Identifying oral cancer

The main signs, symptoms and risk factors of oral cancer in primary care and when to refer.

Close-up of a malignant tumour (centre left) in a man's mouth (Photo: Clinica Claros/Science Photo Library)
Close-up of a malignant tumour (centre left) in a man's mouth (Photo: Clinica Claros/Science Photo Library)

The number of cases of oral cancer in the UK is rising and so it is increasingly likely that primary care professionals will encounter a patient with oral cancer. In the early 1980’s, 1912 cases of oral cancer were reported in the UK. The most recent figures from Cancer Research UK report 7591 cases of oral cancer in the UK,1 with around twice as many cases in men (5103) as in women (2488).

Oral cancer is one of the few types of cancer where survival rates have not improved over this period.

The lack of improvement in survival rates is widely considered to be a result of delayed diagnosis. Survival rates for those diagnosed late are 50%, compared with around 90% for those diagnosed earlier.

A comprehensive understanding of key presenting symptoms, as well as risk factors for oral cancer, will better equip primary healthcare professionals to recognise and refer promptly.

When to suspect oral cancer

Key signs and symptoms of oral cancer include;

  • A mouth ulcer that has not healed within three weeks. The ulcer may have a raised edge and may discharge blood, but may not be painful.
  • Irregularities in the oral cavity, for example red or white patches with an irregular surface texture or appearance.
  • Unusual lumps or swellings in the mouth, head or neck area.
  • Unexplained numbness or persistent pain in the mouth.
  • Difficulty moving the jaw or swallowing.
  • Swelling of the tongue which may cause speech problems.
  • Persistent unexplained dry mouth or halitosis.

Risk factors

Oral cancer can affect anybody, but an estimated 91% of all diagnoses are linked to lifestyle factors.2

Tobacco (smoking): Around one in five people in the UK smoke and this is the cause of roughly two thirds of oral cancer cases. Smokers are three times more likely than non-smokers to develop oral cancer.

Alcohol: Excessive alcohol consumption is associated with around a third of oral cancer cases in men and a fifth in women. Heavy drinkers and smokers have up to 35-times increased risk of oral cancer.

Human papillomavirus (HPV): It is believed that almost every sexually-active person will contract HPV at some time in their lives. The two subtypes of HPV that are associated with oral cancer are 16 and 18.3 HPV 16 and 18 are transmitted to the mouth via oral sex. These subtypes are also responsible for cervical, penile, anal and vaginal cancer.

The fastest growing demographic of oral cancer patients in the UK are otherwise healthy, non-smokers in the 25-50 age range. HPV is considered to be the major contributing lifestyle factor among this demographic and is soon expected to become the leading cause of oral cancer.

Diet: Poor diet is estimated to contribute to up to half of all mouth cancer cases. Non-starchy vegetables and fruits (not salted or pickled), and foods containing carotenoids, have been proven to reduce oral cancer risk. Oral cancer risk is lower in people with the highest intake of fruit, vegetables, caffeinated coffee and green tea, compared with those with the lowest intake.

Chewing tobacco and betel nut: Patients who chew tobacco and betel (or areca) nut are at even higher risk of oral cancer than those who smoke tobacco because of the prolonged period that the chemicals come into contact with cells in the mouth.

The role of primary care

In a recent survey by the Oral Health Foundation more than half of people (56%) would seek advice from their GP first if they suffered with a non-healing mouth ulcer. One in ten said they would approach their pharmacist for advice first. This illustrates the important role primary care professionals have in identifying oral cancer.

If a patient presents with any symptoms of oral cancer (see box), consider an urgent two-week referral to either the local maxillofacial surgery, oral medicine, oral surgery or plastic surgery unit

Patient communication is vital to effectively assess the signs, symptoms, and risk factors. Primary care professionals are also ideally placed to proactively raise awareness of oral cancer among at-risk groups. Recent figures show that less than half of the UK population are able to identify the main symptoms of mouth cancer and even fewer people are aware of the major causes.

  • Karen Coates is a dental nurse and dental advisor at The Oral Health Foundation

References

  1. Cancer Research UK. Oral cancer incidence statistics. Available from: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/oral-cancer/incidence (accessed 6 March 2017).
  2. Cancer Research UK, Oral cancer risk factors. Available from: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/oral-cancer/risk-factors (accesed 6 March 2017).
  3. HPV Action. HPV. Available from: http://www.hpvaction.org/hpv.html (accessed 6 March 2017).

The Oral Health Foundation is the leading national charity working to improve oral health. Our goal is to improve people’s lives by reducing the harm caused by oral diseases – many of which are entirely preventable. Visit www.dentalhealth.org for more information.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus