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Oral Cavity Cancer: Symptoms, Causes & Treatment

By Dr. Akshat Malik in Surgical Oncology , Cancer Care / Oncology , Head & Neck Oncology

Feb 17 , 2025 | 3 min read

Oral cavity cancers (cancers of the mouth) are a significant healthcare challenge. They are among the most common cancers in the Indian subcontinent. According to GLOBOCAN 2020 data, lip and oral cavity cancers constitute 10.3% of all cancers (in both sexes) and account for 8.8% of cancer-related deaths in India. This indicates that every year, approximately 1,35,000 patients are newly diagnosed with oral cancer, and about 75,000 die from it annually.

Oral cavity cancers include cancers of the tongue, buccal mucosa (inner cheek), upper alveolus (upper jaw), lower alveolus (lower jaw), palate, and floor of the mouth.

Causes of Oral Cavity Cancers

Tobacco Consumption: The leading cause of oral cancers. Tobacco is used in two forms: smoked (cigarettes, beedi, hookah) and smokeless (gutkha, khaini, betel quid/paan).

Smokeless tobacco is used by up to 21.4% of India’s population.
Tobacco users have 30 times higher chances of developing oral cancers.

Alcohol Consumption: Increases the likelihood of developing oral cancer.
Areca Nut (Supari): Found in paan, it is a known carcinogen linked to oral cancer.
Chronic Trauma: Ill-fitting dentures or sharp teeth can also lead to cancer.

Symptoms of Oral Cavity Cancer

Patients with a history of tobacco use may present with the following symptoms:

Non-healing ulcers in the tongue or cheek
Growth in the oral cavity
Loosening of teeth
Gradual reduction in mouth opening
Swelling in the neck

Precancerous Conditions

Leukoplakia: Whitish patches in the oral cavity with no clear cause.
Erythroplakia: Similar to leukoplakia, but presents as reddish patches.
Submucous Fibrosis: Whitish bands in the cheek associated with sensitivity to spicy food and progressive reduction in mouth opening.

Early detection and refraining from tobacco use can help prevent the progression of these conditions to cancer.

Diagnosis of Oral Cavity Cancer

Diagnosis involves a thorough examination of the upper aerodigestive tract and the neck to check for lesions or metastasis.

Diagnostic Tests

Biopsy: Tissue from the suspicious site is examined for cancer cells.
FNAC (Fine Needle Aspiration Cytology): Done on neck swellings to detect cancer cells.
Radiological Tests: CT scans and MRIs are used to determine the spread of cancer and plan treatment.
Chest X-ray: To rule out the spread of cancer to the lungs.

Treatment of Oral Cavity Cancer

Treatment depends on the stage of the disease:

Early-Stage (Stage I/II) Treatment

Single Modality Treatment: Surgery or radiotherapy is preferred.
Surgery: Often a single procedure. In selected cases, brachytherapy (a type of radiotherapy) may be used.

Advanced-Stage (Stage III/IV) Treatment

Multi-Modality Treatment: Surgery followed by radiotherapy and/or chemotherapy.
Reconstruction Surgery: Involves using local, regional, or free flaps to reconstruct defects.
Local/Regional Flaps: Chest muscle is commonly used.
Free Flaps: Bone or leg, thigh, or forearm muscle may be used for reconstruction.

Adjuvant Therapy is provided based on adverse histopathological features in the final report. For inoperable or extensive cases, upfront chemo-radiotherapy may be considered.

Post-Treatment Follow-Up

Patients are regularly monitored for residual disease, recurrence, or the appearance of new lesions.

Rehabilitation and Recovery

Rehabilitation is crucial for restoring speech and swallowing functions after treatment.

Speech and Swallowing Therapy

Speech therapists help patients regain speech.
Swallowing therapists teach maneuvers to ease swallowing.
Patients may remain dependent on a semi-solid diet for some time. Family support is vital during this phase.

Occupational Therapy

Jaw-Stretching Exercises: Help improve mouth opening post-treatment.
Physiotherapy: Neck and shoulder exercises are essential after neck dissection.

Prevention of Oral Cavity Cancer

Certain lifestyle changes can significantly reduce the risk of oral cavity cancers:

Tobacco Cessation: Avoid both smoked and smokeless forms of tobacco.
Avoid Areca Nut (Supari): Found in paan and associated with cancer risk.
Alcohol Reduction: Minimising alcohol consumption lowers the risk.

Support for Tobacco Users

De-Addiction Centres: Offer counseling and prescribe nicotine patches or gums.
Counselling Services: Help individuals cope with withdrawal symptoms and quit successfully.

The Tobacco Challenge in India

Around 25% of India’s population consumes tobacco in some form. While the GATS-2 survey shows a decrease in tobacco users nationwide, Punjab has seen an increase in the last seven years, with 13.4% of people currently using tobacco.

In this scenario, fighting the scourge of tobacco is crucial for preventing oral cavity cancers.