Mouth cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs, also known as lip and oral cavity cancer, is a type of cancer that begins in any portion of the mouth. This includes the gums, the lining of the cheeks and lips, oral/mobile tongue (the front two-thirds of the tongue), the floor of the mouth under the tongue, hard palate (the bony roof of the mouth) and the retromolar trigone (area behind the wisdom teeth).
Mouth cancer is more common in males, and is generally diagnosed after the age of 55. However, anyone can develop this disease.
Types of Mouth Cancers
There are several different types of mouth cancers, which are often categorises by the types of cellsthe basic structural and functional unit of all living things they develop from in the body and their location.
Squamous Cell Carcinomas (SCC)
Squamous cell carcinomas (SCCs) are cancers that arise from squamous cells, which are thin, flat cells that cover the inside of the mouth, nose, and throat. They are the most common form of mouth cancer. SCCs can be aggressive, but can have a good prognosisto predict how a disease/condition may progress and what the outcome might be when found early.
Salivary Gland Cancers
Salivary gland cancers are malignancies that develop in the salivary glands in the mouth. Salivary glands are responsible for the production of saliva, which is a fluid that aids in digestion, prevents your mouth from becoming too dry and supports healthy teeth. For more information on salivary gland cancers, please refer to the Rare Cancers Australia Salivary Gland Cancer page.
Buccal Mucosa Cancer
Buccal mucosa cancers are rare cancers that develop in the lining of the cheeks and the back of the lips. The most common type of buccal mucosa cancer is squamous cell carcinomas (SCCs). Buccal mucosa cancer is often aggressive and can have high recurrenceto occur or happen again rates, however they can have a good prognosis when found early.
Tongue Cancer
Tongue cancer is a rare type of oral or mouth cancer that develops on the tongue, a muscular structure in the mouth that aids in speech, digestion and taste. Most tongue cancers develop as squamous cell carcinomas, however in rare cases they can develop as other types. For more information on tongue cancers, please refer to the Rare Cancers Australia Tongue Cancer page.
Rare types of Mouth Cancers
These types of mouth cancers are considered rare:
- Lymphomacancers of the lymphatic system.
- Melanomaa type of cancer that develops from melanocytes, which are the cells that produce pigment generally in the skin (but can develop in other areas of the body).
- Sarcomacancer arising from bones and/or soft tissue.
- Basal cell carcinomacancer arising from tissues that line organs.
- Adenoid cystic tumours.
Treatment
If mouth cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localisedaffecting only one area of body cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumours have been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health. In adult patients, your tumour will be staged and graded to help determine the best treatment option for you.
The treatment options for mouth cancer may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Glossectomycomplete or partial removal of the tongue.
- Mandibulectomycomplete or partial removal of the lower jaw bone (mandible).
- Maxillectomycomplete or partial removal of the upper jaw bone (maxilla).
- Mandibulotomya type of surgery that involves cutting the jawbone to allow better access to the back of the throat, before a jaw reconstruction with titanium plates.
- Lymphadenectomysurgical removal of lymph node(s).
- Reconstructive surgerysurgery to restore appearance and/or function to an area of the body.
- Tracheostomya surgical procedure to create an opening in the neck and into the trachea to allow air to enter the lungs.
- Insertion of feeding tubes, such as gastronomy tube (G-tube)a feeding tube surgically inserted through an incision in the abdominal wall directly into the stomach to get fluids/food/liquids to and from the stomach and nasogastric tube (NG tube)a thin, soft tube that goes in through the nose, down the throat, and into the stomach to get fluids/food/liquids to and from the stomach, also known as a NG tube.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
Some of the riskthe possibility that something bad will happen factors for mouth cancer include:
- Excessive alcohol consumption.
- Smoking and/or tobacco usage.
- Poor oral hygiene.
- Being infected with the Human Papillomavirus (HPV).
- Having a family history of mouth cancer.
- Certain genetic conditions, such as:
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Symptoms of mouth cancer may include:
- Pain in the mouth.
- Difficulty or pain when swallowing.
- Persistent sore throat.
- A persistent sore or swelling in the mouth that doesn’t heal over time.
- Unusual bleeding and/or numbness in the mouth.
- Red and/or white patches on the tongue, lips, mouth or gums.
- Unexplained bad breath.
- Changes and/or difficulties with speech.
- Pain when moving the tongue.
- Unexplained weight loss.
- Loose or ill-fitting dentures.
- Pain in the ear.
- Swelling of the jaw.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis
If your doctor suspects you have mouth cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
- X-raya type of medical imaging that uses x-ray beams to create detailed images of the body .
- Blood teststesting done to measure the levels of certain substances in the blood.
- Endoscopya procedure that involves inserting a long, flexible tube with a light and small camera (endoscope) into the body to view internal organs.
- Biopsyremoval of a section of tissue to analyse for cancer cells.
