Mouth cancer: symptoms, causes, tests and treatment

The NHS says symptoms of mouth cancer can affect any part of the mouth, including the gums, tongue, inside the cheeks or lips. Cancer Research UK adds that a broken area in the lining of the mouth (an ulcer) that will not heal is a common symptom.

• A mouth ulcer that lasts more than 3 weeks.

• A red or white patch inside the mouth.

• A lump inside your mouth or on your lip.

• Pain inside your mouth.

• Difficulty swallowing, or difficulty speaking.

• A hoarse (croaky) voice that does not go away.

• A lump in your neck or throat.

• Losing weight without trying.

• Other signs listed by Cancer Research UK include a persistent sore throat, bad breath that is worse than usual, unusual bleeding or numbness in the mouth, loose teeth for no clear reason, difficulty moving the jaw and ear pain that does not get better in a few days.

The NHS says to see a GP if you have a mouth ulcer that has lasted more than 3 weeks, a lump in your mouth, on your lip, on your neck or in your throat, a red or white patch in your mouth, pain in your mouth that is not going away, difficulty swallowing or speaking, or a hoarse voice that does not go away. A dentist can also help with ulcers, lumps, patches or pain in your mouth.

The NHS stresses that these symptoms are very common and having them does not definitely mean you have mouth cancer, but that finding cancer early may mean it is easier to treat. The Oral Health Foundation similarly says to get anything unusual that lasts 3 weeks or more checked, even if it seems minor.

Mouth cancer develops when abnormal cells in the mouth divide and grow uncontrollably. Cancer Research UK says most mouth and oropharyngeal cancers start in squamous cells and are called squamous cell carcinoma. It can start in the lips, the lining of the cheeks and lips, the front two thirds of the tongue, the gums, the floor of the mouth, the roof of the mouth and the area behind the wisdom teeth.

Oropharyngeal cancer starts in the part of the throat just behind the mouth, including the tonsils and the base of the tongue. Cancer Research UK says that in the UK, more than 50 out of 100 squamous cell oropharyngeal cancers are linked to the human papillomavirus (HPV).

The NHS says it is not always clear what causes mouth cancer. You may be more likely to get it if you do any of the following or have these risk factors.

• Smoke or chew tobacco, betel nut or paan.

• Drink a lot of alcohol. The Oral Health Foundation says the risk is much higher when alcohol and tobacco are used together.

• Have leukoplakia (white patches in the mouth).

• Have been exposed to a lot of sunlight or sunbeds, which can cause skin cancer affecting the lips.

• Have had cancer before, or have a weakened immune system, for example with HIV or AIDS or by taking immunosuppressant medicine.

• Have changes in your genes or some types of human papillomavirus (HPV) infection in your mouth.

The NHS says your dentist or GP will usually ask about your symptoms, lifestyle and other medical conditions, and look and feel inside your mouth. They may also feel your neck and jaw. If they think it could be cancer you may get an urgent referral to a hospital specialist, which does not definitely mean you have cancer.

The NHS says the main tests are removing a small sample of cells from the affected area (a biopsy) and an X-ray, ultrasound scan, CT scan or MRI scan. If cancer is found you may need further tests, such as a biopsy of lymph glands, a PET scan and blood tests, to see how far it has spread. Cancer Research UK also mentions a nasoendoscopy, where a thin flexible tube with a camera is passed through the nose to look at the throat.

The NHS says the treatment depends on the size of the cancer, where it is, whether it has spread, whether it has certain genetic changes, and your age and general health. You may be offered a combination of treatments.

The NHS says you cannot always prevent mouth cancer, but you can lower your chance of getting it by eating a healthy diet including 5 portions of fruit and vegetables a day, exercising regularly, cutting down on alcohol and avoiding drinking more than 14 units a week, and trying to quit smoking and chewing tobacco, betel nut or paan.

Regular dental check-ups usually include a mouth cancer examination, according to the Oral Health Foundation, and dentists are trained to spot early changes.

The NHS says advanced mouth cancer may be hard to treat and not possible to cure. The aim of treatment is then to slow the growth and spread of the cancer, help with symptoms and help you live longer. A symptom control or palliative care team helps manage symptoms and supports you and your loved ones.

A clinical nurse specialist is your main point of contact throughout diagnosis and treatment. The NHS notes that Macmillan Cancer Support has a free helpline open every day from 8am to 8pm.

On the NHS, you can raise a suspicious mouth change with your dentist or GP. If cancer is suspected, an urgent referral goes to a hospital head and neck service, where examination, biopsy and scans take place and a specialist team plans treatment.

Private dental, oral surgery and ENT services can examine your mouth and take a biopsy. If you choose this route, ask how results will be shared with your GP and which multidisciplinary team will review your case if cancer is found.