Cancer of the mouth

This is also known as ‘oral cancer’: it includes cancers which originate in the lining of the cheeks and lips; the front of the tongue; the palate (roof of the mouth); floor of the mouth; gums and the area behind the back teeth. It also includes the salivary glands.

This is a rare form of cancer which usually develops in people aged 40 and above. More men than women are affected.

There is more than one type of mouth cancer which is due to the various structures within this part of the body. These include:

• Lymphomas
• Melanoma
• Salivary gland cancer
• Squamous cell carcinomas

Lymphomas are cancers which develop in the lymph tissue at the base of the tongue and the tonsils.

Melanomas refer to the skin: they occur in skin pigment cells on the lips or around the mouth.

Salivary gland cancer is as the name says: it is a type of cancer which develops within the salivary glands.

Squamous cell carcinomas are forms of cancer which develop in the flat, skin-like cells within the mouth and throat.

Causes of cancer of the mouth

It is difficult to determine a precise cause of any form of cancer. There are many different cancers which are caused by a number of factors. These will definitely increase your risk or possibly increase your risk.

This is an important distinction between the two.

Many people assume the term ‘cancer’ refers to a single disease but they are wrong. There are many different types of cancers which are all caused by different reasons.

So this is why it is difficult to define the exact cause of cancer.

But what we do know is that there are factors which will increase the likelihood of you developing a type of cancer. In this instance, smoking or excess alcohol consumption are definite risk factors for mouth cancer.

Other causes include:

• Sun exposure, e.g. sunbeds
• Have previously had cancer, e.g. rectal cancer (men)
• Human papilloma virus (HPV)
• Weakened immune system, e.g. HIV
• Unhealthy diet

These will definitely increases the risk of mouth cancer.

Then there are those causes which may lead to mouth cancer although this is not to be assumed. These include:

• Poor dental hygiene
• Mouthwashes with a high concentration of alcohol
• Mouth irritation, e.g. poorly fitting dentures
• Family history

But the biggest risk of mouth cancer is smoking. Drinking alcohol to excess is another major risk although slightly less than that of smoking.

Smoking, alcohol and mouth cancer

This applies to all forms of smoking. Whether you smoke cigarettes, cigars, and a pipe or use chewing tobacco then be aware that mouth cancer makes no distinction between any of these.

So, if you smoke a pipe then you are equally at risk of developing mouth cancer as is someone who smokes a packet of cigarettes.

If you drink a lot of alcohol, often to excess then you are at the same risk of developing mouth cancer.

But the highest risk is reserved for people who both smoke and drink. If you are one of these people who enjoys a cigarette when out for a drink then keep this in mind. It is easy to smoke more than usual when having a few drinks in the pub but this will put you at the highest risk of all.

What is the main problem with these?

Alcohol and cigarettes contain many chemicals, some of which are known to cause cancer. They also contain nitrosamines.

Nitrosamines are a group of chemicals which are held to be carcinogenic. When you smoke or drink alcohol these chemicals pass through the mouth and throat and down to the lungs; or they pass over the mouth, throat and into the larynx.

The more you drink or the longer you smoke further increases your risk of mouth cancer.

Symptoms of cancer of the mouth

These include:

• A mouth ulcer which refuses to heal
• Pain in the mouth which does not ease

These are two main symptoms of mouth cancer.

In regard to the mouth ulcer: around 80% of mouth cancer cases have experienced a mouth ulcer which does not heal.

Other symptoms include:

• Bad breath
• Weight loss
• Red or white patch within the mouth or throat
• A sensation of something stuck in the throat
• Loose teeth but for no obvious reason
• Lump in the neck
• Lump in the mouth, on the lip or in the throat
• Impaired speech
• Problems with moving the jaw
• Numb mouth
• Unexplained bleeding in the mouth
• Pain or discomfort when chewing or swallowing
• A persistent sore mouth or throat

These symptoms may indicate another medical condition so do not automatically assume that they are mouth cancer. There are other conditions which cause symptoms that are very similar to these.

However, it is a good idea to get these checked by your GP or your dentist.

Diagnosing cancer of the mouth

Your GP or dentist will examine your mouth and throat to see if there are any abnormal swellings. He/she may use a specially angled mirror to do so. Your GP may also feel the gland (lymph nodes) in your neck and under your arms.

He or she will ask you about your medical history, your lifestyle –in particular, if you are a smoker and if you drink alcohol, how much. Based upon this he/she will then refer you to a specialist for further investigation.

The specialist will also examine you, ask you about your symptoms and general state of health before sending you for tests. These tests will include X-rays, blood tests and an endoscopy.

An endoscopy is a procedure in which a doctor inserts a slim tube (usually flexible and fibre optic) into your mouth to have a closer look at the structures within. This enables him/her to see if there are any unexplained growths in your mouth or throat.

You will also undergo any of the following procedures:

• Biopsy
• Nasendoscopy
• Panendoscopy
• Fine needle aspiration

(Source: Cancer Research UK: mouth cancer)

Biopsy

A biopsy involves removing a small section of tissue from an affected area, e.g. a tumour, to see if it is cancerous. This sample is sent to a laboratory for analysis under a microscope.

Another type of biopsy is called a ‘punch biopsy’where a small circle of tissue is removed for laboratory analysis.

Nasendoscopy

The medical name for the procedure in which a fibre optic tube (endoscope) is inserted into your nose and down through your throat. This scope has a light and a camera mounted at one end and an eyepiece at the other end – for the specialist to look through.

Panendoscopy

This is a very similar procedure although in this case a series of telescopic tubes joined together are used. This is inserted into your mouth and passed down into your throat so that the specialist can have a closer look. This is particularly important if he/she has seen a tumour or has to perform a biopsy.

This tube also has a light and camera fixed to one end and an eyepiece at the other end.

Fine needle aspiration

Fine needle aspiration is carried out if you have a lump in your neck. The specialist will insert a very fine needle into this lump to draw off a sample of cells and tissue. This sample is sent to the laboratory to be examined by a pathologist.

This is also performed if there is a chance that cancer has spread to the lymph glands within your neck.

If the specialist has detected cancer then he/she will send you for additional tests to determine the extent of your cancer.

The word ‘extent’refers to how far the cancer has spread.

These extra tests include:

• Chest X-ray
• Panorex X-ray
• Barium swallow (similar to a barium meal)
• CT scan/MRI scan/Ultrasound scan

Chest X-ray

A chest X-ray can show if cancer has spread to your lungs. This is likely to be very rare unless you have an advanced form of cancer.

Panorex X-ray

This type of x-ray shows images of either the upper or lower jawbone or both. This can also show any signs of cancer.

Barium swallow

If you undergo a barium swallow then you will have to drink a white liquid which contains barium sulphate. This substance enables the inside of your mouth and throat to show up clearly on an X-ray. It also shows any tumours or similar abnormalities.

CT scan

This is also known as a CAT scan and takes a series of X-rays of your mouth, jaw and throat which are then assembled by a computer. Your mouth and throat are shown from different angles which gives a very detailed image of those areas of the body.

Most importantly it also shows any tumours: large or small and whether they have spread to other areas.

MRI scan

An MRI scan uses magnetism to obtain detailed images of the body, in this case the mouth and throat. It produces cross sections of an area of the body which can also be viewed as a series of images at different angles.

This type of scan is capable of showing the soft tissues of the body and any abnormal growths such as tumours.

Ultrasound scan

Another option is an ultrasound scan. This involves the use of a microphone which is passed over an area of the body. This microphone emits sound waves which are absorbed by your body (and are harmless) and bounce off internal organs.

They are then picked up again by the microphone and relayed to a computer where they appear as an image.

What happens after these tests?

You will have to wait for a short period of time to obtain your results.

This can be the worst part of the process. It is natural to assume that a short wait means that you do not have cancer whereas a long wait is confirmation of this. But this is not the case.

You will have to wait the same amount of time for your results, whether they contain good news or bad.

It can help to talk to someone during this time: talk to a close friend, a member of your family or if you prefer, a specially trained counsellor.

Another option is a cancer support group. There are support groups for every type of cancer who provide help and advice to people in your position. They will have people there who have been through what you are going and can understand what it feels like.

Treatment for cancer of the mouth

This will depend upon the type of mouth cancer you have, the extent (also known as the ‘stage’it is at) and your current state of health.

Your treatment will be handled by a care team which consists of a wide range of medical professionals. This includes a cancer specialist, surgeons, cancer nurses, dieticians, dentist and speech therapist to name but a few.

This team will devise a treatment plan based upon your individual needs. There is no ‘one size fits all’ approach to cancer. Everyone is different in regard to cancer which means that every case requires an individual approach.

This team is concerned with finding the best form of treatment for you.

What they will look at is what affect treatment will have upon your ability to speak, chew and swallow and in some cases, your breathing. They will also take your current level of fitness into account as well as your lifestyle.

Treatment options are:

• Surgery
• Radiotherapy
• Chemotherapy
• Biological therapy (for advanced stages of cancer)

You may have one of these forms of treatment only or a combination of treatments. For example, surgery may remove the entire tumour without the need for any other form of treatment.

This will depend upon the stage of the cancer.

But in other situations a combination of chemotherapy and radiotherapy may be more beneficial. Another option is chemotherapy and biological therapy.

Surgery can remove some or an entire tumour although this depends upon the size and extent. A small tumour is easier to remove than a large one.

If the cancer has spread to the surrounding lymph glands then these may be removed as well. Surgery is often performed on early stage cancers although you may be offered radiotherapy instead.

Radiotherapy can be used on its own to treat early stage mouth cancer as well as after surgery. It uses radiation to destroy cancer cells with the aim of preventing them from coming back. It can also be combined with chemotherapy in cases where cancer is at an advanced stage.

Chemotherapy can be combined with radiotherapy to treat advanced cases of cancer or if cancer has returned following surgery and/or radiotherapy. It can help to control the extent of a cancer.

Biological therapy uses naturally occurring substances to treat cancer. It is used in conjunction with radiotherapy in advanced cancer cases.

What about cases where mouth cancer has spread?

These are often treated by a ‘palliative care’team as well as the multi-disciplinary team. The idea behind palliative care is to manage the symptoms of the disease in order to improve your quality of life.

It does not automatically mean that nothing more can be done for you. People assume this when they are referred for this type of treatment and think that they are in the final stages of their disease.

But this is not always the case.

Palliative care is used in the treatment of people who have a terminal illness which includes cancer but it is also used to reduce the symptoms of a disease so that the person can carry on with their life as normal as possible.