cancer usually starts in the cells
lining the mouth. The most common
sites are the lips, tongue and floor
of the mouth, but cancer can also
originate in the gums, cheeks, roof
of the mouth, hard and soft palate,
tonsils and salivary glands. People
over the age of 45 years are at
increased risk, with men twice as
likely as women to develop these
types of cancers.
increases the risk of mouth cancer
six-fold. The location of the cancer
seems to depend on the usage of
the tobacco product – for
example, a person who habitually
tucks plugs of chewing tobacco into
their left cheek may be prone to
cancer of that cheek. Heavy alcohol
consumption increases the risk of
mouth cancer even more. Mouth cancer
is easily cured if treated in its
earlier stages, but around half
of patients don’t consult
with their doctor until their disease
is well advanced.
symptoms of mouth cancer can include:
• A visible mass or lump that
may or may not be painful.
• An ulcer that won’t
• A persistent blood blister.
• Bleeding from the mass or
• Loss of sensation anywhere
in the mouth.
• Trouble swallowing.
• Impaired tongue mobility.
• Difficulty moving the jaw.
• Speech changes, such as
slurring or lack of clarity.
• Loose teeth and/or sore
• Altered taste.
• Swollen lymph glands.
Mouth cancer can spread
The membranes of the mouth, nose
and throat are lined with flat,
firm cells called squamous cells.
Most mouth cancers originate in
these surface cells.
treatment, squamous cell carcinoma
can burrow into the deeper tissue
layers, including muscle and bone,
and spread to nearby structures
such as the throat or lymph glands
of the neck. Mouth cancer can migrate
(metastasise) to other parts of
the body if it accesses the bloodstream
or lymphatic system.
exact cause of mouth cancer is unknown,
although tobacco products are thought
to play a significant role in about
80 per cent of cases. Risk factors
• Tobacco use
• Regular and heavy alcohol
• Advancing age
• Sun exposure
• Poor diet
• Poor oral hygiene
• Gum disease
• Habitual chewing of the
lips or cheeks
• Irritants, such as strong
mouthwashes or ill-fitting dentures
• Leukoplakia (light-coloured
patches of atypical cells inside
• Herpes simplex infection
• Human papilloma virus infection
• Family history of cancer
Mouth cancer is diagnosed using
a number of tests including:
• Medical history
• Physical examination
• Biopsy (a sample of suspect
tissue is removed for examination
in a laboratory)
• CT scan
• MRI (magnetic resonance
• PET (position emission tomography)
• Simultaneous MRI-PET scans.
Treatment depends on the size, type
and location of the cancer and whether
it has spread, but can include:
• Surgery - the tumour is
surgically removed, if small. The
lymph glands on the affected side
may also be removed if the tumour
extends into these.
• Radiation therapy - small,
precise doses of ionising radiation
target and destroy cancer cells.
This type of treatment is often
all that’s needed for small,
• Chemotherapy - the use of
cancer-killing drugs, often in combination
with surgery and/or radiotherapy.
Chemotherapy may sometimes be used
to shrink a tumour before surgery.
• Multi-modal treatments -
Surgery on larger tumours may be
followed with radiation therapy.
Chemo-radiotherapy may also be used.
• Long term monitoring –
this may include regular oral examinations
and occasional X-rays to make sure
the cancer hasn’t come back.
• Therapy – this may
include speech therapy, dietary
advice and regular medical follow-up.
Clinical psychologists, social workers
and counsellors can also help people
come to terms with the post-operative
changes to their lives and appearance.
Side effects of treatment
Depending on the size, type and
location of the cancer, and the
treatments used, side effects can
• Tooth loss – radiation
therapy can destroy poor teeth,
so loose or bad teeth are usually
removed prior to treatment. Dentures
then may be fitted.
• Need for prostheses –
in some cases, diseased bone (such
as parts of the jaw) have to be
removed and replaced with prosthetic
devices. In severe cases where swallowing
is troublesome, the person may have
to be fed indirectly, either via
the nose (naso-gastric tube) or
directly into the stomach (gastrostomy
• Scarring and deformity –
to make sure that no cancerous cells
remain, some healthy tissue bordering
the tumour must also be removed
during surgery. The excision of
a large tumour can cause substantial
scarring and deformity. Surgery
to the tongue, for example, may
cause permanent changes to speech
and swallowing. Sometimes skin or
tissue grafts from other parts of
the body are used to help reconstruct
the face and the structures of the
• Damage to salivary glands
– radiation therapy can harm
the salivary glands and reduce their
output of saliva. This causes a
permanently dry mouth (xerostomia).
Management strategies can include
taking medication to increase the
amount of saliva produced, or regularly
using a prescribed gel or spray
of artificial saliva preparations.
• Infections – most
people who have undergone radiation
therapy for mouth cancer have an
increased susceptibility to mouth
infections such as Candida albicans
or ‘thrush’. Medication
helps alleviate this problem.
• Nausea – some of the
many short-term side effects of
chemotherapy include nausea, vomiting
and hair loss.
Sometimes, the cancer is too advanced
and a cure isn’t possible.
Palliative care is not a cure, but
aims to manage pain and reduce the
severity of symptoms. Some of the
options may include:
• Individually tailored pain
management, developed in consultation
with the person’s doctors
and palliative care experts.
• Pain-killing drugs, such
as paracetamol and opioid drugs,
chosen to suit individual patients
and to minimise side effects.
• Radiotherapy, surgery, hormone
therapy and chemotherapy may also
relieve pain, if these treatments
shrink the tumour size.
• Artificial saliva preparations
or drugs to increase saliva production
can help relieve the discomfort
of a dry mouth.
• Psychological, spiritual
and social counselling to help the
person (and family members) come
to terms with their terminal condition.
• Palliative care can be provided
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