Symptoms

Mouth cancer can present with various signs and symptoms, such as:

• Persistent sore on the mouth or lip
• A red or white patch inside the mouth
• Loosened teeth
• A lump or growth inside the mouth
• Mouth pain
• Ear discomfort
• Difficulty or pain when swallowing

Causes

Oral cancer develops when cells in the mouth or lips undergo mutations (changes) in their DNA. DNA contains instructions that regulate cell behaviour. Mutations cause cells to grow and divide uncontrollably instead of dying as normal cells would. As these abnormal cells accumulate, they can form a tumour that can spread within the mouth and to other parts of the head, neck, or even beyond over time.

Most oral cancers originate from the thin, flat cells (known as squamous cells) lining the lips and the inner mouth. Many cases of mouth cancer are squamous cell carcinomas.

The exact cause of squamous cell mutations leading to mouth cancer is unclear. However, certain risk factors have been identified that increase the likelihood of developing the condition.

Risk Factors

Several factors can increase the risk of mouth cancer:

• Use of tobacco products such as cigars, cigarettes, pipes, chewing tobacco, snuff, and other forms.
• Heavy alcohol consumption.
• Excessive sun exposure to the lips.
• Human papillomavirus (HPV), a sexually transmitted virus.
• A compromised immune system.

Diagnosis

To diagnose oral cancer, the following tests and procedures may be used:

• Physical examination: A doctor or dentist will inspect your mouth and lips for signs of abnormalities, such as lesions or white patches (leukoplakia).
• Biopsy: A sample of cells may be removed for laboratory testing through a procedure known as a biopsy. This involves cutting away a tissue sample with cutting equipment or using a needle. The cells will then be examined in the lab for cancerous or precancerous changes that indicate a risk of cancer in the future.

Assessing the Extent of Cancer

After diagnosing oral cancer, the dentist will determine its stage or extent. Staging tests may include:

• Endoscopy: This procedure involves passing a small flexible camera attached to a light into the throat to check if cancer has spread beyond the mouth.
• Imaging tests: Various imaging tests, including X-rays, MRI, CT scans, or PET (positron emission tomography) scans, can assess whether cancer has spread to other parts. Not all patients require every test; the doctor will choose the appropriate ones based on your specific condition.

Oral cancer stages are usually denoted with Roman numerals I to IV. A lower stage, such as I, indicates a smaller cancer localized to one area, while a higher stage, such as IV, signifies a larger cancer or one that has spread to other areas of the neck, head, or body.

The stage of your mouth cancer is crucial in determining the appropriate treatment options.

Treatment

Treatment for mouth cancer depends on factors such as the cancer's stage, location, overall health, and personal preferences. Treatment options may include surgery, radiation therapy, and chemotherapy. It is essential to discuss your options with your doctor to determine the most suitable approach.

Surgery

Surgical options for oral cancer may include:

• Tumour removal: The surgeon will remove the tumour along with a margin of healthy tissue to ensure all cancerous cells are eliminated. Smaller tumours may be removed with minor surgery, while larger ones may require more extensive methods. In some cases, larger tumours may involve removing part of the jawbone or a section of the tongue.
• Neck dissection: If cancerous cells have spread to the neck lymph nodes, the surgeon may perform a neck dissection to remove lymph nodes and surrounding tissue. This procedure also helps determine if further treatment is necessary after surgery.
• Reconstructive surgery: After cancer removal, reconstructive surgery may be needed to restore the ability to eat and speak. This may involve transplanting grafts of skin, bone, or muscle from other body parts or using dental implants to replace natural teeth.

Surgery for oral cancer carries risks such as bleeding and infection and can impact appearance and the ability to eat, swallow, and talk. Sometimes, a tube may be required for eating, drinking, and taking medication. The tube may be placed in the stomach through the nose for short-term use or directly into the stomach through the skin for longer-term use. Your doctor might also suggest seeing a professional to help you adapt to these changes.

Radiation Therapy

Radiation therapy uses high-energy beams, such as X-rays and protons, to destroy cancerous cells. External beam radiation is the most common method, delivered from a machine outside the body. Alternatively, radiation therapy can be administered by placing radioactive seeds or wires close to the cancer in a procedure called brachytherapy.

Radiation therapy is often given after surgery but can also be used as the primary treatment for early-stage oral cancer. Sometimes, it is combined with chemotherapy to enhance effectiveness, though this combination can intensify side effects. For advanced cases, radiation therapy can help alleviate symptoms like pain.

Possible side effects of radiation therapy to the mouth include dry mouth, cavities, and damage to the jawbone. Before starting radiation therapy, the doctor may recommend seeing a dentist to ensure your teeth are in good condition. Unhealthy teeth might need treatment or extraction before therapy. Your dentist can also advise on how to care for your teeth during and after treatment to minimise future complications.

Chemotherapy

Chemotherapy uses powerful chemicals to destroy malignant cells. These drugs can be administered alone, in combination with other chemotherapy agents, or alongside other treatments. When given with radiation therapy, chemotherapy can enhance the effectiveness of radiation.

Side effects of chemotherapy vary depending on the specific drugs used but commonly include nausea, vomiting, and hair loss. Your doctor will inform you of the side effects associated with the chemotherapy drugs prescribed.

Targeted Drug Therapy

Targeted drug therapy for mouth cancer focuses on specific features of cancerous cells that contribute to their growth. These drugs can be used alone or combined with radiation therapy or chemotherapy.

One targeted drug therapy for mouth cancer is Cetuximab (Erbitux), which inhibits a protein found in various cells, though it is more prevalent in certain cancer cells. Side effects of this drug can include skin rash, headache, itchiness, infections, and diarrhoea. Additional targeted drugs may be considered if standard treatments are ineffective.

Immunotherapy

Immunotherapy uses the immune system to fight cancer cells. Normally, the immune system might fail to recognise cancer cells because they release proteins that hide them from immune cells. Immunotherapy works by disrupting this process.

Generally, immunotherapy is reserved for advanced cases of mouth cancer that do not respond to conventional treatments.

Lifestyle and Home Remedies

Give Up Using Tobacco

Oral cancers are closely associated with tobacco use, including cigars, cigarettes, pipes, snuff, and chewing tobacco. While not all individuals diagnosed with the condition use tobacco, quitting is crucial if you do, as:

• It improves the effectiveness of your treatment.
• It helps the body recover better after surgery.
• It reduces the risk of cancer returning or developing another type of cancer in the future.

Quitting smoking or chewing tobacco can be challenging, especially during the stress of a cancer diagnosis and treatment. However, your healthcare provider can discuss various options, including medications, nicotine replacement therapies, and counselling.

Stop Drinking Alcohol

Alcohol consumption, particularly when combined with tobacco products, significantly increases the risk of oral cancer. Therefore, it is important to stop drinking all forms of alcoholic beverages to reduce the risk of developing a second cancer.

Alternative Medicine

There is no complementary or alternative medicine that can cure mouth cancer. However, these treatments may help manage the disease and alleviate side effects such as fatigue during treatment.

Fatigue is common during cancer treatment. Although your doctor can address the underlying causes, you may still feel persistently worn out. Complementary therapies may help manage fatigue. Discuss the following options with your doctor:

• Exercise: Aim for gentle exercise, such as brisk walking, for about 30 minutes most days of the week. Moderate activities can help reduce fatigue during and after treatment. Consult your doctor before starting any exercise programme to ensure it is safe.
• Massage Therapy: A massage therapist applies pressure to your skin and muscles. Some therapists specialise in working with cancer patients. Ask your physician for recommendations for a local massage therapist.
• Relaxation Techniques: Activities that relax your mind, such as journaling or listening to music, may help you cope.
• Acupuncture: Performed by a trained practitioner, acupuncture involves inserting tiny needles into specific points on the body. Some acupuncturists specialise in working with cancer patients. Your doctor can recommend an acupuncture specialist in your community.

Coping and Support

Discussing treatment options for mouth cancer with your doctor can be overwhelming, especially as you are coming to terms with your diagnosis and making decisions about treatment. To manage this uncertainty, consider the following strategies:

• Learn About Oral Cancer: Prepare a list of questions for your doctor. Consider bringing a friend or a recorder to help note important information. Ask your doctor for recommendations on reliable books or websites for accurate information. Understanding your diagnosis and treatment options can help.