Diagnosis of Oral Cancer



What is cancer?

Cancer is a word used to describe many different diseases which have different causes and which are treated in a variety of ways. All cancers are treatable but not all are curable. There are more than 200 different kinds of cancer, each with its own name and treatment.


What causes cancer?

Our bodies are made up of tiny structures called cells. Healthy cells reproduce by dividing regularly so the growth and repair of the body can take place. Disease can disrupt this normal function. If, for what ever reason, this process gets out of control, cells continue to multiply, developing into a lump which is called a tumour. Benign tumours remain localised, and once treated, often by surgery, do not cause any further problem. Cancers or malignant tumours can spread to nearby organs and other parts of the body if left untreated. Cells can break away from the original primary cancer and travel around the body in the bloodstream. When these cells reach a new site they may form a new tumour often referred to as a secondary or metastasis.


What is cancer of the mouth?

Cancer of the oral cavity (mouth) can develop on the lips and in the mouth itself. It can affect the tongue, hard palate (roof of mouth), the gums, teeth, jaw bones, the floor of the mouth (under the tongue) and the inner part to the lips and cheeks. It can also affect the part of the throat at the back of the mouth. This includes the tonsils and the side walls, the base of tongue (part you cannot see) and the soft palate (soft part of roof of mouth).


What causes cancer of the mouth?

Cancer of the mouth is the sixth commonest cancer in the U.K. and accounts for about 2% of all new cancers. It is more common in men and the elderly, but increasingly affects women and younger people. The exact cause of cancer of the mouth is unknown but is strongly associated with tobacco and alcohol. Individuals that use both are at the highest risk. The incidence of lip cancer is also more common in pipe smokers and those who have been exposed to sunlight, such as those who have worked outdoors or lived in a sunny climate. A further cause is chewing tobacco, betel nut and pan supari. In some cases, however, there may be no obvious cause for your cancer.


What are the signs and symptoms?

The main symptom of cancer of the mouth is usually an ulcer or lump, whether painful or not, which does not heal within a few weeks. If the swelling or ulcer affects the surrounding area such as the tongue it may cause difficulty in chewing, swallowing or some slurring of speech. Sometimes glands in the neck can become enlarged. These glands are part of the body's natural defence against infection. Your doctor will check for any enlarged glands in the neck, but sometimes they may be enlarged simply due to a harmless infection.


What investigations might I still need to have?

When you attended the out-patients’ department the Head and Neck Consultant will have listened to your account of your illness and the symptoms you have developed. He or she will also have examined carefully your mouth and throat and may have performed other tests which have allowed us to make your diagnosis. However there are other tests you may require to help us learn more about your cancer. These include:


  • CT Scan
  • MRI Scan
  • PET Scan
  • Fine Needle Aspiration
  • Tissue Biopsy

What is tumour stage and grading?

All the investigations you may have will tell your consultant what stage and grade your cancer is. This will help the doctor decide on the most appropriate treatment for you.


What is tumour stage and grading?

TNM Staging is measuring system which ranges from tumour in-situ [TIS] to stages 1-4. 'TIS' is the smallest of cancers just starting to grow, moving up to stages T1 to T4, 4 being the largest. 'N' describes nodes [glands] involved range= 0 - 4 'M' describes any distant spread of disease to other parts of the body [metastasis]


Grading is a term used to describe how the cancer cells look under a microscope which gives the doctors an idea of how quickly your cancer may develop. The specific type of tumour will depend on the tissue cells involved and may vary depending on the original site. Your consultant will be happy to discuss this with you.


What happens after my diagnosis?

When a diagnosis of mouth cancer is made, each individual case is discussed at a multi-disciplinary team (MDT) meeting to consider which treatment(s) may be the best option. The members of the team consist of: Maxillofacial consultant surgeons, ENT consultant surgeons; consultant oncologists (cancer specialists); consultant radiologists (a doctor who interprets x-rays and scans); consultant pathologists (a doctor who examines tissues under a microscope to assist diagnosis); consultant restorative dentists; head & neck nurse specialist in cancer, speech and language therapist, dieticians and other doctors and health professionals with an interest in cancer.


Following the MDT meeting your consultant surgeon and other members of your care team will meet with you and discuss the results of your investigations and the treatment options that should be undertaken in your case. Your surgeon will also answer any questions you have on the benefits and risks of these treatments.


Once a treatment plan has been agreed with you, the team should be able to offer you a date to start treatment within 31 days.


What treatments are available?

Surgery, radiotherapy or chemotherapy are the three main options for treatment. They can be given alone as a treatment or a combination can be used to treat the cancer. Most Oral Cancers are treated by surgery alone or a combination of surgery and radiotherapy. Every person diagnosed with cancer is very different and a number of factors will influence which treatment is appropriate for you. These include the type and size of the tumour, whether it has spread to other local areas, your age and your general health. These factors as well as your lifestyle will also influence how effective your treatment will be in possibly curing your cancer and will be discussed with you by your consultant. If a diagnosis of cancer is confirmed your consultant together with the rest of your care team will discuss the various treatment options available with you and advise you of the most effective method of treatment. Specific information on the various treatment options is available. Every individual diagnosed with cancer will experience fears and anxiety in both similar and also very different ways and will find different ways of coping. Your care team is there to provide you with the important information you need, to make an informed decision and consent about your treatment options. Although it is important you are given certain information to enable you to make your decisions, we respect your rights as an individual to receive as much or as little information about your illness and treatment as you wish. Please do not hesitate to discuss any issues regarding information with your team.