Mouth cancer: what are the symptoms?

Medically reviewed: 7, January 2024

Cancer in the mouth

Mouth cancer, also known as oral cancer, is a type of cancer that affects the mouth and its surrounding tissues. It can occur on the lips, gums, tongue, inner lining of the cheeks, roof of the mouth, floor of the mouth, or the back of the throat. Mouth cancer can cause pain, discomfort, and difficulty in eating, speaking, and swallowing. It can also affect your appearance and your quality of life.
If mouth cancer is not detected and addressed in its early stages, it can pose a serious threat to a person’s life.

According to the American Cancer Society, about 54,000 people in the US will get oral or oropharyngeal cancer in 2021, and about 10,000 will die from it. According to statistics gathered by Cancer Research USA, mouth cancers are twice as common in men as women. It is also more likely to affected people over the age of 40. However, recent research shows that it is becoming more common in younger patients and woman.

Cancer of the lip, tongue, gums and floor of the mouth are the most common types of mouth cancer. Less often it involves the inside of the cheeks or the palate. It may also start in one of the salivary glands, or spread to the mouth from surrounding areas such as the throat or nose.

As with many forms of cancer, early diagnosis is important to maximize the benefits of any treatment, to reduce the chances of the cancer spreading to other parts of the body, and to avoid facial disfigurements and speech difficulties.

In this article, we will explain the different types of mouth cancer, the early signs and symptoms, the causes and risk factors, the diagnosis and treatment options, and the prevention and support strategies. We hope that this article will help you understand more about mouth cancer, and what to do if you or someone you know has it.

Why does cancer in a mouth occur?

Cancer of the mouth is often related to tobacco use. Switching from cigarettes to a pipe or cigars, or using snuff or oral tobacco (chewing tobacco), does not reduce the risk. Using low tar or ‘light’ brands will not help either. Keeping a quantity of tobacco in one place in the mouth for long periods is particularly dangerous.

It often causes leukoplakia (see Symptoms), a recognized pre-cancerous condition. Other factors that may encourage the development of mouth cancer include:

• over-consumption of alcohol, especially spirits,
• the combination of alcohol and smoking,
• badly-fitting dentures,
• poor care of teeth, especially if they are rough or jagged,
• constant irritation to the tongue from a sharp edge on a tooth, and
• chewing the areca (betel) nut or betel leaf (pahn) – this is a common practice among certain cultural groups such as those with Bangledeshi heritage.

The combination of alcohol and cigarette smoke is a major cause because the absorption of the cancer-producing substances (carcinogens) in cigarette smoke is enhanced by alcohol.

Types of mouth cancer

Mouth cancer can be classified into different types, depending on the location and the type of cells involved. The most common types of mouth cancer are:

• Squamous cell carcinoma in mouth

This is the most common type of mouth cancer, accounting for about 90% of all cases. Squamous cell carcinoma occurs when the flat, thin cells (squamous cells) that line the mouth and the throat become abnormal and grow out of control. Squamous cell carcinoma can affect any part of the mouth, but it is more common on the tongue, the floor of the mouth, and the lower lip.

• Verrucous carcinoma in mouth

This is a rare type of mouth cancer, accounting for about 5% of all cases. Verrucous carcinoma is a subtype of squamous cell carcinoma, but it has a different appearance and behavior. It usually looks like a large wart or a cauliflower, and it grows slowly and rarely spreads to other parts of the body. It can grow in any part of the mouth, but it is more common on the gums and the inside of the cheeks.

• Oral melanoma

This is a very rare type of mouth cancer, accounting for less than 1% of all cases. Oral melanoma occurs when the cells that produce melanin, the pigment that gives color to the skin and the hair, become abnormal and grow out of control. Oral melanoma can affect any part of the mouth, but it is more common on the roof of the mouth, the gums, and the inner lining of the lips. Oral melanoma is usually dark brown or black in color, but it can also be pink, red, or white.

• Minor salivary gland carcinoma

This is a rare type of mouth cancer, accounting for about 3% of all cases, and occurs when the cells of the small salivary glands that are scattered throughout the mouth and the throat become abnormal and grow out of control. It affect any part of the mouth, but it is more common on the roof of the mouth, the back of the mouth, and the back of the tongue.

There are different subtypes of minor salivary gland carcinoma, such as:

• adenoid cystic carcinoma,
• mucoepidermoid carcinoma,
• polymorphous low-grade adenocarcinoma.

Symptoms of mouth cancer

Any spots or lumps in the mouth that remain for a long time and show no sign of going away should be checked out by a healthcare practitioner (GP, dentist or specialist). Similarly, any crack, ulcer or lump on the lips or inside the mouth that does not heal, even if painless, should be examined.

A developing tumor may cause no pain, but can extend and form ulcers, which may bleed. Cancers of the tongue tend to be painful and cause the tongue to feel unnaturally stiff and inflexible.

There may be difficulty in speaking properly or in swallowing, and a feeling of numbness may occur.

If persistent white patches (leukoplakia) or red patches (erythroplakia) appear inside the mouth, these should be brought to the attention of your GP or dentist, as they can be recognized pre-cancerous conditions (conditions that are likely to be followed by the development of cancer).

Early signs of mouth cancer

Mouth cancer can have different signs and symptoms, depending on the type and the location of the cancer. However, some of the common early signs of mouth cancer are:

• sore or ulcer in the mouth that does not heal within three weeks
• lump or swelling in the mouth, the jaw, or the neck
• white or red patch in the mouth that does not go away
• loose tooth or a change in the way your teeth fit together
• persistent pain or discomfort in the mouth or the throat
• difficulty or pain in chewing, swallowing, or speaking
• change in your voice or a hoarseness
• numbness or tingling in the mouth or the tongue
• bleeding or discharge from the mouth
• weight loss or a negative changes in appetite

If you have any of these signs or symptoms, you should see your doctor or dentist as soon as possible. Do not ignore or delay seeking medical attention, as mouth cancer can progress quickly and become more difficult to treat.

Remember that these signs and symptoms can also be caused by other conditions, such as infections, injuries, or allergies, so do not panic or jump to conclusions.

Only a doctor or a dentist can diagnose mouth cancer, by performing a physical examination and some tests.

HPV oral cancer

HPV stands for human papillomavirus, which is a group of viruses that can infect the skin and the mucous membranes of the body. There are more than 100 types of HPV, and some of them can cause warts or cancers in different parts of the body, such as the cervix, the anus, the penis, the vulva, the vagina, and the mouth. HPV oral cancer is a type of mouth cancer that is caused by HPV infection, especially by HPV type 16.

HPV oral cancer is different from other types of mouth cancer, in terms of the risk factors, the symptoms, the location, and the prognosis. Some of the characteristics of HPV oral cancer are:

• Risk factors

HPV oral cancer is more common in people who have had oral sex with multiple partners, or who have had a partner who has had oral sex with multiple partners. HPV oral cancer is also more common in people who smoke, drink alcohol, have a weak immune system, or have a family history of head and neck cancers.

• Symptoms:

it may not cause any symptoms in the early stages, or it may cause symptoms that are similar to other types of mouth cancer, such as a sore or ulcer in the mouth, a lump or swelling in the neck, a difficulty or pain in swallowing, or a change in the voice. However, HPV oral cancer may also cause some specific symptoms, such as a persistent sore throat, a feeling of something stuck in the throat, an earache, or a cough.

• Location:

it is more likely to affect the back of the mouth, such as the base of the tongue, the tonsils, the soft palate, or the back of the throat. HPV oral cancer is less likely to affect the front of the mouth, such as the lips, the gums, the front of the tongue, or the floor of the mouth.

• Prognosis:

HPV oral cancer tends to have a better prognosis than other types of mouth cancer, as it responds better to treatment, and has a lower risk of recurrence or metastasis. Usually it has a five-year survival rate of about 80%, compared to about 50% for other types of mouth cancer.

Signs of gum cancer

Gum cancer is a type of mouth cancer that affects the gums, which are the soft tissues that surround and support the teeth, can cause pain, bleeding, swelling, and infection in the gums, and it can also affect the teeth and the jawbone. Gum cancer can spread to other parts of the mouth, the head and neck, or the body, if not treated early.

Some of the signs of gum cancer are:

• sore or ulcer on the gum that does not heal within three weeks
• lump or growth on the gum that does not go away
• red or white patch on the gum that does not disappear
• loose tooth or a change in the way your teeth fit together
• persistent pain or discomfort in the gum or the tooth
• bleeding or atypical discharge from the gum
• bad breath or a bad taste in the mouth

If you have any of these signs, you should see your dentist or doctor as soon as possible. Do not ignore or delay seeking medical attention, as gum cancer can progress quickly and become more difficult to treat.

Remember that these signs can also be caused by other conditions, such as gingivitis, periodontitis, or dental abscesses, so do not panic or jump to conclusions. Only a dentist or a doctor can diagnose gum cancer, by performing a physical examination and some tests.

Oral lichen planus cancer symptoms

Oral lichen planus is a chronic inflammatory condition that affects the mucous membranes of the mouth, such as the inner lining of the cheeks, the tongue, the gums, and the lips. Oral lichen planus causes patches of white, lacy, or web-like patterns on the mucous membranes, which may be accompanied by redness, swelling, or ulcers. You can feel pain, burning, itching, or sensitivity in the mouth, and it can also affect the taste and the appearance of the mouth. It is not contagious, but it can be triggered by stress, infection, medication, or allergy.

Oral lichen planus is not a type of cancer, but it can increase the risk of developing mouth cancer, especially if it is erosive or ulcerative. Erosive or ulcerative oral lichen planus is a severe form of the condition, where the mucous membranes are eroded or ulcerated, exposing the underlying tissue and blood vessels. Erosive or ulcerative oral lichen planus can cause even more pain, bleeding, and infection, and it can also make the mucous membranes more vulnerable to the effects of carcinogens, such as tobacco, alcohol, or HPV.

Some of the symptoms of oral lichen planus cancer are:

• persistent or worsening sore in the mouth that does not heal within three weeks
• lump or growth in the mouth that does not go away
• change in the color or texture of the mucous membranes, such as a red, white, or speckled patch

If you have oral lichen planus, you should see your dentist or doctor regularly, and check your mouth for any signs of cancer. Practice good oral hygiene, and avoid smoking, drinking alcohol, or having oral sex with multiple partners. If you notice any changes in your mouth or throat, you should seek medical attention as soon as possible.

Oral lichen planus cancer can be typically treated by surgery, radiation therapy, chemotherapy, or a combination of these methods, depending on the stage and the location of the cancer, and can be cured if detected and treated early, so it is important to be aware of the symptoms, and to act promptly.

Squamous cell carcinoma in mouth

Squamous cell carcinoma is the most common type of mouth cancer, accounting for about 90% of all cases. It occurs when the flat, thin cells (squamous cells) that line the mouth and the throat become abnormal and grow out of control and can affect any part of the mouth, but it is more common on the tongue, the floor of the mouth, and the lower lip.

Squamous cell carcinoma mouth can be caused by various factors, such as:

• Tobacco use:

Smoking cigarettes, cigars, pipes, or chewing tobacco can expose the mouth to harmful chemicals, such as tar, nicotine, and carcinogens, that can damage the DNA of the squamous cells, and cause them to mutate and multiply. Tobacco use is the most important risk factor for squamous cell carcinoma mouth, and it can increase the risk by up to 20 times.

• Alcohol use:

Drinking alcohol can irritate and dry the mucous membranes of the mouth, and make them more susceptible to the effects of tobacco or other carcinogens. Alcohol use can also interfere with the metabolism of the squamous cells, and impair their ability to repair the DNA damage. Alcohol use is the second most important risk factor for squamous cell carcinoma mouth, and it can increase the risk by up to 6 times.

• HPV infection:

Papillomavirus can cause squamous cell carcinoma mouth, by altering the DNA of the squamous cells, and making them grow abnormally. HPV infection is the third most important risk factor for squamous cell carcinoma mouth, and it can increase the risk by up to 4 times.

• Other factors:

There are some other factors that can increase the risk of squamous cell carcinoma mouth, such as poor oral hygiene, chronic inflammation, exposure to sunlight, exposure to radiation, exposure to asbestos, exposure to betel nut, genetic predisposition, or a weak immune system.

Some of the symptoms of squamous cell carcinoma mouth are:

• Changes in your teeth can also indicate a problem. If you have a loose tooth or notice a change in the way your teeth fit together, it is recommended to seek medical attention.
• Moreover, persistent pain or discomfort in the mouth or throat should not be ignored, as it may be a sign of an underlying issue.
• If you have a sore in your mouth that does not heal within three weeks, it could be a sign of a potential health issue.
• Similarly, if you notice a lump or growth in your mouth that does not go away, it is important to get it checked by a healthcare professional.
• Additionally, be cautious if you have a white or red patch in your mouth that does not disappear, as this could be a symptom of an underlying condition.
• Similarly, a change in your voice or hoarseness should not be overlooked, as it could be a symptom of a larger problem.
• If you experience numbness or tingling in your mouth or tongue, it is important to seek medical advice, as this sensation may be a sign of an underlying condition.

Oral melanoma

Oral melanoma is a very rare type of mouth cancer, accounting for less than 1% of all cases and starts growing when the cells that produce melanin, the pigment that gives color to the skin and the hair, become abnormal and grow out of control. It can start anywhere in the mouth, but it is more common on the roof of the mouth, the gums, and the inner lining of the lips. Speaking about colors, melanoma is usually dark brown or black in color, but it can also be pink, red, or white.

Oral melanoma can be caused by various factors, such as:

• Sun exposure:

Exposure to ultraviolet (UV) rays from the sun or from artificial sources, such as tanning beds, can damage the DNA of the melanocytes, the cells that produce melanin, and cause them to mutate and multiply. Sun exposure is the most important risk factor for oral melanoma, and it can increase the risk by up to 10 times.

• Genetic factors:

Some people have a higher risk of developing oral melanoma, because they have inherited certain genes or mutations that make them more prone to the effects of sun exposure or other carcinogens. Genetic factors can also influence the color, shape, size, and number of moles or freckles on the skin or the mouth, which can indicate a higher risk of oral melanoma.

• Other factors:

There are some other factors that can increase the risk of oral melanoma, such as smoking, drinking alcohol, having a weak immune system, having a history of oral cancer, having a history of melanoma in other parts of the body, or having a history of dysplastic nevus syndrome, which is a condition where the moles or freckles are abnormal and irregular.

Some of the symptoms of oral melanoma are:

• A mole or a freckle in the mouth that changes in color, shape, size, or texture
• A new mole or a freckle in the mouth that appears after the age of 30

Inner cheek cancer symptoms

Inner cheek cancer is a type of mouth cancer that affects the inner lining of the cheeks, which are the soft tissues that form the walls of the mouth. Inner cheek cancer can cause pain, discomfort, and difficulty in eating, speaking, and swallowing. It can change the appearance and the shape of the mouth, which should be considered as one of the most significant symptoms if the disease. It may also spread to other parts of the mouth, the head and neck, or the body, if not treated early.

Inner cheek cancer can be caused by various factors, such as:

• Tobacco
• Drinking Alcohol
• HPV infection or human papillomavirus

There are some other factors that can increase the risk of inner cheek cancer, such as poor oral hygiene, chronic inflammation, exposure to sunlight, radiation, asbestos, betel nut, genetic predisposition, or a weak immune system.

Some of the symptoms of inner cheek cancer are:

• If a sore inside the cheek doesn’t heal after three weeks, or if there is a lump or growth that doesn’t go away, it could be a problem.
• A white or red patch that doesn’t go away could also indicate an issue.
• Difficulties or pain while chewing, swallowing, or speaking should be taken seriously.
• Numbness or tingling in the mouth or tongue should be addressed promptly.
• Any unexplained bleeding or discharge from the mouth should be seen by a doctor.
• Unexplained weight loss or loss of appetite should also be investigated.

Beginning oral cancer stages

Oral cancer can be divided into different stages, depending on the size and the spread of the tumor. The stages of oral cancer are:

Stage 0

This is the earliest stage of oral cancer, where the cancer cells are only found in the surface layer of the mucous membranes, and have not invaded the deeper tissues or the lymph nodes. Stage 0 oral cancer is also called carcinoma in situ, and it can be cured by surgery or laser therapy.

Stage I

This is the first stage of invasive oral cancer, where the tumor is 2 centimeters or smaller, and has not spread to the lymphatic system nodes or even other organs. Stage I oral cancer can be treated by surgery, radiation therapy, or a combination of these methods.

Stage II

This is the second stage of invasive oral cancer, where the tumor is larger than 2 centimeters but smaller than 4 centimeters, and has not spread to the lymph nodes or other parts of the body. Stage II oral cancer can be treated by surgery, radiation therapy, or a combination of these methods.

Stage III

This is the third stage of invasive oral cancer, where the tumor is larger than 4 centimeters, or has spread to one lymph node on the same side of the neck as the tumor, but not to other parts of the body. Stage III oral cancer can be treated by surgery, radiation therapy, chemotherapy, or a combination of these methods.

Stage IV

This is the fourth and final stage of invasive oral cancer, where the tumor has spread to more than one lymph node on the same or opposite side of the neck as the tumor, or to other parts of the body, such as the lungs, the liver, or the bones. Stage IV oral cancer is the most advanced and the most difficult to treat, and it may require a combination of surgery, radiation therapy, chemotherapy, immunotherapy, or targeted therapy.

Diagnosis of mouth cancer

Any lump, or tissue change in the mouth that does not clear up within a month should be reported to a doctor.

Dentists can also inspect for oral cancers during routine dental check-ups.

A visual examination is usually the first step, followed by touching of the affected area, to feel for lumps or other unusual signs such as fissures or ulcers. It may also be helpful to discuss the oral health history of the patient, for example how long any lumps or ulcers have been present, whether there has been a history of pain or bleeding, and whether they have had difficulty swallowing or talking.

A small biopsy (taking a small amount of tissue for analysis) can confirm the diagnosis.

X-rays and CT scans may also be necessary, to determine the extent of the cancer and to find out if it has affected bones or other areas.

Mouth cancer treatment

Mouth cancer treatment depends on many factors, such as the type, stage, location, and size of the cancer, as well as the patient’s overall health, preferences, and goals. The main treatment options for mouth cancer are surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy.

Some patients may receive only one type of treatment, while others may receive a combination of treatments. The treatment plan is tailored to each patient’s individual needs and circumstances, and it is discussed and agreed upon by the patient and the multidisciplinary team of specialists who are involved in the care of the patient.

Surgery

Surgery is the most common treatment for mouth cancer, especially for early-stage cancers that are small and localized. Surgery involves removing the tumor and a margin of healthy tissue around it, to ensure that all the cancer cells are eliminated. Depending on the extent of the surgery, the patient may also need to have some of the lymph nodes in the neck removed, to check if the cancer has spread to them.

Sometimes, the surgery may also involve removing a part of the jawbone, the tongue, or the palate, if the cancer is large or has invaded the surrounding structures.

In such cases, the patient may need reconstructive surgery, which uses skin, bone, or muscle from another part of the body to rebuild the affected area and restore its function and appearance.

Radiation therapy

Radiation therapy is another common treatment for mouth cancer, especially for advanced-stage cancers that are large or have spread to the lymph nodes or other parts of the body. Radiation therapy uses high-energy beams, such as X-rays or protons, to kill the cancer cells or stop them from growing. Radiation therapy can be given externally, by a machine that directs the beams to the tumor and the surrounding area, or internally, by placing radioactive sources inside the mouth or the neck.

Chemotherapy

Chemotherapy is a treatment that uses drugs to kill the cancer cells or stop them from growing. Chemotherapy can be given orally, by injection, or by infusion, depending on the type and dose of the drugs. It could be done alone, or in combination with surgery, radiation therapy, or targeted therapy, to increase the effectiveness of the treatment and reduce the risk of recurrence. Chemotherapy can also be given as a palliative treatment, to relieve the symptoms and improve the quality of life of patients with advanced or incurable mouth cancer.

Targeted therapy

Targeted therapy is a treatment that uses drugs that target specific molecules or genes that are involved in the growth and spread of the cancer cells. Targeted therapy can be given orally, by injection, or by infusion, depending on the type and dose of the drugs.

Immunotherapy

Immunotherapy is a treatment that uses drugs that stimulate the immune system to recognize and destroy the cancer cells. Immunotherapy can be given by injection or by infusion, depending on the type and dose of the drugs.

Photodynamic therapy

A new treatment called Photodynamic therapy (PDT) is also being used on some types of cancer of the mouth. The process involves the utilization of laser light in conjunction with a drug that is sensitive to light, aiming to eradicate cancer cells.

When oral cancer is treated early the outlook for recovery is good. After surgery, it may be necessary to carry out some reconstructive surgery on the soft tissue or skin, or to replace bones with prosthetics (artificial replacements). Restorative dentistry, speech therapy and dietary counseling may be required for those whose mouths have been altered by the treatment.

Psychological support may also be required for those whose appearance or speech has altered or who find the treatment particularly distressing.