How to spot the signs of mouth cancer

Mouth cancer
Worldwide, 650,000 people are diagnosed with mouth cancer each year

Mouth cancer, also known as oral cancer, affects around 8,800 people in the UK each year according to the Oral Health Foundation, and more than 3,000 people died from the illness in 2022. Worldwide, 650,000 people are diagnosed annually. Despite these numbers, there is little awareness of the condition and many patients struggle to get diagnosed, which is concerning as survival rates generally depend on early identification and treatment.

What is mouth cancer?

Mouth cancer is the most common type of head and neck cancer and can affect areas in and around the mouth, including the lips, tongue, inside the cheeks, roof of the mouth and gums. The most common type of mouth cancer is oral squamous cell carcinoma (OSCC), which accounts for nine out of 10 cases. Squamous cells are found in many places around the body, including the inside of the mouth and under the skin. Squamous cell carcinoma is characterised by abnormal, accelerated growth of squamous cells. When caught early, most cases are curable.

Joss Harding is a dental hygienist and the president elect of the Mouth Cancer Foundation. She explains that vigilance and early detection are vital for improved survival rates.

“If you have a tumour smaller than a thumbnail, you have a 50 per cent chance of surviving longer than five years,” she says. “Unfortunately, because of delays caused by Covid and the fact that a lot of people attend late, patients can already be at an advanced stage before they are referred, so there are more complications and treatment is a lot more dramatic and invasive.”

The mortality rate of OSCC has remained static in recent decades. One of the reasons for this is late diagnosis. A study published in Frontiers journal in 2022, which reviewed papers on diagnostic delays in OSCC, reported that patients waited between 45 days and approximately six months. One of the main causes of delay was patient lack of knowledge about the signs, symptoms and risk factors of oral cancer. Professional delay was also cited as a factor.

What are the causes and signs of mouth cancer?

There are several lifestyle risk factors for mouth cancer. The main one is smoking, followed by regularly drinking more than 14 units of alcohol a week. Regularly drinking excessive amounts of alcohol can increase the risk of developing mouth cancer fourfold, and those who drink and smoke together are 30 times more likely to develop the disease. The human papilloma virus (HPV) is another significant factor. HPV is primarily transmitted through sexual contact, including any form of oral sex, but some studies suggest other routes, including infected objects or materials, fingers and non-sexual mouth and skin contact. It is estimated that as rates of smoking and alcohol consumption drop, HPV could overtake them as the main risk factor for mouth cancer within a decade.

Poor diet, social deprivation and exposure to sun have also been identified as risk factors, and it is important to understand that mouth cancer can develop in people who have none of the associated risk factors.

Mouth cancer presents in several ways. Signs to look out for include a mouth ulcer that lasts more than three weeks, a red or white patch inside the mouth, unusual lumps, mouth pain, difficulty swallowing or speaking, hoarseness and unexplained weight loss.

How can I check for mouth cancer?

Dentists and dental hygienists should now routinely screen patients for mouth cancer during appointments, and Harding recommends that everyone over the age of 16 should check for signs in front of a mirror once a month after brushing their  teeth. The Mouth Cancer Foundation website provides detailed information, a video and guidance on self-checking. People should look out for unusual swellings, skin changes, sores, ulcers, lumps or bumps on the face, neck and jaw, inside the lips and cheeks, on the gums and under and around the tongue. Look for any red, white or rough patches and tenderness.

If you notice anything that concerns you or does not clear up after three weeks, see your GP or dental professional.

What are the treatments?

Treatments for mouth cancer vary depending on the type and location of the tumour and how soon it is detected. Typically, treatment involves surgery to remove the tumour, plus radiotherapy. Lymph nodes are often removed from the neck, and reconstruction surgery may be needed if larger parts of the tongue and jaw are removed. Immunotherapy and chemotherapy are sometimes required, particularly when the cancer has spread to other parts of the body. Proton beam therapy may also be increasingly used, and ongoing studies are exploring whether this innovative new form of radiotherapy can improve outcomes for a range of cancers.

What are the effects?

The impact of mouth cancer is often life-changing. Patients who require surgery and radiotherapy will experience many after-effects, which can include speech impairment and changes to the way they look and eat.

“For a lot of patients, socialising, eating and drinking will never be the same again,” explains Harding. “There are 62 late effects, including dry mouth, speech and changes in taste. Patients often have to have sloppy food, and when they go out, they eat more slowly if they are eating orally. They can feel very self-conscious about eating and drinking in front of other people.

“The earlier they are seen and referred, the better the outcomes.”

My mouth cancer diagnosis’

Karen Liesching-Schroder, a primary-school nursery assistant from Rochford, Essex, was diagnosed seven years ago when she was 43

Karen Liesching-Schroder
'If I can give any advice, it is to be vigilant and make sure you're familiar with your mouth,' says Liesching-Schroder - Daniel Jones

“I’d never heard much about mouth cancer, so when I was diagnosed it hit me like a ton of bricks. I was healthy and I didn’t fit the criteria. I never smoked, I didn’t drink much and there was no HPV.

“I had an ulcer on the side of my tongue that wouldn’t heal and was incredibly painful. Eating and talking hurt. I thought it might be an autoimmune problem.

“Many patients will tell you it is hard to get diagnosed, and that was also my experience. About 18 months previously, I had an ulcer in the same place and had seen a consultant and had a biopsy. When it came back clear, I was told that if it returned I should see a dentist and not waste NHS time.

“In August 2015, during the school holidays, I had an ulcer again. I didn’t even mention it to my husband because of the previous experience. It got worse and, by October, I realised that people couldn’t understand what I was saying because it was affecting my speech. I was surviving on yoghurt. I had an appointment to see a nurse who spotted that there was a hole in my tongue. I was referred to another consultant and prescribed hydrocortisone tablets to put into the hole.

“It took until February to have a painful biopsy. I was called back in and that’s when I found out I had tongue cancer. I was told I would be off work for six months and needed major surgery and radiotherapy, and I would have to learn to talk, eat and drink again.

“They took the side of my tongue away and I had a neck dissection to remove lymph nodes, then after that I had radiotherapy. Six months after treatment I had another portion of my tongue removed which led to more problems with swallowing and speech.

“I was lucky enough that the cancer had not spread, and it was decided that I didn’t need to have my tongue rebuilt, which would have involved more surgery and a graft of tissue from my wrist. I was able to talk but not clearly. I wasn’t offered speech therapy initially – I only got that a couple of years later.

“You have to rebuild your life after mouth cancer and adapt to your new mouth and how you talk, eat and drink. There are a lot of psychological problems, especially lack of confidence.

“I now run the Mouth Cancer Foundation’s private Facebook page and we get more and more patients asking for support because there is not enough out there for them, or enough awareness.

“If I can give any advice, it is to be vigilant and make sure you’re familiar with your mouth. Check every month and if something doesn’t look or feel right, get it checked and push for a referral if you are not being taken seriously.”


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