• Patients with mouth cancers are treated by members of the BC Cancer Agency’s Head and Neck Tumour Group.
• For healthcare professional information on treating this cancer, please see our Cancer Management Guidelines.
• Mouth cancer may also be called oral cancer, tongue cancer, or lip cancer.
• The mouth or oral cavity includes: the lips, gums, the front two thirds (the mobile part) of the tongue, the hard palate, the floor of the mouth, the lining of the cheeks, and the salivary glands.
• The mouth is necessary for talking, eating, chewing, and swallowing. Salivary glands make the saliva that moistens the mouth and helps digest food.

What causes it and who gets it?
Listed below are some of the known causes of this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors. 

• Tobacco use in any form increases risk of developing mouth cancer. The longer tobacco has been used, the greater the risk.
• Heavy drinking in those who do not smoke increases the risk for mouth cancer.
• Drinking alcohol in combination with tobacco use greatly increases the risk of mouth cancer.
• Passive smoking (spending time in a smoking environment, or living with a smoker) increases risk.
• Long-term unprotected exposure to strong sunlight increases the risk of lip cancer.
• Chewing betel or areca nuts (found in paan, chaalia, gutka and naswar) increases the risk of mouth cancer.
• A diet low in fruits and vegetables increases the risk of mouth cancer.
• Chronic irritation from poorly-fitted dentures may increase the risk.
• Chronic gum disease (periodontal disease) may increase the risk of tongue cancer.
• Infection with human papillomavirus may increase risk of developing mouth cancer.
• Statistics:
• BC
• Canada

Can I help to prevent it?

• Most mouth cancers can be prevented. Tobacco and alcohol use are the major risk factor for developing mouth cancer. Don’t start smoking or chewing tobacco products.
• If you smoke, quit. If you chew tobacco, stop. This will reduce your risk, even after years of use.
• If you drink alcohol, limit your intake.
• Patients who are cured of mouth cancer are more likely to develop a second cancer if they continue to use tobacco and alcohol. Even if you are diagnosed with a mouth cancer, quitting tobacco and alcohol can reduce the possibility of the cancer happening again.
• If you work outdoors, use sunscreen on your lips, and protect your face by wearing a broad-brimmed hat.
• Eat a healthy diet rich in fruits and vegetables. The Canada Food Guide recommends eating 7-10 servings each day.
• Visit your dentist regularly.

Screening for this cancer

• Regular dental checkups, including a full-mouth examination are the best method of screening for mouth cancers.
• The BC Cancer Agency’s Oral Cancer Prevention Programme works with dentists and dental hygienists to prevent the development of oral cancer, and to detect it at the earliest possible stage.

Signs and Symptoms

• Your dentist will check your mouth for these signs during your regular visits. If any of the following symptoms last for more than two weeks, go see a dentist or doctor.
• The most common symptom is an ulcer or sore or swelling in the mouth that doesn't heal.
• A lump, thickening or rough spot in the mouth that doesn’t go away or seems to be growing.
• The appearance of different coloured spots in the mouth or lips. They may also feel different.
• White spots are known as leukoplakia.
• Red coloured spots are called erythroplakia.
• Pain, numbness, tenderness of the lips, mouth jaw or ear.
• Chewing or swallowing difficulties.
• A change in the way your teeth fit together.
• A change in your voice.

Diagnosis 
This is a list of some or all of the tests used to diagnose this type of cancer. 

• A biopsy, which is the removal of a small bit of tissue for examination in a laboratory, is the usual first step in diagnosing mouth cancers.
• A diagnostic imaging examination may be recommended depending on biopsy results. This could include:
• CT - computed tomography.
• MRI - magnetic resonance Imaging.
• PET - positron emission tomography.
• For more information on all cancer diagnostic tests, see our Recommended Websites, Diagnosis section.

Types and Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

• T describes the site and size of the main tumour (primary)
• N describes involvement of lymph nodes
• M relates to whether the cancer has spread (presence or absence of distant metastases)

• The most common type of mouth cancer is squamous cell carcinoma, occurring in the cells that line the mouth.
• Adenocarcinomas, sarcomas and melanomas can also occur.

Treatment
Cancer therapies can be highly individualized – your treatment may differ from what is described below.

• Localized oral tumours are usually removed through surgery or laser excision.
• Early stage tumours are treated with either surgery or radiotherapy.
• Surgery is usually chosen for tumours that can be removed with a good functional result.
• Radiotherapy is preferred when surgery would require major reconstruction. Radiotherapy options include radioactive implants (which treat only the primary site) and external beam irradiation (which can treat both the primary tumour and nearby lymph nodes). External beam therapy is given on an outpatient basis and usually lasts between two and five weeks.
• Clinically advanced tumours are often treated with both surgery and radiation. Case-by-case treatment decisions are made for each patient, based on the specific site of the tumour, the extent of the disease and the patient’s overall general condition.
• Mouth cancer surgery may remove underlying bone and may require reconstruction with skin, muscle and/or bone taken from other areas of the body.
• If the patient is able to tolerate it, treatment may include radiotherapy twice daily; or radiotherapy and chemotherapy.
• Some cancers have a high risk of microscopic spread to neck nodes and if the risk is high, the neck may be irradiated even if there is no definite evidence of tumour spread to the lymph nodes.
• Prognosis is fairly good for patients diagnosed with an oral cancer. BCCA survival statistics show that 62% of total patients diagnosed with mouth cancer in 2003, survived at least 5 years. Survival statistics must be viewed with caution, and should not be used to predict individual response to treatment.

Follow-up after Treatment 

• Guidelines for follow-up after treatment has ended have been developed by the BC Cancer Agency and are listed on our website.
• You will be returned to the care of your family physician or specialist for regular follow-up.
• Follow-up testing is based on your type of cancer and your individual circumstances.
• The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face.

Coping with Cancer

The Coping with Cancer section of our website is a joint project among different BC Cancer Agency departments and programs. This website section provides information and links that can help cancer patients with the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.

The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.

Search our library catalogue

• The BC Cancer Agency Library has many resources about cancer, coping, talking to children, etc.  Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.
• Automatically get a bibliography of books, videos and other items available through our library.

Recommended websites
The BC Cancer Agency has selected and evaluated these useful websites for your further information.

Mouth Cancer 
Swallowing
Websites for cancer survivors, and how to stay healthy after treatment.

Videos
View videos on cancer-related topics that the BC Cancer Agency produces.

How can I help with research at BCCA?
BC Cancer Agency patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help: 

• The BCCA is deeply involved in cancer research.  We operate various Research Programs, the BC Cancer Research Centre and Canada's Michael Smith Genome Sciences Centre.
• Clinical Trials – join our treatment-based research. Ask your oncologist if you qualify for a clinical trial. What are the pros and cons of joining a clinical trial?
• Tumour Tissue Bank – support our research by donating some of your cancer tissue.
• BC Cancer Foundation – support our research with a donation of money.

This information has been reviewed and approved by a member of the Head and Neck Tumour Group.