Ear, Nose, Throat, Head and Neck Surgery Specialist
Prof. Dr. Murat Topdağ

Born in Malatya in 1978, Murat Topdağ completed his primary and secondary education, then attended high school in Istanbul. He graduated from the English program of Cerrahpaşa Tıp Fakültesi. Prof. Dr. Murat Topdağ is married and has two children.

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What Is Mouth Cancer?

Mouth cancer is a general term for cancers that affect the inside of the mouth. This cancer type may occur deep in the oral cavity or appear on the lips, mistaken for a simple sore. However, cancer does not go away on its own. If not treated, it can spread from the mouth to the throat and other parts of the head and neck.

About 63% of patients diagnosed with oral cancer survive five years. Oral cancers occur in about 11 of every 100,000 people. They are more common in men than in women, and somewhat more prevalent in fair-skinned individuals than in those with darker skin.

As with other types of cancer, mouth cancer is divided into stages. The stage indicates its location and the penetration into surrounding tissue. Oral cancers are staged with the TNM system. T indicates the location and size of the primary tumor.

N shows whether the tumor has spread to surrounding lymph nodes, and M indicates whether there is metastasis to other tissues.

How Is Mouth Cancer Treated?

Treatment for mouth cancer varies based on the stage of the disease. At its earliest stage, the cancer is called carcinoma in situ. Here, the cancerous cells have not grown deeply into the tissue.

It is usually treated with surgery, where the upper portion of the cancerous tissue and some surrounding area are removed, a process called Mohs surgery. Regular check-ups are required to watch for recurrence. If it reappears, radiotherapy is used.

Stages I and II have a high success rate with surgery, radiotherapy, or chemotherapy. A combined therapy known as chemoradiation (chemotherapy plus radiotherapy) or a combination of surgery plus radiotherapy can be used.

Stages III and IV are considered advanced. In stage III, the cancer has spread to surrounding tissues and lymph nodes. In stage IV, it has spread to organs beyond the mouth.

In such advanced conditions, the tumors may be impossible to remove with surgery. Also, some patients may not be well enough for an operation. Depending on their health status, only chemotherapy or chemotherapy combined with radiotherapy can be applied.

Types of Mouth Cancer

Cancers that appear in the mouth are often categorized by where they develop. These include buccal mucosa (inside the cheek), floor-of-mouth cancer, gum cancer, hard palate cancer, lip cancer, and tongue cancer.

Buccal mucosa cancer forms inside the cheeks. It typically develops in thin, flat cells known as squamous cells. Floor-of-mouth cancer appears under the tongue, with a higher risk in people who consume alcohol or smoke.

Gum (gingival) cancer is also more frequent among those who use alcohol and tobacco and is often mistaken for gum inflammation. Gum cancer is typically detected by the dentist during a routine exam.

Hard palate cancer refers to a tumor forming in the hard palate near the front of the mouth. The palate separates the oral cavity from the nasal cavity, and as it grows, it usually first spreads to the nasal cavity.

Lip cancer results from some of the cells in the lips beginning to multiply uncontrollably. These cells turn aggressive and cause lesions or tumors. Lip cancer is the most common type of mouth cancer.

In general, the tongue is divided into three sections. Cancers can develop in any of these sections. If they grow in the back one-third of the tongue, it is categorized as oropharyngeal or throat cancer.

What Causes Mouth Cancer?

As with other cancers, the exact mechanism behind mouth cancer is unclear. Tumors that cause cancer are formed when cells that should die begin to multiply uncontrollably. Cancer arises due to mutations in the cell’s DNA that regulate its life. Tobacco and alcohol use are the primary triggers for mouth cancer.

Smoking and drinking both damage cell DNA, leading to cancer. Alcohol, tobacco, or both combined significantly increase risk.

Precisely tracking what triggers the DNA changes leading to oral cancer is practically impossible. We still do not fully understand what sparks the DNA changes that cause mouth cancer.

In addition to smoking and alcohol, chewing tobacco, an unhealthy diet, and human papillomavirus (HPV) infection are potential contributors to mouth cancer.

Symptoms of Mouth Cancer

Symptoms of oral cancer play an important role in diagnosis, although some can be confused with benign mouth sores.

Common signs include non-healing sores in the mouth or on the lips, persistent pain in the mouth, lumps on the lips or inside the mouth, white patches inside the mouth, chewing or swallowing difficulties, trouble moving the jaw or tongue, numbness in the tongue or other mouth areas, jaw swelling or pain, teeth feeling loose, ear pain, and weight loss.

Stages of Mouth Cancer

• Stage 0 (Carcinoma in Situ): The cancer is limited to the lining of the lips or oral cavity and is noninvasive.
• Stage 1: The tumor is at most 2 cm in diameter. The cancer is confined to the mouth, with no spread to lymph nodes or distant organs.
• Stage 2: The tumor is larger than 2 cm but smaller than 4 cm. The cancer remains in the mouth and has not yet spread to lymph nodes or other organs.
• Stage 3: The tumor may be larger than 4 cm, or it has spread to a lymph node on the same side of the neck as the cancer. This node is up to 3 cm in size.
• Stage 4A: Regardless of tumor size, it has invaded the lower jaw, the floor of the mouth, the palate, the inferior alveolar nerve, or the skin of the face. The cancer may have spread to one or more lymph nodes in the neck, each up to 6 cm in diameter.
• Stage 4B: The tumor may have grown into the cheek’s soft tissues, muscles, nerves, or the skull base. Alternatively, it may have encased the internal carotid artery in the neck. The cancer has spread to neck lymph nodes, one larger than 6 cm, or the cancer cells have invaded surrounding tissue in those nodes.
• Stage 4C ( final stage of mouth cancer ): The cancer has spread to other parts of the body, defined as distant metastasis. It most commonly spreads to the lungs, liver, or bones. This is known as metastatic oral cancer.

How Is Mouth Cancer Diagnosed?

Early detection of oral cancer significantly increases the odds of successful treatment. If a mouth-related complaint does not resolve itself within three weeks, a specialist should be consulted. Biopsy is commonly used to confirm the diagnosis. A sample of tissue is taken from the suspicious area.

If an incision is needed for the biopsy, the procedure can be done under local anesthesia. The small tissue sample is then examined in a lab, revealing whether there are precancerous or malignant cells.

Besides biopsy, nasal endoscopy and panendoscopy are also used to diagnose. In nasal endoscopy, a long, thin, flexible tube with a camera and light is used. Panendoscopy is similar, but uses a wider tube for improved access, and is performed under general anesthesia. Small tumors can be removed with this method.

Recovery Process After Surgery

The length of the recovery period depends on the type of surgery and the patient’s general health. Patients usually stay in the hospital for a few days, which may vary depending on the operation’s complexity. After discharge, enough time and rest at home are crucial for recovery.

After awakening in the recovery room, patients may spend several days in the ICU, where nurses and doctors keep close watch and provide care. The patient is moved to a regular room once their condition improves.

In the post-op phase, the following tubes and drains may be used:

• An IV in the arm for fluid supplementation.
• Tubes in the neck for breathing or feeding.
• Drains near the wound to remove excess fluids.
• A catheter placed into the bladder for urine collection.

Speech difficulties frequently occur, especially if the surgery was in the mouth, tongue, or throat. In these cases, written communication tools are provided by the nurses so that patients can communicate.

Pain is common after surgery, requiring effective pain management. Pain relievers are typically administered via:

• Patient-controlled analgesia or epidural routes.

The timeline for resuming oral intake depends on the type of operation. Early on, fluids are given intravenously, then normal diet is gradually introduced. A dietitian adjusts the patient’s diet, gradually decreasing liquid feeding.

Early mobility is encouraged to support recovery. A physical therapist can help with regular exercises, and once the patient is home, gradually resuming daily activities is important.

Follow-up appointments evaluate recovery and address any complications. These visits allow assessment of the patient’s progress and well-being.

Dietary and Lifestyle Changes for Those Undergoing Surgery

After mouth cancer surgery, patients should make certain dietary and lifestyle modifications to speed recovery and improve quality of life. First, nutrient-dense foods are necessary to provide energy and enhance healing capacity. Patients might also opt for small, frequent meals to cope with eating difficulties and to optimize nutrient intake. Soft foods are particularly ideal for those with chewing or swallowing issues, while avoiding hot, spicy, acidic, or hard foods can protect mouth tissues.

• Nutrient-Rich Foods: Vegetables, fruits, whole grains, lean protein sources.
• Small, Frequent Meals: Avocado, hummus, enriched dairy products.
• Soft, Moist Foods: Soups, smoothies, yogurt, pureed vegetables.
• Avoiding Irritants: Spicy and acidic foods, tough textures.

Additionally, lifestyle changes also support recovery. Good oral hygiene lowers infection risk, and regular dental check-ups are critical. Proper hydration helps manage dryness in the mouth. Physical activity can promote both physical and psychological recovery, while avoiding harmful habits minimizes the risk of recurrence and supports long-term health.

Prevention of Bademcik Tumors

Preventing tonsil tumors requires living a healthy lifestyle and maintaining hygienic conditions. Reinforcing personal hygiene is also essential.

Regularly washing hands, for at least twenty seconds, is key to reducing infection risk. Avoiding crowded and poorly ventilated spaces and ensuring adequate air circulation is also recommended.

Furthermore, a healthy diet and proper sleep pattern help strengthen the immune system, offering protection against infections. Some recommended measures:

• Frequently washing hands for at least twenty seconds.
• Avoiding crowded, stuffy areas and ensuring proper ventilation.
• Limiting physical contact, especially with ill individuals.
• Adopting a healthy, balanced diet.
• Maintaining adequate and regular sleep.

On top of that, some home remedies include gargling with salted or lemon water to reduce infection risk around the tonsils, then rinsing the mouth with warm water.

All these actions help ward off tonsil tumors and support overall good health.

FAQ

Where Does Mouth Cancer Spread?

If left untreated, mouth cancer can have serious consequences. It initially begins in the lining of the mouth and over time can penetrate deeper tissues. It can also spread easily to adjacent soft tissues and potentially affect the nervous system, causing pain and numbness. Moreover, it can spread to:

• Lymph nodes
• Blood vessels
• Bones

This makes treatment more complicated and greatly reduces quality of life. Thus, early detection and prompt intervention are crucial. Regular check-ups are necessary to prevent disease progression.

Is Mouth Cancer Fatal?

Mouth cancer can be fatal. With early diagnosis and treatment, it can be controlled, but if neglected, serious outcomes result.

• Persistent pain
• Functional loss
• Irreversible facial and oral deformities

These complications significantly reduce quality of life and may lead to death. Hence, regular dental visits are vital. Detecting mouth cancer early prevents spread and helps achieve the best possible outcome.

Which Department / Doctor to Visit for Mouth Cancer?

Choosing the right specialist for diagnosis and treatment of mouth cancer is critical. Once the patient notices lesions on the tongue or in the mouth, they begin to worry.

When these lesions last longer than two or three weeks, a specialist must be consulted. Typically, this entails going to an Ear, Nose, and Throat (ENT) department. ENT specialists are experienced in the diagnosis and treatment of oral cavity cancers. They focus on:

• Assessing lesions
• Conducting necessary tests
• Determining the treatment plan

Patients should make an appointment as soon as they notice symptoms.

Is Mouth Cancer Genetic or Contagious?

Mouth cancer can result from genetic or environmental factors. It is not contagious; it cannot be passed from one person to another. Certain genetic predispositions raise the risk within a family, particularly if there is a history of mouth cancer. Such predispositions include:

• Family history
• Genetic factors

External factors like smoking can also raise the risk, but do not imply contagiousness. Every person’s risk factors differ depending on their lifestyle and genetic makeup, so awareness and regular check-ups are essential.

What Happens If Mouth Cancer Is Untreated?

If untreated, mouth cancer puts the patient’s health in jeopardy. The cancer cells start in the mouth area and can spread to nearby tissues, increasing infection risk and making treatment more challenging. Moreover, it may spread to lymph nodes and then to other organs in the head and neck. The disease’s progression can cause:

• Pain
• Difficulty swallowing
• Speech problems

As the cancer becomes more advanced, the probability of successful treatment decreases and the patient’s quality of life deteriorates. Hence, early detection and treatment are vital.

Does Mouth Cancer Heal on Its Own?

Mouth cancer does not go away by itself. Early diagnosis is crucial in controlling the disease, and sometimes it also involves the neck region for therapy. This is important since the cancer can spread there. The treatment may include surgery, radiotherapy, or chemotherapy.

The chosen method depends on the cancer’s extent and location. With early recognition and comprehensive care, mouth cancer can often be cured. It is thus essential to have regular check-ups and watch for risk factors. A multidisciplinary approach is fundamental during the treatment process.

At What Age Does Mouth Cancer Occur?

Mouth cancer typically appears later in life. Research shows that about 95% of cases occur in people over age 40, with a mean diagnosis age of 60. The ratio of women to men is 1 to 2. Principal factors contributing to mouth cancer include:

• Alcohol consumption
• Smoking or tobacco use

These two account for about 75% of cases. Therefore, lifestyle changes can reduce risk.

Is There Pain in Mouth Cancer?

Mouth cancer may progress silently at first, not causing pain early on. Patients might not sense discomfort while the disease advances. Yet, such an absence of pain does not mean other symptoms can be ignored.

For instance, persistent sores in the mouth or cracks on the lips should be taken seriously, as they can signal cancer, even if they are not painful initially.

Likewise, spots or swellings in the mouth can go unnoticed if they do not cause pain but can trigger bleeding or complications as the disease progresses.

Hence, any change in the mouth lasting longer than two or three weeks calls for professional evaluation and a potential early diagnosis.

How Is Mouth Cancer Surgery Performed?

During mouth cancer surgery, removal of the tumor and a safety margin of healthy tissue is typically needed. If the cancer has spread into the jawbone, part of the jawbone may have to be removed. This procedure is vital to ensure complete tumor removal.

After resecting the jawbone, reattaching or reconstructing it is necessary for completion of the procedure and for patient recovery.

Depending on tumor size and extent, the surgery can be more or less extensive. The doctor will plan accordingly. Once the tumor is removed, the best treatment method is decided upon.

Which Doctor Should One See for Mouth Cancer?

When an unhealed wound persists in the mouth or on the tongue for more than three weeks, early diagnosis is essential. These symptoms may point to more serious health concerns.

Hence, you should promptly consult an ENT specialist. These physicians are expert in diagnosing cancers of the mouth and tongue, providing a chance for early detection.

Early recognition expands treatment options and helps prevent disease progression. Patients should fully describe their complaints to the doctor, enabling an accurate diagnosis and a suitable treatment plan.

Which Mouth Sores Might Indicate Mouth Cancer?

Sores that may suggest mouth cancer typically do not heal. Lesions lasting longer than two weeks should be scrutinized. Also, red or white patches in the mouth, particularly if rough, raised, or ulcerated, can indicate possibly premalignant or malignant changes (erythroplakia or leukoplakia). Additionally, new or unusual swellings, lumps, or thickened areas on the lips, gums, tongue, or mouth floor may be a sign.

Does Mouth Cancer Show Up on X-Rays?

Usually, mouth cancer does not show up directly on an X-ray. However, indirect indications, such as bone loss in the jaw or changes around the teeth, might be visible. Thus, X-rays can help in suspect cases, but a biopsy or other advanced procedures are needed for a definitive diagnosis.

What Are the Signs and Early Stages of Mouth Cancer?

The onset and early stages of mouth cancer often go unnoticed, as they may be painless and mimic other oral issues. Non-healing sores or ulcers lasting more than two weeks are typical first signs. Also, red or white patches in various mouth areas, either flat or raised, might appear. Pain, numbness, lumps, or thickened spots in the oral mucosa may occur, along with possible trouble chewing, swallowing, or speaking. Malalignment of the teeth could also indicate mouth cancer, as can persistent sore throat or hoarseness in early stages.

Is There a Chance of Survival in Stage 4 Mouth Cancer?

In stage 4C, known as metastatic mouth cancer, survival is limited. For instance, the five-year relative survival rate in floor-of-mouth cancer is around 20%. However, this depends on factors like the patient’s overall health and response to therapy. Each case is unique, so survival chances differ. Treatment is primarily aimed at slowing disease progression.

It can be misleading to self-diagnose based on images or photos of people with mouth cancer; if you suspect anything, see a doctor.

References:

https://www.mayoclinic.org/diseases-conditions/tonsil-cancer/symptoms-causes/syc-20367939

https://my.clevelandclinic.org/health/diseases/21931-tonsil-cancer