol have a synergistic effect (their combined effect is greater than each one added together separately), people who drink and also smoke a lot have a significantly higher risk of developing oral cancer compared to others. Somebody who smokes 40 cigarettes per day AND consumes an average of 30 pints of beer a week is 38 times more likely to develop oral cancer compared to other people.
- Too much sun exposure on the lips, as well as sunlamps or sunbeds.
- Diet – people who consume lots of red meat, processed meat and fried foods are more likely to develop oral cancer than others.
- GERD (gastro-esophageal reflux disease) – people with this digestive condition where acid from the stomach leaks back up through the gullet (esophagus) have a higher risk of oral cancer.
- HPV (human papillomavirus) infection.
- Prior radiation treatment (radiotherapy) in the head and/or neck area.
- Regularly chewing betel nuts – these nuts, from the betel palm tree, are popular in some parts of south east Asia. They are slightly addictive and are also carcinogenic.
- Exposure to certain chemicals – especially asbestos, sulphuric acid and formaldehyde.
What causes oral cancer?
Cancer starts when the structure of the DNA (deoxyribonucleic acid) alters – a genetic mutation. DNA provides the cells with a basic set of instructions, much like a computer program for life. The instructions tell cells when to grow, reproduce, and die, among other things. When there is a genetic mutation cells grow in an uncontrollable manner, eventually producing a lump (tumor).
If the cancer is left untreated it grows and eventually spreads to other parts of the body, usually through the lymphatic system – a series of nodes (glands) that exist throughout the body. The lymph glands produce many of the cells of our immune system. As soon as the cancer reaches the lymphatic system it can spread anywhere in the body and invade bones, blood and organs. The cancer cells continue reproducing uncontrollably, gradually occupying more and more space.
Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells, cancer cells do not experience programmatic death and instead continue to grow and divide. This leads to a mass of abnormal cells that grows out of control.
With time, oral cancer may spread firstly to other parts of the mouth, then the head and neck, and eventually to other parts of the body. Mouth cancers typically start in the squamous cells (flat, thin cells) than line the lips and the inside of the mouth – they are referred to as squamous cell carcinomas.
Although we know what the risk factors are, experts are not sure what cause the mutations in squamous cells that eventually lead to mouth cancer.
How is mouth cancer diagnosed?
A general practitioner or dentist will carry out a physical examination and ask the patient questions about his/her symptoms. If oral cancer is suspected the patient will be referred to either an oncologist or an ENT (ear, nose and throat) specialist. An oncologist is a doctor who specializes in diagnosing and treating cancers. ENT specialists are also known as Otolaryngologists.
- Biopsy – the doctor may take a small sample of tissue to see if there are cancerous cells. In most cases the patient will be under general anesthetic. In some instances, just a local anesthetic is used, especially if the biopsy involves taking a sample from the surface of the tissue (fine needle aspiration biopsy).
As soon as mouth cancer is diagnosed the doctor will determine the extent (stage) of the cancer. Tests to help staging may include:
- Endoscopy – the doctor passes a lighted scope down the patient’s throat to see whether the cancer has spread beyond the mouth.
- Imaging tests – the following tests may help the doctor determine whether the cancer has spread:
- Computerized tomography (CT) scans
- Magnetic Resonance Imaging (MRI) scans
- PET (positron emission tomography) scans
Staging the cancer (identifying its stage) provides a universally understood definition of a particular cancer’s progress. It helps in the planning of treatment protocol for that particular cancer, helps in determining prognosis (predicting likely outcomes), and also allows accurate end-results reporting.
- Tobacco – smoking, chewing and snorting (snuff) tobacco increases the risk of developing oral cancer. Therefore, quitting helps lower your risk.
- Alcohol – if you drink a lot, cut down or give up. If you stay within the recommended guidelines for alcohol consumption, or stop drinking completely, your risk of developing oral cancer will drop significantly.
- Diet – a diet high in fruit, vegetables, fish oil, olive oil, combined with moderate quantities of lean animal or plant-based protein, as well as whole grains, will lower your risk of developing oral cancer. Cut out all junk foods, saturated fats, and processed meats.
- Sun exposure – avoid excessive sun exposure to your lips. Some sun is good for you, too much is bad for your skin and lips. Apply a sunscreen lip product.
- Coffee – researchers from the American Cancer Society found that those who consume at least four cups of caffeinated coffee each day have a much lower risk of developing mouth and throat (oral/pharyngeal) cancer compared to others of the same age and sex who only have an occasional cup or drink no coffee at all.The scientists emphasized that their study needs to be backed up with a larger one, and should only be seen as “good news for coffee drinkers” and not as a source for recommending at least four cups of coffee a day. They published their research in the American Journal of Epidemiology (December 9th, 2012 issue).