Oral tumours

What is an oral tumour?

An oral tumour is an abnormal growth in your mouth, which can be non-cancerous (benign) or cancerous. The most common cancerous oral tumour is oral cancer, also called mouth cancer, which can develop on your lips, gums, tongue, or the inside lining of your cheeks.

What are the symptoms of an oral tumour?

Symptoms can affect any part of your mouth, including your gums, tongue, the inside of your cheeks, or your lips. Signs to look out for include:

• a mouth ulcer or sore that lasts more than three weeks, or that bleeds easily
• a red or white patch inside your mouth, which may feel rough or crusty
• a lump inside your mouth, on your lip, or in your neck
• pain, numbness or tenderness in your mouth or face without an obvious cause
• difficulty or pain when chewing, swallowing, speaking, or moving your jaw or tongue
• a hoarse or croaky voice that does not go away
• losing weight without trying
• persistent bad breath or earache

These symptoms are very common and are often caused by other, less serious conditions. Having them does not definitely mean you have an oral tumour, but it is important to get them checked by a GP or dentist, as finding a problem early makes it easier to treat.

What causes oral tumours and who is at risk?

Oral cancer starts when cells in the lining of your mouth change and begin growing and multiplying abnormally. Around 75% of people who develop oral cancer smoke, use tobacco products, or drink alcohol heavily, and the risk is greater if you do both.

Other things that can increase your risk include:

• chewing betel quid, even if it does not contain tobacco
• having a weakened immune system
• human papillomavirus (HPV) infection
• long-term ultraviolet light exposure on your lips, from sunlight, sunbeds or sunlamps
• an unhealthy diet with little fresh fruit or vegetables
• a family history of oral cancer

Having one or more of these risk factors does not mean you will definitely develop an oral tumour, and around 25% of people who develop oral cancer have none of the known risk factors. Oral cancer most often affects people aged 60 and over and is more common in men than women.

Are there different types of oral tumour?

Not every growth in the mouth is cancer. Non-cancerous (benign) tumours do not spread to other parts of the body, unlike cancerous ones. Sometimes, patches of abnormal cells in the mouth are described as pre-cancerous, meaning they could turn into cancer if left untreated.

Among cancerous oral tumours:

• squamous cell carcinoma (SCC) is by far the most common type, making up more than 90% of cases. It starts in the flat, skin-like cells that line the inside of the mouth
• verrucous carcinoma is a low-grade type of SCC that rarely spreads elsewhere in the body, though it can grow deeply into nearby tissue
• salivary gland cancers can develop in the glands that line the mouth, though a lump in these glands is more often benign than cancerous
• lymphoma can develop from lymph tissue at the back of the tongue, the tonsils, or lymph nodes in the neck, and usually shows up as painless swelling
• melanoma, which develops from pigment-producing cells, accounts for between 1% and 2% of mouth cancers
• sarcoma, arising in connective tissue such as muscle or bone, is uncommon in the mouth
• odontogenic tumours start in the jaw and teeth and can be either benign or cancerous

How are oral tumours diagnosed?

Your dentist or GP will usually ask about your symptoms, lifestyle and any other medical conditions, then look and feel inside your mouth. They may also feel your neck and jaw. You can ask for someone else to be in the room while you are examined.

If they want to investigate further, they may take a sample of cells using a small brush or spatula (a brush biopsy) or remove a small piece of tissue (an incisional biopsy) to be examined under a microscope. A small mirror or a thin, flexible endoscope may also be used to look at areas of your throat that are otherwise hard to see.

You may get an urgent referral to a specialist if a GP or dentist thinks your symptoms could be cancer. This does not definitely mean you have cancer though. If a tumour is confirmed, further tests help determine its size and whether it has spread, which guides your treatment options.

How are oral tumours treated?

Non-surgical treatment

Treatment depends on the type of tumour, whether it has spread, and your general health and age. Non-surgical treatments used for oral cancer, often alongside surgery, include:

• radiotherapy, which uses strong beams of energy to kill cancer cells or stop them growing
• chemotherapy, which uses anti-cancer drugs
• targeted therapy, which uses drugs designed to attack specific cancer cells while sparing healthy ones
• immunotherapy, which helps your immune system fight the cancer

Surgical treatment

Surgery is a common treatment for oral cancer and the standard approach is to remove the tumour, sometimes followed by radiotherapy or chemotherapy. Surgical options include:

• primary tumour surgery, removing the tumour through your mouth or through an incision in your neck
• a glossectomy, the partial or total removal of your tongue
• a mandibulectomy, surgery on your jawbone
• a maxillectomy, removing part or all of the hard palate (the bony roof of your mouth)
• a sentinel lymph node biopsy or neck dissection, to check whether cancer has spread to lymph nodes in your neck and remove any that are affected
• reconstructive surgery, to fill gaps or replace part of your lips, tongue, palate or jaw, sometimes using tissue taken from elsewhere in your body

When should I see a doctor?

See a GP or dentist if you have:

• a mouth ulcer that has lasted more than three weeks
• a lump in your mouth, on your lip, on your neck or in your throat
• a red or white patch in your mouth
• pain in your mouth that is not going away
• difficulty swallowing or speaking
• a hoarse voice that does not go away

A dentist can also help with ulcers, lumps, patches or pain in your mouth, and regular dental check-ups can help catch early signs of a problem.