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Oral Cancer Causes and Sings

Cancers of the mouth, and more broadly cancers of the upper aerodigestive tract, particularly affect alcohol and tobacco users. Their symptoms can be very diverse, making them difficult to detect. Often diagnosed too late, their management is mainly based on surgery and radiotherapy. Suppression of alcohol and tobacco use are the main means of preventing the development of these tumours.

Cancers of the upper aerodigestive tract and cancers of the mouth

Cancers of the mouth belong to the cancers of the upper aerodigestive tract (VADS), also called cancers of the ENT sphere or cancers of the head and neck, which may concern :

  • The lips;
  • The mouth;
  • The pharynx;
  • The esophagus;
  • The nasal fossae;
  • Sinuses;
  • Middle ear cavities;
  • Larynx;
  • Trachea.

Cancers of the mouth itself can develop at different levels of the oral cavity:

  • The floor of the mouth;
  • The tongue;
  • The tonsils;
  • The palate;
  • The cheeks;
  • The gums;
  • Lips.

In the majority of cases, these cancers are squamous cell carcinomas, i.e. tumours that develop from the cells of the tissues lining the organs (the epitheliums). Other types of tumours, such as verrucous carcinoma, malignant melanoma and Kaposi’s sarcoma, are less common.

Causes and epidemiology of oral cancers

Oral cancers represent more than 10,000 new cases each year in France. Men are three times more affected than women, although women are increasingly concerned by these cancers.

The known risk factors for oral cancer are as follows:

  • Mainly chronic or heavy alcohol consumption;
  • Also tobacco, in all its forms (cigarettes, cigars, pipes, chewing tobacco, chewing betel, snuff);
  • The combination of alcohol and tobacco is responsible for the highest risk of oral cancer;
  • Human papillomavirus infections;
  • Age, the incidence of these cancers increasing with age;
  • Certain chronic or poorly treated oral problems, such as chipped teeth with sharp edges, dental fillings, poorly fitting cavities or dentures, or poor oral hygiene;
  • Frequent x-rays in the head and neck area;
  • Chronic candidiasis (infection with a fungus);
  • Heavy sun exposure in the case of tumours affecting the lips.

Clinical signs and prognosis of oral cancers

Most often, the first signs of oral cancers go unnoticed because patients do not complain of pain for a long period of time. These tumours can manifest themselves in different forms, such as :

  • Open sores;
  • growths, ulcerations;
  • Flat or slightly raised spots;
  • Soft or very hard lesions;
  • Discoloured (white) or on the contrary red or brown areas in a region of the mouth.

Symptoms of oral cancers also vary according to the location of the tumour. After a long, painless phase, the first signs of pain gradually lead to :

  • A discomfort in swallowing, reminiscent of a sore throat;
  • Difficulty speaking;
  • Difficulty eating, which can lead to weight loss and undernutrition.

The prognosis for oral cancer depends on several criteria:

  • The location of the tumor;
  • The stage of the tumor and its possible extension to other organs (metastases);
  • Its origin.

Screening and prevention of oral cancers

Currently, more than two out of three oral cancers are diagnosed too late, with a less favourable prognosis. The great variability of symptoms is partly responsible for this difficulty in screening.

Early detection of oral cancers is necessary to optimise the effectiveness of treatment and the chances of cure. Treating physicians and dental surgeons have a crucial role to play in this screening, as patients rarely detect the first cancerous lesions themselves, which are usually painless.

Increased surveillance is recommended for people with the following risk factors:

  • Regular consumption of alcohol;
  • Regular smoking;
  • Regular use of cannabis;
  • Use of other substances, such as betel quid.

In general, any unusual symptoms that have persisted for more than 10 days should be investigated by a physician to determine the nature of the problem and its cause.

In addition to screening, preventive measures can be recommended to reduce the risk of developing oral cancer, including :

  • Avoid excessive consumption of tobacco and alcohol;
  • Adopting good oral hygiene and seeing a dental surgeon regularly;
  • Proper sun protection;
  • Get vaccinated against human papillomavirus infections.

Diagnosis of oral cancers

To diagnose oral cancer, a doctor will prescribe a number of medical tests when he or she detects a suspicious oral lesion:

  • A careful examination of the oral cavity using a mirror and/or a flexible viewing tube (endoscope);
  • Biopsies of the oral lesions to identify the nature of the tumor;
  • Imaging tests (CT scan, MRI (Magnetic Resonance Imaging)) to determine the size of the tumour, the stage of the cancer and its possible spread.

Cancers of the mouth can spread to other organs, such as :

  • Lymph nodes in the neck;
  • The larynx;
  • The lungs;
  • The oesophagus.

Management of oral cancers

The treatment strategy for oral cancers depends on several criteria:

  • The part of the mouth involved;
  • The precise location of the tumor;
  • The histological characteristics of the tumor;
  • The stage of the tumour and the possible existence of metastases.

The management of oral cancers is multidisciplinary and is mainly based on three treatments:

  • Surgery to remove the tumour, which is the first and sometimes the only treatment for oral cancers;
  • Radiotherapy, if surgery does not remove the entire tumour;
  • Anticancer drugs, only in the advanced stages of oral cancer:

-Chemotherapy;

-Targeted therapies, such as immunotherapy, which is growing rapidly in this indication.


Surgery involves removing the tumour from the mouth, and sometimes the lymph nodes under and behind the jaw and along the neck. This type of surgery can have a significant impact on the patient’s physical appearance. Reconstructive surgery may then be considered as a second step.

Radiotherapy has important side effects, in particular :

  • Destruction of the salivary glands causing chronic dry mouth associated with dental problems (cavities);
  • Osteoradionecrosis (destruction of bone tissue impacted by radiation from radiotherapy sessions), which can be prevented by specific dental care.

In addition to these treatments to fight cancer, comprehensive care can include multiple aspects, such as :

  • Psychological support;
  • A social support to carry out all the administrative procedures and requests for specific assistance;
  • Nutritional follow-up to limit the risk of undernutrition;
  • Speech therapy to re-educate the voice and reduce swallowing problems;
  • Reinforced dental follow-up;
  • Help to stop smoking;
  • Alcohol withdrawal assistance.

Estelle B. / Doctor in Pharmacy