Mouth cancer

Mouth cancer, often known as oral cancer or cancer of the oral cavity, is used to describe cancer that starts anywhere in the mouth. More than 853 people in Victoria are diagnosed with mouth cancer each year – that’s over 16 people diagnosed every week. Mouth cancer starts in the cells lining the mouth. Damaged cells can then grow uncontrollably to form a tumour.

The two main risk factors for mouth cancer are alcohol and tobacco use, and the combined effect of drinking and smoking is far greater. Mouth cancer risk increases as you get older, and men are three times more likely than women to develop the disease. Mouth cancer can be treated if diagnosed early, so it’s important to see your dental practitioner or doctor immediately if you notice any changes in your mouth.

Symptoms of mouth cancer

The most common sites of mouth cancer are the lips, tongue and floor of the mouth, but it can also develop in the gums, the inside lining of the cheeks, roof of the mouth, hard and soft palate, tonsils and salivary glands. The symptoms of mouth cancer can include:

• A visible mass or lump that may or may not be painful
• An ulcer that won’t heal
• White or red patches on the mouth, tongue or gums
• Loss of sensation anywhere in the mouth
• Trouble swallowing
• Reduced tongue movement
• Difficulty moving your jaw
• Loose teeth or sore gums
• Changes in taste
• Swollen lymph glands

Having these symptoms does not mean that you have mouth cancer, but if you experience any of these for more than two weeks, you should speak to your dental practitioner or doctor.

Risk factors for mouth cancer

Tobacco and alcohol are responsible for over 75% of mouth cancers, by exposing your mouth to cancer-causing substances (carcinogens). If you smoke and drink, your risk of developing mouth cancer is much higher. Alcohol may enable other carcinogens, including tobacco, to enter and damage cells.

Tobacco use includes cigarettes, cigars, pipes and chewing. If you smoke or chew tobacco or ‘paan’ (betel quid preparation), you are twice as likely to develop mouth cancer than a non-smoker. Chewing or smoking areca nut, betel quid, paan or gutka also increases your risk. The location of the cancer depends on the usage of the tobacco product – for example, if you have a habit of chewing tobacco in your left cheek, you may be prone to cancer of that cheek.
Mouth cancer is six times more common in alcohol drinkers than in non-drinkers. The more you drink, the greater the risk.

Other risk factors include:

• Human papillomavirus (HPV)
• Being over 40 years of age
• Being male - Men are three times as likely to develop mouth cancer as women
• Sun exposure - ultraviolet (UV) radiation can lead to skin cancer on the lips
• Being overweight or obese

Diagnosing mouth cancer

Mouth cancer is diagnosed using tests including:

• Physical examination of the mouth by your dentist or doctor
• Biopsy (taking a sample of skin of the mouth for examination in a laboratory)
• X-ray
• Ultrasound
• CT scan
• MRI (magnetic resonance imaging) scan
• PET (position emission tomography) scan

Test results can take a few days to come back. It is natural to feel anxious waiting to get your results. It can help to talk to a close friend or relative about how you’re feeling. You can also contact the Cancer Council on 13 11 20 and speak with a cancer nurse.

How mouth cancer can spread

The skin of the mouth, nose and throat are lined with flat, firm cells called squamous cells. Most mouth cancers originate in these surface cells. Without treatment, squamous cell carcinoma can spread deeper, including to the muscle and bone, or to the throat or lymph glands in the neck. Mouth cancer can also spread to other parts of the body if it gets into the bloodstream or lymphatic system, so it’s important to diagnose and treat it early.

Treatment for mouth cancer

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, localised cancers.
• 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.
• Ongoing care – this may include speech therapy, dietary advice, regular medical follow-up and counselling.

All treatments have side effects. These will vary depending on the type of treatment you are having. Many side effects are temporary, but some may be permanent. Your doctor will explain all the possible side effects before your treatment begins.

When mouth cancer can’t be cured

If your mouth cancer has spread to other parts of the body and it is not possible to cure it by surgery, your doctor may still recommend treatment. Treatment for control of cancer may include chemotherapy, radiotherapy, surgery, immunotherapy or pain-relieving medications (or a combination of these). Treatment may help to relieve symptoms, might make you feel better and may allow you to live longer. You may hear your doctor call your treatment ‘palliative’. This means treatment designed to relieve symptoms rather than cure. The Cancer Council booklet Treatment for advanced cancer may be helpful to read.

Reducing your risk of mouth cancer

Having regular check-ups with your dental practitioner and telling them of any changes to your mouth is important, especially if you have had a lump or mouth ulcer for more than two weeks.

These are ways you can reduce your risk of mouth cancer:

• Stop smoking or chewing tobacco or paan
• Reduce the amount of alcohol you drink
• Getting vaccinated against HPV – the vaccine is available for free to all Victorians aged 12 to 25 years. People under 26 years who missed the vaccine at secondary school can access free catch-up HPV vaccines from their GP, some pharmacies or local council immunisation provider. The vaccine can significantly reduce the chances of developing HPV-related illnesses (including cervical, mouth and throat cancers).
• Eat a healthy diet, including plenty of non-starchy vegetables and fruit (which are thought to help lower the risk of mouth cancer)
• Keep a healthy body weight
• Use sun protection on your lips

Following this advice doesn’t mean that you will never get mouth cancer, but it can reduce your risk and has other health benefits too.

Where to get help

• Your dentist (or other dental practitioner) or doctor
• Dental Health Services Victoria provides public dental services through the Royal Dental Hospital of Melbourne and community dental clinics, for eligible people. For more information about public dental services Tel. (03) 9341 1000, or 1800 833 039 outside Melbourne metro
• Australian Dental Association ‘Find a Dentist’ search function or Tel. (03) 8825 4600
• Cancer Council Victoria, Cancer Information and Support Service Tel. 13 11 20
• Peter MacCallum Cancer Centre, Appointments and Enquiries Tel. (03) 9656 1111
• Victorian Comprehensive Cancer Centre, Tel. (03) 8559 7160
• Speech Pathology Australia, Tel. (03) 9462 4899
• Head and Neck Cancer Australia