What do I Need to Know about Oral Cancer? Where can it Present?

As we said in our introduction, you can get oral cancer of any soft tissue in your mouth.The most common areas are (in order):

• The sides of the tongue

• Floor of the mouth

• Outsides of the lips

• Lower alveolar ridge (the part of the jaw bone that supports your teeth).

Most oral cancers of the HPV virus type tend to be at the back of the throat and can often be hidden from view.

What does it Look Like?

Oral cancer has these main appearances:

• A classic ulcer surrounded by thick rolled edges that is breaking down in the centre and bleeds easily

• A small ulcer in the depth of a fissure

• A raw superficial area of mucosa (erosion)

• A hard palpable nodule within your soft tissues

• An area of gum overgrowth (gingival hyperplasia) in a single place in your mouth.

• Very early on oral cancer can look very similar to everyday little scrapes and ulcers. Any unusual sore, patch, bump, lump, swelling, changes in colour, rough spots or crust on your lips, or anywhere inside your mouth that is not healing needs to be checked out.

What are the Signs and Symptoms of Oral Cancer?

Most oral cancers are asymptomatic to begin with, meaning they don’t give you any pain or altered feelings- these only come much later on. For this reason they often go undetected unless you are seeing your dentist who is trained at picking up the early signs. 27-50% of patients present for treatment with tumours over 4cm. That is not good! Most of these are elderly and they are used to wearing ill-fitting dentures and their mouths being uncomfortable.

NOW before you go panicking! As many of you will ‘I have an ulcer!!!! ARRRRGHHH-‘ please understand there are a number of different things that these signs and symptoms could be. The vast majority of the time they are not oral cancer.

Until a biopsy or swab of a suspicious area is taken we will not know, but with this condition we do not want to take any chances- early detection could mean the difference between life and death- is that something you are willing to risk?

Perhaps the most important thing to note, is that the sign or symptom is persisting and unexplained. It just doesn’t seem to be going away and there is no clearly definable cause. For most things the cut off point is about 2 weeks, by which time we would expect things to have healed up significantly and be returning to normal.

You should see your dentist if you notice or experience any of the following:

• White, red or speckled (both white and red) patches anywhere inside your mouth that aren’t going away.

• A non-healing ulcer. A typical ulcer (in dentist speak RAS- = recurrent apthous ulceration), or for you Americans a ‘canker sore’ looks like this] with a thin red border and a little yellow or pale whiter inside. A classic ulcer of this type is painful, starts to heal after about 8 days and is pretty much gone inside two weeks. Now major RAS, which is a larger version of the ulcer (at least ½ cm across) can take up to a month to heal and may do so with a bit of scarring.

• Any swellings/thickenings, lumps/bumps, rough spots/crusts. Oral cancer doesn’t feel like normal gum- it has a scratchy, rougher surface almost sandy in its texture. A firm roughened mass is more suspect and not to be confused with a dental abscess which is generally more fluctuant (squidgy). A common ‘scare’ and ‘worry’ we see is people mistaking common, harmless bony growths called ‘mandibular’ or ‘maxillary tori’ for something more sinister. These most commonly occur in the palate (maxillary tori) or on the inside of your jaw next to the lower premolars (mandibular tori) where they are largely symmetrical in appearance.

• Reduced mobility of the tongue. If your tongue doesn’t appear to be functioning normally e.g. when you try to stick it out straight, it veers off to one side- this is worth getting checked out.

• Unexplained bleeding. See- Bleeding gums for a range of common explanations for blood in the mouth.

• Nerve changes. Changes in the feelings of your nerves that supply your lower lip or tongue. For example, if you hadn’t been to the dentist and you started to notice some tingling (parasthesisa- like pins and needles), or numbness (anaesthesia), it is important to see a doctor/dentist straight away. Ear pain on one side that lasts more than one week; the nerve that that supplies the tongue or pharynx has fibres connecting it to the ear and so oral cancer in these areas can give rise to an earache. Pain from a severe toothache can also radiate up to the ear.

• Sore throat/ difficulty swallowing that just won’t go away. Any infection that causes your lymph glands to swell up or inflammation at the back of your throat can cause your throat to be painful- such as viruses or infections but these would be expected to go away within two weeks.

• Lump in the neck. Finding a lump in your neck could mean that oral cancer tissue from the back of the tongue or throat had spread into a lymph node in the neck. This is a more advanced stage of the disease. Some people just have very prominent glands, but if the lump is asymmetrical then it is worth investigating.

• Speech problems. A change in the quality of your voice (hoarseness or your speech become slurred) that persists beyond 8 days. A change in the normal tissue on or around the vocal chords would cause this. If you have been in a loud place or at a footy match the previous day, you would expect to be back to normal inside a week.

• A change in your bite. Your teeth move slightly all the time and more drastic changes can be expected following a tooth extraction. If however for no particular reason, your teeth aren’t coming together in the normal way, or your dentures not are fitting or biting in the same way, it is better to get checked out.