Oral cancer: signs, risk factors and how it’s found

What is oral cancer?

Oral cancer starts when cells in the mouth begin to grow out of control. It can show up on the lips, the tongue (especially the sides and underside), the inner cheeks, the gums, the floor of the mouth and the hard palate. Cancer in the back of the throat, tonsils and base of the tongue is called oropharyngeal cancer and is closely related.

The trouble is that early oral cancer often looks like an everyday mouth problem. A canker sore, a bite on the cheek or an irritated spot from a rough tooth can all look similar at first. The key difference is time: ordinary sores heal, and cancer does not.

What are the early signs of oral cancer?

Many early changes are painless, which is one reason they get missed. Watch for:

• A sore or ulcer in the mouth or on the lip that has not healed after two weeks
• A white or gray patch that cannot be wiped off
• A red or velvety patch, or a mixed red-and-white patch
• A lump, thick spot or rough area on the gums, tongue, cheek or lip
• Bleeding in the mouth with no clear cause
• Numbness or a lasting sore feeling in the mouth, lip or face
• Trouble chewing, swallowing or moving the tongue or jaw
• A lasting sore throat, hoarse voice or feeling that something is stuck in the throat
• Ear pain on one side without an ear infection
• A lump in the neck, or dentures that suddenly stop fitting

None of these signs means you have cancer. Most turn out to be something minor. But any of them lasting more than two weeks deserves a professional look.

White and red patches: leukoplakia and erythroplakia

Two terms come up often. Leukoplakia is a white or gray patch that will not rub off. Most are harmless, but some contain abnormal cells that can turn into cancer over time. Erythroplakia is a flat or slightly raised red patch that may bleed easily. It is less common but more likely to contain abnormal cells. A patch with both red and white areas is also treated with extra caution.

You can’t tell which kind you have by looking in a mirror. Only a biopsy, where a small tissue sample is checked under a microscope, can say for sure.

What raises your risk of oral cancer?

Anyone can get oral cancer, but some things make it more likely. The more of these that apply to you, the more important regular checks become.

Risk factor	Why it matters
Smoking cigarettes, cigars or pipes	Tobacco smoke damages the cells lining the mouth and throat.
Chewing tobacco, snuff or betel quid (paan)	Holding tobacco or betel nut against the cheek or gum exposes the same spot again and again.
Heavy alcohol use	Alcohol irritates mouth tissue, and the risk is much higher when combined with tobacco.
HPV infection	Certain types of HPV are linked to cancers of the throat, tonsils and base of the tongue.
Sun exposure	Years of sun without lip protection raise the risk of lip cancer.
Older age	Most cases are found in adults over 55, though younger people can be affected, especially with HPV-related cancers.
Past oral cancer	People who have had it once need closer follow-up.

You can lower your risk by not using tobacco or betel products, limiting alcohol, using lip balm with SPF outdoors and talking with your doctor about the HPV vaccine for eligible ages.

How do dentists check for oral cancer?

An oral cancer screening is a quick look-and-feel exam, usually done during a routine dental exam and cleaning. It takes a few minutes, does not hurt, and is done by the dentist by eye and by touch, with no special lights, dyes or devices.

1. We ask about your health history, tobacco and alcohol use, and any changes you have noticed.
2. We look at your lips, cheeks, gums, tongue (including the sides and underneath), the floor and roof of your mouth and the back of your throat.
3. We gently feel your jaw, neck and the tissues inside your mouth for lumps or firm areas.
4. If a spot looks unusual but could be from irritation, we may ask you back in about two weeks to see if it has healed.
5. If a spot still looks suspicious, we explain what we see and refer you to a specialist for a biopsy and further testing. We don’t do biopsies in our office.

Dr. Harsh Patel has training in oral and maxillofacial pathology, the field that studies diseases of the mouth and jaw. You can read more on his profile page. You can meet both of our dentists on our about us page.

What happens after a referral?

A specialist may take a small tissue sample to confirm what the spot is. If more information is needed, they may use a lighted scope to look at the throat and voice box, or order imaging. These tests are done outside our office. We help you understand the next steps and can look after your routine dental care before, during and after cancer treatment.

Is oral cancer treatable?

Yes, and it is far easier to treat when found early. Small, early cancers often need less surgery and have better outcomes than cancers found after they have spread to the neck. That is the whole point of screening: catching changes while they are small and often painless.

If you want to know more about what a screening includes and what affects the cost, see our post on oral cancer screening cost. For more detail on specific warning signs, read 5 warning signs of oral tumors.

Frequently asked questions

Sources

• American Cancer Society
• National Institute of Dental and Craniofacial Research
• American Dental Association – MouthHealthy