Oral, Lip and Tongue Tumours

What is oral, lip and tongue cancer?

Oral (oral cavity) cancer is cancer that develops on the lips, the front two thirds of the tongue, the gums, the inner surface of the cheeks, the floor of the mouth and the hard palate. It is one of the most common head and neck cancers, and the great majority are squamous cell cancers that develop from the cells lining the mouth.

The back of the tongue, the tonsils and the side and back walls of the throat belong to the oropharynx; cancers in this area have different features and are more often linked to HPV.

What are the symptoms?

The most important symptom of oral cancer is a sore or patch that lasts longer than two weeks and does not heal. These symptoms can be confused with common problems such as mouth ulcers (aphthae) or denture sores; however, if they last more than two weeks they should be examined.

• A sore (ulcer) on the lip, the tongue or inside the mouth that does not heal within two weeks and bleeds easily
• White, red or red-and-white patches that cannot be scraped off
• Swelling, hardening or a lump inside the mouth, on the lip or in the neck
• Pain, numbness or restricted movement of the tongue
• Difficulty chewing, swallowing or speaking; a denture that starts to fit poorly
• Persistent bad breath, pain spreading to the ear, unintentional weight loss

What are leukoplakia and erythroplakia?

Leukoplakia and erythroplakia are patches inside the mouth, some of which may carry pre-cancerous changes.

• Leukoplakia: a flat, white or grey patch that cannot be scraped off. Most are benign, but in some of them cancer can develop over time.
• Erythroplakia: a flat or slightly raised red patch that may bleed when scraped. It is more likely than leukoplakia to be pre-cancerous or an early cancer.
• Erythroleukoplakia: a patch in which red and white areas occur together.

Whether these patches are benign or malignant cannot be told from their appearance; patches lasting more than two weeks need a biopsy.

Tongue cancer

Tongue cancer is one of the most common oral cancers and usually starts on the side of the tongue. A sore that does not heal, a raised area, a white or red patch on the tongue, pain and restricted movement of the tongue, and difficulty speaking or swallowing are the warning signs to look out for. The main risk factors are smoking and other tobacco products, alcohol, and constant irritation from a broken tooth or an ill-fitting denture.

In early stages, treatment is usually surgical removal of the tumour together with part of the tongue (partial glossectomy). In advanced stages, neck dissection, radiotherapy and chemotherapy may be added.

Risk factors

• Smoking, chewing tobacco and other tobacco products
• Alcohol; the risk rises markedly when combined with smoking
• Long-term sun exposure in lip cancer
• HPV infection (mostly in cancers of the throat)
• Constant irritation from a broken tooth or an ill-fitting denture
• Older age: most common over the age of 60; more common in men

Diagnosis and staging

Dentists are often the first to notice suspicious changes inside the mouth during routine check-ups; the definitive assessment is made by an ENT specialist working in head and neck surgery or by an oral and maxillofacial surgeon.

1. Examination: the whole inside of the mouth is inspected and felt, and the lymph nodes in the neck are assessed. If needed, the base of the tongue, the throat and the larynx are examined with an endoscope.
2. Biopsy: a small piece of tissue is taken from the suspicious area; the definitive diagnosis is made by pathology.
3. Imaging: CT, MRI and, when necessary, PET-CT are used to assess the depth of the tumour, bone involvement and spread.

The cancer is staged according to the TNM system: T shows the size of the tumour and how deeply it has grown into the tissue, N shows spread to the lymph nodes in the neck, and M shows distant spread. Treatment is planned according to this stage.

How is it treated?

The main treatment for oral cancer is surgery. For advanced tumours, or where there is a risk after surgery, radiotherapy and, if needed, chemotherapy are added; the treatment decision is made together with radiation oncology and medical oncology.

• Removal of the tumour: through the mouth or, if needed, through an incision in the neck, together with the surrounding healthy tissue.
• Glossectomy: removal of part or all of the tongue.
• Excision of a lip tumour: removal of the part of the lip containing the tumour.
• Mandibulectomy and maxillectomy: removal of the affected part of the bone if the tumour extends into the lower or upper jaw.
• Neck dissection: removal of the lymph nodes in the neck.
• Reconstruction: if there is extensive tissue loss, the tongue, lip, palate or jaw can be rebuilt in the same operation with tissue and bone taken from other parts of the body.

After surgery: eating, speech and recovery

Recovery time varies from a few weeks to a few months, depending on the location and size of the tumour and the extent of the operation. After extensive operations, one or more nights may be spent in intensive care.

• In the first weeks after major operations, nutrition is given through a thin tube running from the nose to the stomach (nasogastric tube); eating by mouth resumes within a few weeks.
• In patients who have had tongue surgery and reconstruction, speech usually begins in the first weeks; pronunciation improves markedly within a few months, although it may not be as clear as before.
• Speech and swallowing therapy provides support during this time.

Risks and follow-up

The risks vary with the extent of the operation: they include bleeding, infection, changes in swallowing and speech, problems related to the reconstruction tissue and, after neck surgery, weakness of shoulder movement. The risks are discussed in detail before surgery.

People treated for oral cancer have a higher risk of developing a second cancer in the head and neck area, especially if smoking and alcohol continue. That is why regular follow-up visits after treatment are very important.

Is oral cancer life-threatening?

The outcome of oral cancer depends largely on the stage. Small tumours detected at an early stage are mostly treated successfully and lead to a smaller operation, less tissue loss and faster recovery. As the tumour grows and spreads to the neck, treatment becomes more difficult. That is why an early assessment of sores and patches lasting more than two weeks is vitally important.

How does the process work with Prof. Dr. Öner Çelik?

1. Consultation: the inside of the mouth, the neck and, if needed, the throat are examined endoscopically at the clinic in Suadiye.
2. Diagnosis: the type and stage of the tumour are determined with a biopsy and imaging.
3. Treatment decision: surgery and additional treatments are planned together with the relevant specialties; the effects on speech, swallowing and appearance are discussed.
4. Surgery and follow-up: surgery is performed at Maltepe University Hospital; regular follow-up continues at the clinic.

Details are on the your treatment in Istanbul page.