Mouth cancer

Mouth cancer can start in any part of the mouth. Symptoms include:

  • an ulcer or sore in the mouth that does not heal
  • a white or red patch in the mouth that does not go away
  • a lump in the mouth or on the lip.

If you have symptoms, it is important to have them checked by your GP or dentist. They may refer you to a specialist for tests. These may include a test to examine your mouth closely. The doctor may also take a small sample of tissue (biopsy) to make a diagnosis.

Treatments for mouth cancer include:

  • surgery to remove the cancer
  • radiotherapy, which treats the cancer with high energy x-rays
  • chemotherapy and targeted therapy, which use drugs to destroy cancer cells.

Your doctor will discuss with you the best treatment for you. Side effects of treatment depend on your situation and the treatment you have. Your taste, speech and swallowing may be affected. You may also find it difficult to eat.

There are lots of things that can help you manage side effects during and after treatment.

What is mouth cancer?

Mouth cancer is one of the most common types of head and neck cancer. It can start in any part of the mouth.


The mouth

Mouth cancer can develop in any part of the mouth. The mouth (oral cavity) includes the:

  • lips
  • tongue (front two-thirds)
  • floor of the mouth (under the tongue)
  • inside lining of the cheeks and on the lips
  • roof of the mouth (the hard palate)
  • area behind the wisdom teeth
  • upper and lower gums.
The oral cavity
The oral cavity

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Causes and risk factors of mouth cancer

The main causes of mouth cancer are:

  • smoking or chewing tobacco
  • drinking large amounts of alcohol.

Your risk of developing mouth cancer is higher if you do both.

Other things that may increase your risk of mouth cancer are:

  • chewing betel quid (paan), gutkha or pan masala (even if it does not have tobacco in it)
  • having medical problems that cause a weak immune system
  • eating an unhealthy diet without enough fresh fruit and vegetables
  • long-term ultraviolet light exposure (from sunlight, sunbeds or sunlamps), which increases the risk of lip cancer.


Symptoms of mouth cancer

The most common symptom of mouth cancer is an ulcer or sore that does not heal in three weeks. This may be in the mouth or on the lip.

Other symptoms may include:

  • a white (leukoplakia) or red (erythroplakia) patch in the mouth that does not go away
  • a lump or thickening in the mouth or on the lip
  • difficulty or pain with chewing, swallowing or speaking
  • bleeding or numbness in the mouth
  • bad breath (halitosis)
  • loose teeth or dentures that do not fit well anymore
  • a lump in the neck
  • losing a lot of weight over a short period of time.

These symptoms can be caused by other conditions. But it is important to have them checked by your doctor or dentist. Mouth cancer can be treated more successfully when it is diagnosed early.


How mouth cancer is diagnosed

You usually start by seeing your GP or dentist. They will examine your mouth closely. They will refer you to a specialist doctor if:

  • they think that your symptoms could be caused by cancer
  • they are not sure what the problem is.

The specialist doctor will ask about your symptoms and general health. They will check your mouth using a small mirror and light.

If your only symptom is a lump in your neck, you may be referred to a hospital that has a neck lump clinic.

You may have some of the following tests.

Nasendoscopy

You may have this test in the outpatient clinic. The doctor passes a thin, flexible tube called a nasendoscope into your nose, over the back of your tongue and down into the upper part of your throat. The tube has a light and camera at the end, to help the doctor get a better view of the back of your mouth. You might find this a bit uncomfortable, but it only takes about a minute.

Before the test, the doctor may numb your nose and throat with an anaesthetic spray. Some people prefer to have this done without the anaesthetic spray. If you have this spray, do not eat or drink for about an hour afterwards, or until the numbness wears off. This is because there is a risk that food and drink may go down the wrong way and into your lungs when you swallow. You could also burn your mouth or throat with hot food or drinks.

Biopsy

To make a diagnosis, your doctor needs to remove a small piece of tissue or some cells from the area that looks abnormal. This is called a biopsy. A doctor who specialises in analysing cells (pathologist) looks at the sample under a microscope. They check the sample for any cancer cells.

A biopsy can be taken in different ways. Your doctor may take a biopsy while they are examining you with the nasendoscope. Or they might arrange for you to have a general anaesthetic to take the biopsy.

At the neck lump clinic

This is a one-stop clinic where you can have all the tests needed to check for cancer in a neck lump.

You will usually have an ultrasound scan and a sample of tissue taken from the lump using fine needle aspiration. You may also have a nasendoscopy here to look at the back of your mouth.

The clinic may give you the results of your tests on the same day. But sometimes you may need to wait up to 7 to 10 days.

Ultrasound scan of the neck

This test uses sound waves to produce a picture of your neck and lymph nodes on a computer screen. Lymph nodes are part of the lymphatic system, which helps to protect us from infection and disease.

The scan is painless and only takes a few minutes. The doctor puts some gel onto your neck and moves a small device which produces sound waves over the area. They look for any changes in the size or appearance of the lymph nodes in your neck.

Fine needle aspiration (FNA) of the lymph nodes

You may have this test if the lymph nodes in your neck do not feel or look normal on a scan. It is done to see whether there are any cancer cells in the lymph nodes.

The doctor passes a fine needle into the lymph node. They withdraw (aspirate) some cells into a syringe. Sometimes the doctor uses an ultrasound scan to help guide the needle into the area.

The test might be uncomfortable, but it is very quick. You do not usually need a local anaesthetic to numb the area. It is common to have some bruising or soreness in the area the sample was taken from. The soreness may last for a week or so. Taking mild painkillers should help. Ask your nurse or doctor what they recommend.

After the test, a doctor who specialises in analysing cells (called a pathologist) will look at the sample under a microscope to check for cancer cells.

It’s hard to imagine how you will cope with the diagnosis of cancer. It has become a familiar word to all of us, but its meaning is highly personal.

Christine


Further tests for mouth cancer

These tests may be used to help diagnose mouth cancer and to check whether it has spread.

CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10 to 30 minutes and is painless. It uses a small amount of radiation. This is very unlikely to harm you and will not harm anyone you come into contact with. You may be asked not to eat or drink for at least four hours before the scan.

CT scan
CT scan

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You may be given an injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma. You could have a more serious reaction to the injection.

You will probably be able to go home as soon as the scan is over.

MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Staging for mouth cancer

The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps doctors decide on the best treatment for you. 

The most commonly used staging systems for mouth cancer are the TNM and number staging systems.

TNM staging system

TNM stands for tumour, node and metastases.

  • T describes the size of the tumour. It is numbered between 0 and 4 depending on the size and extent of the tumour. T0 means that there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous. A T1 tumour is small and has not spread, while a T4 tumour has spread into nearby muscles, bones or skin.
  • N describes whether the cancer has spread to the lymph nodes. N0 means that no lymph nodes are affected. N1, N2 or N3 means there are cancer cells in the lymph nodes. The number depends on how many lymph nodes contain cancer cells, the size and where they are.
  • M describes whether the cancer has spread to another part of the body. This is called metastatic cancer. M0 means the cancer has not spread. M1 means the cancer has spread to distant organs, such as the liver or lungs.

Number staging system

There are usually 3 or 4 number stages for each cancer type. Stage 1 describes a cancer at an early stage when it is usually small in size and has not spread. Stage 4 describes a cancer at a more advanced stage when it has usually spread to other parts of the body.

Your doctor can tell you more about the stage of your cancer.

Other terms used

Your doctor may use other terms to describe the stage of the cancer:

  • Early or local – a small cancer that has not spread.
  • Locally advanced – cancer that has started to spread into surrounding tissues or nearby lymph nodes, or both.
  • Local recurrence – cancer that has come back in the same area after treatment.
  • Secondary, advanced, widespread or metastatic – cancer that has spread to other parts of the body.


Grading

The grade of a cancer gives the doctors an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer.

  • Grade 1 or low grade – the cancer cells look like normal cells and usually grow slowly.
  • Grade 2 and 3 – the cancer cells look different to normal cells and are slightly faster growing.
  • Grade 4 or high grade – the cancer cells look very different to normal cells and may grow more quickly.


How mouth cancer is treated

Treatments used for mouth cancer include surgery, radiotherapy, chemotherapy and targeted therapy. You may only need one type of treatment. But sometimes two or more treatments are given. When chemotherapy and radiotherapy are given together, it is called chemoradiation.

Your treatment will depend on the stage and grade of the cancer you have, as well as your general health. Your specialist doctor or nurse will explain the best treatment for you and any likely side effects.


Surgery for mouth cancer

Surgery is often the only treatment needed to remove an early-stage mouth cancer. The surgeon removes the cancer and a small area (margin) of normal tissue all around the tumour. There is less chance of cancer cells being left behind, because the surgeon takes this extra area of normal tissue.

The surgeon may also remove some lymph nodes from the neck. They may do this to remove cancer that has spread to the lymph nodes or to reduce the risk of the cancer coming back.

How the surgeon removes the cancer depends on its size and where it is in the mouth. The main aim of surgery is to remove the cancer completely. But your surgeon will also do everything possible to minimise the changes that surgery may cause to your speech, swallowing or facial appearance.

Some people need a bigger operation. They may need to have part of their jawbone or tongue removed. The surgeon may use tissue, skin or bone taken from somewhere else in the body to rebuild these areas.

You may see a dietitian and speech and language therapist (SLT). They will help you prepare for the operation. They will also help you cope with any changes to your speech or how you swallow.

We have more information about what to expect before and after surgery.

Effects of surgery

Depending on the type of operation you have, it might:

  • affect your speech
  • affect your sense of taste and smell
  • affect how you swallow
  • leave scars or change your appearance.

Your surgeon will explain what to expect and what support is available.

You can read more in our general information about head and neck cancers. You may also find some of these organisations helpful:

  • Changing Faces supports people who have conditions or injuries that affect their appearance. It offers a skin camouflage service for people living with scarring or a skin condition that affects their confidence. Call 0300 012 0275 or email info@changingfaces.org.uk
  • Let’s Face It is a support network for people with facial disfigurements. Call 01843 833724 or email chrisletsfaceit@aol.com
  • Saving Faces has an expert patient helpline that puts people in touch with someone who has had the same condition or similar surgery. Call 07792357972 or email helpline@savingfaces.co.uk

A man is pressing his finger on his throat in a doctor's office.

Speech therapy and voice restoration after cancer

A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.

About our cancer information videos

Speech therapy and voice restoration after cancer

A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.

About our cancer information videos


Radiotherapy for mouth cancer

Radiotherapy uses high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.

Radiotherapy is sometimes given instead of surgery to treat early-stage mouth cancers. It is often used after surgery to reduce the risk of the cancer coming back or to treat cancer that has come back. Radiotherapy may also be used to treat the neck area if there are signs of cancer in the lymph nodes.

Planning your radiotherapy treatment

To make sure that your radiotherapy is as effective as possible, it has to be carefully planned. Planning your treatment makes sure the radiotherapy is aimed precisely at the cancer, so it causes the least possible damage to the surrounding healthy tissue. The treatment is planned by a specialist doctor called a clinical oncologist.

You usually need to have a clear plastic mould or mask made before your treatment is planned. This helps keep your head in the same position for each session of radiotherapy. The mask should not be uncomfortable and does not affect your breathing. We have a video that shows how radiotherapy masks are made. If you are worried about the mask, let your radiotherapy team know so they can help.

Having radiotherapy

Radiotherapy is normally given as a series of short, daily outpatient treatments with a rest at the weekend. Each treatment only takes a few minutes. It is given in the radiotherapy department using equipment similar to a large x-ray machine. Radiotherapy only treats the area of the body the rays are aimed at. It does not make you radioactive.

There are different types of radiotherapy. The type of radiotherapy usually used to treat head and neck cancers is called intensity-modulated radiotherapy (IMRT). IMRT uses high-energy rays that are shaped very precisely to target the area of cancer. This means a higher dose of radiation is given to the tumour, and healthy areas nearby get a lower dose. This can reduce side effects.

The number of treatments you have depends on the aim of your treatment. Your doctor or nurse will tell you how many treatments you are likely to have.

Side effects of radiotherapy

You may have side effects during radiotherapy. These usually get better slowly over a few weeks or months after treatment finishes, but many people continue to have a dry mouth.

Some side effects develop later on after treatment finishes and can last longer. These are less common, but can happen months or even years after your treatment. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Sore and sensitive skin

The skin over your face and neck will slowly redden or darken, depending on your skin tone. It may also feel sore and itchy (a bit like sunburn). This starts after about 2 weeks of treatment and lasts for up to about 4 weeks after radiotherapy has finished.

When you wash your face and neck, it is important to use only the soaps, creams and lotions your radiotherapy team recommend. This is because chemicals in some products can make the skin more sensitive to radiation. Moisturisers need to be sodium lauryl sulphate (SLS) free. Your radiotherapy team can give you more information about how to care for your skin when you have radiotherapy and after you have finished treatment. They can also tell you when and how to use sun-protection cream after your treatment.

We have more information about skin care when you have radiotherapy to the head and neck area.

Sore mouth

It is important to look after your mouth during radiotherapy. Following a mouth care routine to keep your mouth clean helps prevent problems. Your mouth and throat may become sore after a couple of weeks of treatment. You may develop mouth ulcers. You might also find it difficult to speak, or notice changes to your sense of taste and smell. Eating food can become difficult and you may find it painful to swallow. Your doctor can prescribe medicines to help.

We have more information about coping with a sore mouth.

Dry mouth

Radiotherapy to the head and neck may reduce the amount of spit (saliva) you make. It can make the mouth and throat dry. This can affect eating, speaking and sleeping. It also makes you much more likely to have tooth decay. So it is really important to care for your teeth during and after treatment.

It also helps to carry a bottle of water with you so you can take frequent sips of water. Or you could use a water spray instead. Artificial saliva can also help moisten your mouth and throat. It comes in different forms, such as gels, sprays, mouthwashes, pastilles or tablets. Your doctor or dentist can prescribe artificial saliva, or you can buy it from a chemist.

We have more information aboutcoping with a sore mouth.

Thick, sticky saliva (mucus)

Radiotherapy to the head and neck affects the salivary glands. Your saliva may become thicker, stringy and sticky. Your mouth and throat may also feel dry. This can make eating and talking difficult.

Rinsing your mouth regularly can help with this. Your specialist head and neck team can give advice on the type of mouth rinse that might be best for you. Sometimes a build-up of mucus can cause coughing, especially at night. Your nurse or doctor may prescribe a nebuliser to help to loosen the mucus. A nebuliser is a machine that changes a liquid medicine into a mist or fine spray. Your nurse or doctor can also prescribe mouthwashes, lozenges, artificial saliva sprays or gels to help.

Changes in the saliva usually get better within about 8 weeks of radiotherapy ending, but sometimes it continues for several months or longer.

Difficulty eating

If you find it hard to eat and drink because of any side effects, let your doctor or nurse know. They can give you advice and medicines to help. They may refer you to a dietitian for more advice. You may need food supplements to add extra energy or protein to your diet. Some supplements can be used to replace meals, and others are used in addition to your normal diet. You can get some of these from your chemist or the supermarket. Your doctor, nurse or dietitian can also prescribe them for you.

Some people need to be fed through a tube if they cannot eat and are losing lots of weight. This is known as nutritional support or tube feeding. It is usually only done for a short time until treatment is finished and their swallowing is back to normal.

Tiredness

This is a common side effect that may last for a couple of months after treatment. Try to get plenty of rest and pace yourself. Balance this with some physical activity, such as short walks. This will give you more energy.

Late effects of radiotherapy

Your doctor, specialist nurse or radiographer can tell you whether your treatment may cause any late effects. They will also tell you what you can do to help reduce your risk of problems. And they can tell you what support is available.

Our general information about head and neck cancers has more information about:

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Chemotherapy for mouth cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

This treatment can be given:

  • before surgery or radiotherapy to shrink the cancer and make it easier to treat
  • at the same time as radiotherapy (chemoradiation) – the chemotherapy can make the cancer cells more sensitive to radiotherapy treatment
  • to treat cancer that has spread or come back after earlier treatment.

The chemotherapy drugs most often used to treat mouth cancer are cisplatin and fluorouracil (5FU). These are usually given into a vein (intravenously). Chemotherapy is not usually used to treat lip cancer.

Chemotherapy is usually given as several sessions of treatment, called treatment cycles. Each treatment cycle is followed by a rest period, to give the body time to recover.

Side effects of chemotherapy

The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will explain the treatment you are offered and what to expect.

Chemotherapy can reduce the number of white blood cells in the blood during treatment. This makes you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens.

Chemotherapy can also cause other side effects, such as:

  • feeling tired
  • a sore mouth
  • feeling sick (nausea) or being sick (vomiting)
  • diarrhoea
  • hair loss.

Let your doctor or nurse know about any side effects during treatment. They can often give you advice and help to reduce these.

We have more information about coping with the side effects of chemotherapy and about different chemotherapy drugs.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Chemoradiation for mouth cancer

Your doctor may talk to you about having chemotherapy and radiotherapy together. This can be given instead of surgery to treat early-stage mouth cancers. Or it can be given after surgery to reduce the risk of cancer returning. Having chemoradiation is more effective than having chemotherapy or radiotherapy alone, but it can cause more severe side effects. It is important that you are well enough to cope with the side effects of having both treatments together.


Targeted therapies for mouth cancer

Targeted therapies interfere with the way cells grow and divide. They are sometimes known as biological therapies.

Cetuximab is the most commonly used targeted therapy to treat mouth cancer. This drug may stop the cancer cells growing and dividing. It may also make the cancer more sensitive to the effects of radiotherapy. It is given as a drip (infusion) into a vein once a week.

You might have cetuximab with radiotherapy if you cannot have chemoradiation. You may also have it with chemotherapy to treat cancer that has spread or come back.

Side effects of cetuximab

The most common side effect of cetuximab is a skin rash on the face, neck or body. This may start during the first 2 to 3 weeks of treatment. Your specialist nurse or doctor will give you advice on what can help. The rash usually goes away completely when treatment stops.

Cetuximab may also cause an allergic reaction while the drip is being given. This is more common with the first treatment, so you have this slowly over a few hours. The nurse gives you drugs to help prevent or reduce a reaction. If you have a reaction, they treat it quickly.

Signs of a reaction can include:

  • a headache
  • high temperature or chills
  • a rash
  • feeling itchy, sick, breathless or unwell
  • pain in the back, tummy or chest.

Tell your nurse straight away if you have any of these symptoms. Rarely, a reaction can happen a few hours after treatment. If you develop any of these symptoms or feel unwell after you get home, contact the hospital straight away for advice.


Clinical trials for mouth cancer

Cancer research trials are done to try to find new and better treatments for cancer. Trials that are done on patients are known as clinical trials.

Research into treatments for mouth cancer is ongoing. But because mouth cancer is rare, there may not always be a relevant trial in progress. If there is, you may be asked to take part. Your doctor must discuss the treatment with you, so you fully understand the trial and what it means to take part. You can decide not to take part, or to withdraw from a trial at any stage. You will still receive the best standard treatment available.


Follow-up after treatment

After your treatment finishes, you will have regular check-ups and tests. These may continue for several years. You may also have regular follow-up appointments with a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist. If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.


Your feelings

For some people, it takes several months to recover from treatment. It can be hard to cope if treatment has changed your appearance, voice or how you eat and drink.

It is common to feel overwhelmed by different feelings. For example, you may feel shocked, scared, upset or angry. Everyone has their own way of coping. But it is important to be able to express how you feel.

Some people find that it helps to share their feelings with family or friends. Others get help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope. But remember that help is available if you need it.

You might want to join a local cancer support group. Meeting other people in a similar situation and sharing your experience may help you feel less alone. You can ask your specialist nurse if there are any local support groups in your area.

If you are finding it difficult to talk, our Online Community (community.macmillan.org.uk) is also a good place to meet people who may be in a similar situation.

There are national support groups that you may find helpful:

  • Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
  • Changing Faces offers advice and information to anyone who is affected by a change in their appearance.

You may also want to talk to our cancer support specialists. Call us free on 0808 808 00 00 (Monday to Friday, 9am to 8pm).

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