Cancer is a significant and growing health problem globally. In 2021, it is one of the leading causes of death after cardiovascular disease and COVID-19. Cancer can develop anywhere in the body. Cancer affecting the head and neck is one of the most prevalent cancers in developing countries, especially in Southeast Asia.
Mouth cancer, also known as oral cancer, refers to cancers occurring in any part of the mouth, including the lips, gums, tongue, the inner lining of the cheek, the roof of the mouth, the floor of the mouth, and the back of the throat. In Thailand, as in the rest of the world, the number of people with mouth cancer continues to climb. It is becoming increasingly prevalent among younger age groups.
Data published by the National Cancer Institute of Thailand shows that approximately 4,440 new cases of mouth cancer will be detected each year—roughly 12 new cases per day, with higher burdens in the Northeast of Thailand; this observation is likely associated with betel nut chewing. Moreover, males and older individuals (>45 years of age) are more commonly affected by mouth cancer. Like many cancers, major risk factors for developing mouth cancer include excessive tobacco use and alcohol consumption, human papillomavirus (HPV) infection, and regular use of betel quid.
Despite significant advancements in cancer treatments over recent decades, the prognosis of mouth cancer remains very poor, with less than 50% of affected individuals surviving for more than 5 years after their diagnosis. This is because of the late clinical presentation of most oral cancers in an advanced stage with invasion of adjacent tissues and structure or with metastasis to distant sites, making curability less likely. Even if it is curable, advanced-stage patients need more aggressive combination therapies such as surgery followed by radiotherapy with or without chemotherapy.
For patients with unresectable oral cancer, or unsuitable for surgery due to comorbidities, chemoradiotherapy or radiotherapy alone has also yielded good clinical outcomes. Many cancer patients experience several functional and aesthetic impairments such as restricted mouth opening, lack of saliva, and speech and swallowing impairments which can diminish patients’ quality of life. Therefore, early detection of mouth cancer is of paramount importance as it increases the chances of beating the disease while minimising cancer treatment side effects, especially for high-risk individuals.
Persistent mixed white and red patch (Image courtesy of Dr.Kununya Pimolbutr)
A lump inside the mouth (Image courtesy of Dr.Chakkapan)
What are the signs and symptoms of mouth cancer?
Mouth cancers can present clinically in several different ways depending on the stages and location involved. People with mouth cancer frequently come to see a physician with a non-healing ulcer or unexplained soreness or pain in the mouth that does not go away within two weeks. However, there are other "warning signs and symptoms" that might indicate mouth cancer, including:
- Red or mixed white and red patches in the mouth or on the lips
- A sore or ulcer that does not heal or bleeds easily
- Swelling or lump inside the mouth or in the head and neck region
- Tenderness, pain, or numbness in the mouth or lips
- Unexplained weight loss
- Unexplained loose teeth
- Ear pain
- Difficult or painful swallowing
- A sensation of something being stuck in the throat or voice change (hoarseness)
- Difficulty moving the tongue or jaw
If these symptoms persist for more than 2 weeks, it is worth having them checked by your dentist or doctor. However, having these symptoms does not necessarily mean you have mouth cancer as they can be caused by other health conditions.
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Is it important to screen for mouth cancer? And how often should you do it?
Early detection and treatment of mouth cancer can improve not only long-term survival but also reduce the onerousness of cancer treatments. Mouth cancer, especially in its early stage, can be difficult to detect as it is often painless with subtle changes in the lining of the mouth. Dentists play a vital role in detecting early mouth cancer as they are frequently the first clinicians who can spot any suspicious changes by incorporating a systematic examination of the mouth. This can be done in a matter of minutes as an integral part of routine dental check-ups. Therefore, it is important to see your dentist regularly, at least twice a year, for a professional cleaning as well as an oral cancer screening.
In conclusion, the earlier the cancer is diagnosed, the more likely it is to be cured successfully.
Authors: Dr Kununya Pimolbutr, DDS. Oral Medicine Specialist, MedPark Hospital; Dr Chakkapan Samphaiboon, DDS. Oral and Maxillofacial Surgeon, MedPark Hospital
Series Editor: Katalya Bruton (firstname.lastname@example.org), Director, Dataconsult Ltd. Dataconsult’s Thailand Regional Forum at Sasin provides seminars and documentation to update business on future trends in Thailand and the Mekong Region.