Mouth Cancer Symptoms

This article describes the symptoms that might indicate cancer of the mouth.  There are a number of cancers that might affect the mouth region.  Many of the symptoms that these various cancers cause are similar and thus highlight some of the more important signs to be aware of.

The mouth is made of many important and related structures.  The mouth (or oral cavity) is composed of the lips, mucosal surfaces, tongue, floor of the mouth, teeth, bones of the face, soft and hard palates, and the supporting structures such as nerves, lymphatic and blood vessels.  The vast array of cell types contained therein helps to explain many of the different types of cancers that might arise in this very dense area.

Some of the common oral cancers include:

  • Squamous cell carcinoma (the most common overall)
  • Adenocarcinoma
  • Lymphoma

Several of the common symptoms of mouth cancer are non-specific (as with many cancers) and their appearance is considered more concerning in those who are at risk for mouth cancer.  Understanding what helps maintain a healthy mouth and what places one at risk for mouth cancer is therefore important.

Common risk factors for mouth cancer include:

  • Cigarette smoking (increases the risk of mouth cancer greatly, at least 15x)
  • Alcohol abuse (more than doubles the risk for mouth cancer)
  • Combined cigarette smoking and alcohol abuse (increases the risk much more than either alone and not simply an additive risk but exponentially)
  • Excessive sun exposure
  • Exposure to known irritants of the mouth and other types of carcinogens such as chewing betel nuts that are common in certain parts of the world such as Papua New Guinea
  • Certain infections such as the Human Papilloma Virus (HPV)

Some of the most common symptoms of oral cancer (including related cancers of the head and neck) are:

  • Pain: Pain is a common symptom of oral cancer and those associated cancers of the neck.  The same type of cancer is common in both areas and tends to overlap in disease spectrum (i.e. squamous cell carcinoma).  Pain might occur with swallowing, coughing, extending the tongue, or all the time.  The cause of the pain is variable but might involve the cancer growing near or into a nerve in the tongue or near the check.  There are many sensation nerves in the mouth region and a tumor or ulcer in any of the above mentioned areas might cause some sort of discomfort.  This is quite a non-specific symptom as many non-cancer conditions might cause pain in the mouth such as a toothache, an apthous ulcer, or minor abrasion.
  • Oral lesion: An abnormal “spot”, ulcer, bump, growth, white plaque, bleeding area, or any combination of these would be considered an oral lesion.  Most oral cancers have some detectable lesion on examination.  There are many bumps or small tumors of the mouth that are not cancer related such as cysts near the gums or teeth or benign apthous ulcers.  The presence of a lesion that is new, uncomfortable or does not seem to heal is concerning and should be brought to the attention of your doctor for further investigation.  This type of symptom is more concerning in someone who has risk factors as described above.
  • Weakness or numbness of the mouth region:  Any weakness of the mouth, tongue or related areas or numbness of these areas might indicate a cancer in this area.  The reason for this is that cancers tend to grow into adjacent structures and destroy or impair their function.  There are a number of nerves that supply sensation and give motor function to the mouth such as:
    • Facial nerve
    • Hypoglossal nerve
    • Lingual nerve
    • Glossopharyngeal nerve
    • Auriculotemporal nerve
    • Many others and branches of these
  • Lump in the neck: A lump in the neck in addition to a suspicious lesion in the mouth might indicate cancer in that area.  The neck, particularly on the sides, has many pockets of lymph nodes.  If a cancer of the mouth spreads outside of its area into the lymphatic system, it might cause enlarged firm or rubbery lymph nodes in the neck.  This indicates an aggressive disease and also usually dictates that extensive surgery will be required also to fully treat the cancer.  There are other things besides cancer that could cause this same scenario.  For example, if a person has an abscess or infected area near the gums it would not be unexpected to also have tender and enlarged lymph nodes on the same side of the neck as well. This is because lymph nodes help to drain infection and inflammation away.  The lymph node enlargement that occurs with cancer is typically a bit larger, not tender and very firm or even quite hard.

Having any of the above symptoms should be considered a “red flag” and should prompt notification of your physician for further investigation into these symptoms.  Occasionally, the problem can be solved with a simple examination and determined to be something other than cancer.  If cancer is a consideration, a sample of the cells in the form of a biopsy will need to be done to confirm the presence of a cancer and determine the type of it.  Once cancer is confirmed, additional information will need to be obtained concerning how much is present with imaging such as an MRI or other type of study.

REFERENCES:

  1. www.cancer.gov/cancertopics/wyntk/oral/page1
  2. seer.cancer.gov/statfacts/html/oralcav.html
  3. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18th ed.  Chapter 33.  New York, NY: Saunders.
  4. Goldman L, Schafer, AI;  (2011) Goldman: Goldman’s Cecil Medicine, 24th ed. Chapter 196. New York, NY: Elsevier.
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.