Mouth cancer & pre-malignant conditions

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Luke has vast experience in the diagnosis and management of malignant and premalignant conditions of the mouth and jaws.

Mouth cancer

Mouth cancer, also known as oral cancer, is one of the rarer forms of cancer in the UK, accounting for just one in every fifty cancers. It mostly affects people over sixty, although younger people may get mouth cancer as a result of the human papilloma virus (HPV). Around 8,300 people are diagnosed with mouth cancer each year in the UK, about 1 in every 50 cancers diagnosed. More than 2 in 3 cases of mouth cancer develop in adults over the age of 55. Only 1 in 8 (12.5%) happen in people younger than 50. Men are more likely to get mouth cancer than women.

Caught early, there is a good chance of cure. 80% of patients will live for five years or more after early diagnosis and treatment. However, if mouth cancer is not caught early there is just a 20% chance of surviving this long as the cancer spreads quickly, either directly to the jaw bone, throat and skull or indirectly via the lymphatic system. Once the cancer reaches the lymphatic system it can spread anywhere in the body including the lungs and other major organs.

Mouth cancers usually form on the tongue, in the lining of the mouth, on the lips or on the gums. Very rarely mouth cancer will affect the salivary glands, the tonsils or the pharynx.

Symptoms of mouth cancer

Mouth cancer can cause a wide range of symptoms, most of which can also be caused by far less serious conditions such as minor infections. These symptoms only become a cause for concern if they persist for more than three weeks. Symptoms include:

  • Swellings within the mouth
  • Mouth ulcers that don’t clear up after 2-3 weeks
  • Red patches on the tongue or mouth lining
  • Painful swallowing
  • Neck pain
  • Swollen lymph nodes or glands
  • Changes in sense of taste
  • Loose teeth

If you experience any of these symptoms for more than three weeks, it is essential to get checked out by your GP, as early diagnosis is crucial for the treatment of mouth cancer.

The importance of early diagnosis

If mouth cancer is caught early, then there is a good chance that it can be cured. 80% of patients will live for five years or more after early diagnosis and treatment. However, if the cancer is not caught early, there is just a 20% chance of surviving this long, as the cancer can spread quickly, either directly, to the jaw bone, throat and skull, or indirectly, via the lymphatic system. Once the cancer reaches your lymphatic system, it can spread to anywhere in your body, including your lungs and other organs.

How is mouth cancer diagnosed

If your doctor suspects you may have mouth cancer, they will send you for a biopsy. This is a procedure in which a small sample of tissue is taken and examined for the presence of cancer cells. The tissue sample can be taken in three ways:

  • Punch biopsy – in which tissue is cut directly from the tongue or mouth
  • Fine needle biopsy – in which tissue and fluid are drawn from a lump or gland using a needle.
  • Panendoscopy – in which a tube is inserted down the nose to take a sample from the throat.

Mr Cascarini carries out all of these diagnostic procedures.

Risk factors in mouth cancer

The major risk factors for mouth cancer include:

  • Smoking – smoking 40 a day increases your risk by a factor of five
  • Alcohol – drinking excessively increases your risk by a factor of five
  • Drinking and smoking – combining heavy drinking and smoking increases your risk by a factor of almost 40.
  • HPV – this is a virus that can be present in the genitals and is passed on through intimate contact, even if intercourse does not take place.
  • Diet – it is thought that a diet high in red meat, processed foods and fried foods may increase the risk of mouth cancer.
  • Smoking cannabis, chewing qat and eating betel nuts are also thought to be risk factors, as is poor oral hygiene.

Gallery

Large pyogenic granuloma
Tongue erosion
Severe form of dysplasia
Squamous cell carcinoma - lower gum
A squamous cell carcinoma of the tongue.
Oral squamous cell papilloma
Large pyogenic granuloma

Mouth cancer treatment

As with many cancers, treatment for mouth cancer usually involves a combination of surgery, radiotherapy and chemotherapy.

Surgery for mouth cancer

The primary treatment for mouth cancer is the surgical removal of the cancerous cells and the surrounding tissue. This may involve removal of part of the jawbone or cheekbones, part of the tongue or even part of the facial skin, depending on the site and extent of the cancer. If bone is removed, it can be reconstructed using bone grafts or prosthetics. The skin and tongue can also be repaired using grafts.

Surgery may be undertaken in the traditional way, cutting away at the cancerous tissue, or may be done using a laser technique called Photodynamic Therapy (PDT), which uses chemicals to make the cancerous cells more sensitive to light and so more easily destroyed.

Selective neck dissection

To remove lymph nodes from the neck when the cancer is in the mouth is a low risk procedure which takes about 45 minutes. This video shows Mr Cascarini operating.

Elective Neck Dissection

Find out more about neck dissection.

Radiotherapy for mouth cancer

Radiotherapy uses radiation to kill off cancer cells, especially those that have not been removed by surgery. Radiotherapy is usually used to prevent the return of mouth cancer, but it can also be used to target the cancer itself.

Standard radiotherapy delivers a dose of radiation to the general area of the tumour and its surrounding cells, whereas internal radiotherapy uses probes inserted directly into the tumour site to deliver the radiation. Standard radiotherapy is given daily for three to seven weeks, while internal radiotherapy only takes one to eight days.

Chemotherapy for mouth cancer

Chemotherapy is an additional safeguard that is usually only used where there is a significant risk of the cancer returning. It uses powerful chemicals to damage the cancer cells and prevent them from reproducing.

There are also a number of specialist cancer drugs available, such as the antibody Cetuximab, which target the cancer cells in different ways. However, these treatments are only available on the NHS in special circumstances where other treatments are not possible. They can be bought privately, but are very expensive, with a course of Cetuximab for example costing between £7,000 and £14,000.

A multi-disciplinary treatment team

The treatment of mouth cancer is a highly complex process, and involves a number of highly skilled professionals from different disciplines. Luke works in a team with a pathologist and radiotherapists and clinical oncologists to provide a continuum of care for every patient.

Precancerous conditions of the mouth

Some cells in the mouth can undergo changes that make them more likely to develop into cancer. It doesn’t mean these cells are a cancer yet but if left untreated they could eventually become cancerous. Common precancerous conditions include leuoplakia, erythroplakia and lichen planus.

Leukoplakia and speckled leukoplakia

White or grey patches (leukoplakia) or a blend of white and red patches (speckled leukoplakia) on the tongue, inside cheek, gums or under the tongue.

To diagnose these conditions, a sample of the cells is collected during a biopsy and sent to a lab for testing.

By comparing the look, size and shape of the cells in the discoloured area, the level of abnormality can be assessed and then closely monitored for any changes.

Homogenous leukoplakia

Risk factors

The chance of developing leukoplakia and speckled leukoplakia increases if someone:

  • Is a heavy smoker
  • Chews tobacco
  • Drinks excessive amounts of alcohol

Treatment

Whilst there is often no active treatment, a close watch is kept on the condition with tests and examinations to detect any changes. Tobacco and alcohol should be avoided. Sometimes removal of the precancerous area is necessary.

Erythroplakia

Erythroplakia is characterised by a red patch or red spots inside the mouth that may bleed when touched or scratched.

To diagnose erythroplakia, a sample of the cells is collected during a biopsy and sent to a lab for testing.

Risk factors

Some cells in the mouth can undergo changes that make them more likely to develop into cancer. It doesn’t mean these cells are a cancer yet but if left untreated they could eventually become cancerous. Common precancerous conditions include leuoplakia, erythroplakia and lichen planus.

Treatment

Some cells in the mouth can undergo changes that make them more likely to develop into cancer. It doesn’t mean these cells are a cancer yet but if left untreated they could eventually become cancerous. Common precancerous conditions include leuoplakia, erythroplakia and lichen planus.

Lichen planus

Some cells in the mouth can undergo changes that make them more likely to develop into cancer. It doesn’t mean these cells are a cancer yet but if left untreated they could eventually become cancerous. Common precancerous conditions include leuoplakia, erythroplakia and lichen planus.

Treatment

Whilst there is no cure, there are ways to reduce pain and discomfort. Corticosteroids can help ease inflammation. Ointments and gels can also be prescribed. Lifestyle changes ease outbreaks as the condition can be triggered by stress, allergies or medication. Lifestyle changes that can help include good oral hygiene, not eating spicy, salty and acidic food and not drinking caffeine. Smoking and alcohol are not advised. Recognising stress triggers and how to manage them is also beneficial.

Luke summarises his expertise

TESTIMONIALS

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