Mouth cancer: warning signs, risk factors and getting checked

Mouth cancer is a serious condition, and the NHS says finding it early may make it easier to treat. Mouth ulcers and sore spots often have other causes, so the aim of this article is not to alarm but to explain what to look out for and when to get checked. It uses information from the NHS, the US National Institute of Dental and Craniofacial Research (NIDCR) and the World Health Organization (WHO).

1. Introduction

Mouth cancer, also called oral cancer, can affect the gums, tongue, inner cheeks and lips ^[1]. NIDCR describes oral cancer more widely as cancer of the mouth and the back of the throat, including the lining of the mouth, the floor of the mouth and the base of the tongue ^[3]. It mostly affects people over 40 and is more common in men than in women ^[3].

The WHO estimated that lip and oral cavity cancers caused about 389,846 new cases and 188,438 deaths worldwide in 2022 ^[4].

2. Causes and risk factors

The NHS says the cause of mouth cancer is often unclear, but several factors raise the risk ^[2]:

• Smoking, chewing tobacco, betel nut or paan
• Heavy alcohol use
• Leukoplakia, which means white patches in the mouth
• Lots of sun exposure or use of sunbeds, which can also cause cancer of the lip
• Having had cancer before
• A weakened immune system, including HIV or AIDS or taking immunosuppressant medicine
• Certain gene changes, and certain types of human papillomavirus (HPV) infection in the mouth

NIDCR agrees that all forms of tobacco, including chewing tobacco and snuff, raise the risk, that heavy drinking does too, and that using tobacco and alcohol together raises it further. It also lists HPV 16, increasing age, low fruit and vegetable intake and inherited gene changes ^[3]. The WHO links oral cancers strongly to tobacco, alcohol and areca nut (betel quid) ^[4].

3. Signs and symptoms

The NHS lists these possible symptoms ^[1]:

• A mouth ulcer that lasts more than three weeks
• A red or white patch inside the mouth
• A lump in the mouth, on the lip, or in the neck or throat
• Ongoing mouth pain
• Difficulty swallowing or speaking
• A hoarse voice that does not go away
• Unexplained weight loss

NIDCR adds jaw swelling that makes dentures uncomfortable, mouth bleeding, numbness of the tongue or mouth, and ear pain, and advises seeing a dentist or doctor if symptoms last more than two weeks ^[3]. The NHS stresses that these symptoms are common and often have other causes, so they do not mean you have cancer ^[1].

4. Diagnosis and tests

A dentist or doctor will ask about your symptoms, lifestyle and medical history, then examine your mouth, neck and jaw. The NHS says you can ask someone to be with you during the examination. If cancer is a concern, you may be referred quickly for tests or to a hospital specialist, and a referral does not mean you have cancer ^[1].

NIDCR explains that an oral cancer examination is painless, takes only a few minutes and is something a regular dental check-up is a good time for. The dentist or hygienist checks the face, neck, lips, mouth and back of the throat. If something looks unusual, further tests or a specialist referral may be advised ^[3].

5. Treatment and management

Treatment is planned by a specialist team and depends on your general health and on where the cancer is, its size and type, and whether it has spread. NIDCR describes the main options as surgery, with radiation therapy or chemotherapy when needed, and notes that more advanced cancers may need a combination. Newer approaches include targeted therapy, which uses drugs aimed at specific cancer cells, and immunotherapy, which helps the immune system to respond ^[3].

The care team can include head and neck surgeons, oral and maxillofacial surgeons, ear, nose and throat doctors, cancer specialists, dentists, speech pathologists, nurses, dietitians and mental health counsellors. NIDCR recommends a dental examination before cancer treatment starts, ideally about a month ahead, so the mouth has time to recover from any dental work needed ^[3].

6. Prevention and self-care

The NHS says mouth cancer cannot always be prevented, but you can lower your risk by ^[2]:

• Stopping smoking and chewing tobacco, betel nut or paan
• Cutting down on alcohol
• Eating a healthy diet with plenty of fruit and vegetables
• Exercising regularly
• Getting any symptoms checked by a doctor or dentist

The WHO adds that using tobacco, including areca nut, and drinking alcohol are the shared risk factors that public health measures aim to reduce ^[4]. NIDCR says sun exposure can cause lip cancer ^[3], and the NHS says heavy exposure to sunlight or sunbeds can cause skin cancer that affects the lips ^[2]. Regular dental check-ups give a chance for the mouth to be looked at, even when you feel well ^[3].

7. Special groups

Chewing tobacco, betel quid and paan are named as risk factors by both the NHS and the WHO, which is relevant to readers in India and other places where they are used ^{[2, 4]}. People who chew these products, smoke or drink heavily, and people with white patches in the mouth, should be especially alert to changes and attend regular check-ups. NIDCR notes that HPV-related oral cancers have become more common ^[3], and the WHO notes that HPV is an increasing cause among younger people in North America and Europe ^[4].

8. When to see a doctor

See a dentist or a doctor if you have a mouth ulcer that lasts more than three weeks, a red or white patch, a lump in the mouth, lip or neck, ongoing mouth pain, a hoarse voice that does not go away, or difficulty swallowing or speaking ^[1]. NIDCR advises acting if symptoms last more than two weeks ^[3]. The NHS says that if cancer is the cause, early detection may make it easier to treat ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Mouth cancer can affect the lips, tongue, gums and cheeks, and the main risk factors are tobacco, betel quid and paan, heavy alcohol and some HPV infections. Many ulcers and patches have other causes, but any change that lasts more than two to three weeks should be checked. Avoiding tobacco and betel products, cutting down on alcohol and having regular dental check-ups are practical steps, and your doctors will decide on tests and treatment.