What Do Early Stages of Mouth Cancer Look Like?

Early signs of mouth cancer include a sore in the mouth that doesn't heal; a white or red patch on the gums, tongue, tonsils, or lining of the mouth; or loose teeth.

Mouth cancer (oral cavity cancer or oral cancer) is cancer that occurs when cells in the mouth grow out of control. 

The oral cavity includes: 

• The lips
• The inside lining of the lips and cheeks (buccal mucosa)
• The teeth
• The gums
• The front two-thirds of the tongue
• The floor of the mouth below the tongue
• The bony roof of the mouth (hard palate)
• The area behind the wisdom teeth (retromolar trigone) may be included as a part of the oral cavity, but it's usually considered part of the oropharynx

Early stages of mouth cancer may look like:

• Sore in the mouth that doesn't heal (the most common symptom)
• White or red patch on the gums, tongue, tonsils, or lining of the mouth
• Loose teeth 
• Lump or thickening in the cheek
• Lump or mass in the neck

Other symptoms of mouth (oral cavity) cancers include:

• Pain in the mouth that doesn’t go away (also very common)
• Sore throat 
• Feeling that something is stuck in the throat 
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Numbness of the tongue or other part of the mouth
• Jaw swelling that results in dentures not fitting properly or becoming uncomfortable
• Pain around the teeth or jaw
• Changes in voice
• Weight loss
• Constant bad breath

The exact cause of mouth cancer is not known, but risk factors for developing mouth cancer include: 

• Smoking and tobacco use 
• Heavy alcohol use
• Human papillomavirus (HPV) infections
• Betel quid and gutka use 
  • Betel quid is made of areca nut (betel nut), spices, lime, and other ingredients
  • It is commonly chewed in Southeast Asia, South Asia, and other areas of the world
• Gender
  • Twice as common in men as in women
  • It is thought this is due to more men using tobacco and alcohol 
• Age
  • Most oral cancers occur in adults over age 55
• Ultraviolet (UV) light
  • Responsible for cancers of the lip in people who are exposed to sunlight for long periods of time
• Poor nutrition
• Diets low in fruits and vegetables are linked with an increased risk of oral cancers 
• Weakened immune system
• Lichen planus
• Graft-versus-host disease
• Certain genetic syndromes
  • Fanconi anemia 
  • Dyskeratosis 

Mouth cancer is diagnosed with a patient history and a physical examination of the mouth, head, and neck. 

Tests used to confirm a diagnosis of oral cancer include: 

• Biopsy
• Imaging tests
  • Chest x-ray
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Barium swallow
• Blood tests
  • Complete blood count (CBC)
  • To check for nutritional deficiencies
  • Tests to check for liver disease and kidney disease
• Electrocardiogram (EKG) or pulmonary function tests (PFTs) if surgery is planned
• Dental exam

Treatment for mouth (oral cavity) cancers includes:

• Surgery 
  • Removal of the tumor and a margin (edge) of normal-looking tissue around it (tumor resection)
  • Mohs micrographic surgery (for some cancers of the lip) 
  • Glossectomy (removal of the tongue)
  • Mandibulectomy (removal of the jaw bone)
  • Maxillectomy (removal of the hard palate, which is the front part of the roof of the mouth)
  • Robotic surgery
  • Laryngectomy (removal of the voice box)
  • Dental extraction and implants
• Radiation therapy 
  • External beam radiation therapy (EBRT)
  • Brachytherapy (also called internal radiation or interstitial radiation)
• Chemotherapy 
  • Cisplatin (Platinol, Platinol-AQ)
  • Carboplatin (Paraplatin)
  • 5-fluorouracil (5-FU)
  • Paclitaxel (Taxol)
  • Docetaxel (Taxotere)
  • Hydroxyurea (Hydrea, Droxia)
  • Methotrexate (Otrexup, Xatmep, Trexall)
  • Bleomycin (Bleo 15K)
  • Capecitabine (Xeloda)
• Targeted therapy 
  • Monoclonal antibody: Cetuximab (Erbitux)
• Immunotherapy 
  • Immune checkpoint inhibitors 
    • pembrolizumab (Keytruda) 
    • nivolumab (Opdivo)
• Palliative treatment 
  • Pain management
  • Ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) 
  • Opioids 
• Nutrition
  • Feeding tube if needed

Life expectancy for mouth (oral cavity) cancers is often expressed in 5-year survival rates, that is, how many people will be alive 5 years after diagnosis. 

Lip cancer 5-year survival rates:

• Localized (no sign the cancer has spread outside the organ where it started, for example, the lip, tongue, or floor of mouth): 92%
• Regional (cancer has spread to nearby structures or lymph nodes): 60%
• Distant (cancer has spread to distant parts of the body, such as to the lungs): 28%

Tongue cancer 5-year survival rates:

• Localized (no sign the cancer has spread outside the organ where it started, for example, the lip, tongue, or floor of mouth): 81%
• Regional (cancer has spread to nearby structures or lymph nodes): 68%
• Distant (cancer has spread to distant parts of the body, such as to the lungs): 39%

Floor of the mouth cancer 5-year survival rates:

• Localized (no sign the cancer has spread outside the organ where it started, for example, the lip, tongue, or floor of mouth): 77%
• Regional (cancer has spread to nearby structures or lymph nodes): 38%
• Distant (cancer has spread to distant parts of the body, such as to the lungs): 20%

Some cases of mouth (oral) cancers can be prevented. 

• Don’t smoke and avoid tobacco use
• Limit or avoid alcohol use
• Get the HPV vaccine (Gardasil, Cervarix) to prevent human papillomavirus (HPV) infection
• Limit exposure to ultraviolet (UV) light
• Eat a healthy diet
• Wear properly fitted dentures
• Treat pre-cancerous growths such as leukoplakia or erythroplakia