The mouth (oral cavity)

The mouth and oropharynx help us breathe, talk, eat, chew and swallow. The medical term for the mouth is the oral cavity. Mouth cancer includes cancer that starts anywhere in the oral cavity. In other words, the
Lips Front two thirds of the tongue Upper and lower gums, (the gingiva) Inside lining of the cheeks and lips (the buccal mucosa) Floor of the mouth, under the tongue Roof of the mouth (the hard palate) Area behind the wisdom teeth (called the retromolar trigone)

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The oropharynx
Pharynx is the medical name for the throat. The pharynx is divided into 3 parts, and the oropharynx is one of these parts. The other two parts are the nasopharynx and the laryngopharynx. The oropharynx connects the mouth to the top of the throat. It is the part of the throat just behind the mouth. Cancers that start in this area are called oropharyngeal cancers. Oropharynx is pronounced oar-oh-fah-rinks. Oropharyngeal is pronounced oar-oh-fah-rin-jee-al.

The areas within the oropharynx include

The back third of the tongue The soft area at the back of the roof of the mouth (the soft palate) The tonsils and two ridges of tissue in front of and behind the tonsils (called the tonsillar

pillars) The back wall of the throat

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What throat cancer means

The term throat cancer can be confusing because people use it to mean different things. The throat includes the 3 parts of the pharynx (including the oropharynx). People also use the term to include structures near the pharynx, such as the thyroid gland, the voice box (larynx) or the food pipe (oesophagus). So throat cancer is not a very precise term. To avoid confusion, it is important to know the exact medical name of the cancer you or your relative have so that you can find the right information. Cancers are treated according to where they start in the body. The treatment for thyroid cancer is not the same as treatment for oropharyngeal cancer, for example. If you are not sure of the medical name of your cancer, you can ask your doctor or nurse to write it down for you. There is information in our questions and answers section to help you understand the term throat cancer and guide you to information about the type of cancer you need to know about. The tonsils are part of the oropharynx and we have information about cancer of the tonsil.
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Lymph nodes in your neck

Like other parts of the body, the head and neck contain lymph nodes (also called lymph glands). These small, bean shaped glands are part of the lymphatic system. Lymph nodes are often the first place cancer cells spread to when they break away from a tumour.

There are major groups of lymph nodes in the neck. Mouth and oropharyngeal cancers can spread to these lymph nodes. So people with these types of cancer often need an operation to remove lymph nodes from the same side of the neck as the cancer. More rarely, a surgeon may suggest removing nodes from both sides. These operations are called neck dissections. There is information about the lymph glands and the lymphatic system in the about your body section. Cancer that begins in the lymph nodes (rather than spreading to them) is called lymphoma. If you are looking for information about lymphoma, this is not the right section for you. You need to go to thenon Hodgkin lymphoma or Hodgkin lymphoma section.

Possible risk factors

We have included information on the factors below because we are sometimes asked about them. But we must stress that there is not enough evidence for these to be thought of as definite risk factors. With further research, some may turn out not to be risk factors at all.
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Irritation to the lining of the mouth

Some people have worried that long term irritation to the lining of the mouth can cause mouth cancer. For example, dentures that do not fit properly could cause irritation. But most research studies have not found a link. Even so, you should have dentures checked by your dentist at least once every 5 years. It is also important to clean and rinse them twice a day and take them out at night. This helps to prevent substances known to cause mouth cancer, such as tobacco and alcohol, staying trapped under your dentures.
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Mouth cleanliness
Studies show that people who brush their teeth only once a day or less, compared to two or more times a day, and people who go to the dentist rarely, have a slightly increased risk of oral cancer.
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Mouthwash
Some studies have suggested that mouthwashes with a high alcohol content could increase the risk of mouth cancer. But other studies have found that this is not the case. An overview of studies in 2012 found that mouthwashes do not increase the risk of mouth or oropharyngeal cancer

Symptoms of mouth cancer

This page is about the symptoms of mouth cancer and oropharyngeal cancer. You can find information about
A quick guide to what's on this page Ulcers that do not heal Persistent discomfort or pain in the mouth White or red patches in the mouth or throat Difficulty in swallowing Speech problems A lump in the neck Weight loss Bad breath (halitosis) Other symptoms More information

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A quick guide to what's on this page

Ulcers that do not heal

A sore area (ulcer) that doesn't heal is one of the two most common symptoms of mouth cancer. 80 out of every 100 people with mouth cancer (80%) have a mouth ulcer that does not heal.
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Persistent discomfort or pain in the mouth

Ongoing pain or discomfort in the mouth is the other most common symptom of mouth cancer.
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White or red patches in the mouth or throat

An abnormal looking patch in the mouth could be a sign of cancer or precancerous changes. Areas of abnormal cells may look red or white. White patches are called leukoplakia (pronounced loo-ko-play-kee-a), and the red patches are called erythroplakia (pronounced air-ith-row-play-kee-a). These patches are not cancer, but if left untreated they may lead to cancer. There is more information about leukoplakia and erythroplakia in this section. A white or red patch in the mouth or throat does not necessarily mean cancer. A fungal infection called thrush can cause them. The white patches of thrush usually rub off, leaving a sore, red patch underneath. If you have anti fungal treatment and the patches go away, they are not related to cancer.
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Difficulty in swallowing
Mouth cancer can cause pain or a burning sensation when chewing and swallowing food. Or you may feel that your food is sticking in your throat. Difficulty swallowing can also be caused by other conditions such as a harmless narrowing of the food pipe (oesophagus). If you have this symptom it is important to see your doctor and get some treatment.
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Speech problems

Cancer in your mouth or throat can affect your voice. Your voice may sound different. It may be quieter, husky, or sound as if you have a cold all the time. Or you may slur some of your words or have trouble pronouncing some sounds.
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A lump in the neck

You may have a lump in your neck caused by an enlarged lymph node. Swelling of one or more lymph nodes in the neck is a common symptom of mouth and oropharyngeal cancers. A hot, red, painful lump usually means an infection, rather than a cancer. Lumps that come and go are not usually due to cancer either. Cancer usually forms a lump that slowly gets bigger.
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Weight loss
Weight loss is a common symptom of many cancers. With mouth or oropharyngeal cancer you may eat less due to mouth pain or because it is difficult for you to swallow. Extreme weight loss may be a sign of advanced cancer. See your doctor if you have lost 10lbs or more in a short time and you are not dieting.
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Bad breath (halitosis)

Most people have bad breath at some time in their life and it is not a sign of cancer. But if you have cancer bad breath may be worse and happen more often because of your illness. There is moreinformation about bad breath in the section about coping physically with cancer.
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Other symptoms
Other symptoms of mouth cancer might include one or more of the following
A lump or thickening on the lip A lump in the mouth or throat Unusual bleeding or numbness in the mouth Loose teeth for no apparent reason

 Difficulty moving the jaw

Screening for mouth cancer

This page is about the current situation in the UK regarding screening for mouth and oropharyngeal cancer. There is information about

A quick guide to what's on this page Cancer screening The current situation for mouth and oropharyngeal cancer What you can do

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Cancer screening
Screening means testing people for early signs of cancer before they have any symptoms. To be able to carry out screening, doctors need to have an effective and accurate screening test. The test must be reliable at picking up cancers that are there. And it must not give false positive results in people who do not have cancer.
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The current situation for mouth and oropharyngeal cancer

There is no national screening programme in the UK for mouth or oropharyngeal cancer because these cancers are relatively uncommon. With uncommon diseases, it is most cost effective to screen people who have an increased risk of developing them. But first we must be sure we know who is at higher risk of mouth cancer. People who both smoke and drink heavily are at higher risk of mouth and throat cancers. In November 2010 the Cochrane Library carried out a review of studies that looked into screening programmes for mouth cancer. It stated that we do not currently have evidence to show that a screening programme for mouth cancer can help to pick up mouth cancers earlier. We need more research to find this out.
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What you can do

You can do a couple of things to find early signs of mouth cancer.
Have regular dental check ups, at least yearly even if you have false teeth Check inside your mouth with a small mirror for any changes that could be due to mouth

cancer Many dentists routinely check for mouth or oropharyngeal cancer. So they are often the first to spot these cancers in their patients. You need to report any changes that you or your dentist find to your GP. This is especially important if you smoke and drink heavily. There are UK guidelines for GPs that advise them when they need to refer people to a specialist in mouth cancer.

Types of mouth and oropharyngeal cancer

This page has information about the different types of mouth and oropharyngeal cancer. You can find information about

A quick guide to what's on this page Mouth and oropharyngeal cells Squamous cell cancers of the mouth and oropharynx Other types of mouth and oropharyngeal cancer Non cancerous growths in the mouth and oropharynx Precancerous conditions Grade of mouth and oropharyngeal cancers

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Mouth and oropharyngeal cells

Several types of tissue make up the mouth and oropharynx. Each tissue contains several types of cells. Cancer can develop from any of these cell types. It is important that your doctor finds out exactly which type of cancer you have so you get the right treatment.
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Squamous cell cancers of the mouth and oropharynx

More than 9 out of 10 mouth and oropharyngeal cancers (90%) are squamous cell carcinoma.Squamous cells are the flat, skin like cells that cover the inside of the mouth, nose, larynx and throat. Carcinoma just means cancer. So squamous cell carcinoma is cancer that starts in these cells. There is an unusual type of squamous cell carcinoma called verrucous carcinoma. About 1 in 20 mouth cancers (5%) are this type. Verrucous carcinoma rarely spreads to other parts of the body but can grow very deeply into surrounding tissues.

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Other types of mouth and oropharyngeal cancer

Squamous cell cancer is not the only type of cancer that can develop in the mouth and oropharynx. 1 in 10 mouth and oropharyngeal cancers (10%) are one of the following types
Salivary gland cancer Adenoid cystic cancer Lymphoma Melanoma

Salivary gland cancer

There are minor salivary glands throughout the lining of the mouth and oropharynx. It is more common for a lump in this area to be non cancerous (benign). But cancers can develop in these glands and are mostly adenocarcinomas.

Adenoid cystic cancer

Adenoid cystic cancer is a rare type of cancer that develops from glandular tissue and occurs mostly in the salivary glands but can also occur in the mouth. The parotid gland is the most common place to find a cancerous tumour. But only about 1 out of every 5 tumours (20%) found in the parotid gland are cancerous. We have a section about salivary gland cancer.

Lymphoma
Lymphomas are cancers that develop from cells in the lymph nodes. The base of the tongue and tonsils are made up of lymph tissue that can develop into cancer. There are also many lymph nodes in the neck. Painless swelling of a lymph node is the most common symptom of lymphoma. If you are looking for information about lymphoma, you need to go to the lymphoma section. Your treatment will be very different to treatment for mouth and oropharyngeal cancer.

Melanoma
Melanomas develop from the pigment producing cells that give the skin its colour. Melanomas of the head and neck can occur anywhere on the skin or inside the nose or mouth (oral cavity). If you have a melanoma of the mouth or lip, some of the information in this section will be helpful, for example in the radiotherapy or surgery sections. But there is also a section about melanoma that you may like to look at.
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Non cancerous growths in the mouth and oropharynx

A growth or tumour is not always a cancer. Non cancerous growths are called benign. The main difference is that a cancer can spread, while a benign tumour doesn't. Some mouth and oropharynx tumours are not cancerous (benign) and so don't spread to other parts of the body. There is information about the differences between cancer cells and normal cells in our section about cancer.
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Precancerous conditions
Two different medical conditions can cause abnormal areas in the mouth or throat. They are harmless to begin with but if left untreated can turn into a cancer in a small number of people. Doctors call these conditions precancerous. They are
Leukoplakia and Erythroplakia

Leukoplakia causes white patches in the mouth. Erythroplakia is a slightly raised red area in the mouth that bleeds easily. These white or red patches may be harmless. But they can be precancerous and contain abnormal cells. If not treated, these cells could go on to develop into a cancer. Doctors call these abnormal cells dysplasia (pronounced dis-play-zee-a). Your doctor will need to take a sample of these cells. This is the only way to find out exactly what the patches are. The tissue sample is called a biopsy. Your doctor will send the biopsy to a lab, where a specialist checks for abnormal cells by examining the sample under a microscope. If left untreated, precancerous changes may go on to develop into a cancer years later. Only about 5 out of every 100 people (5%) diagnosed with leukoplakia have either cancerous or precancerous changes. But about half (50%) of the red erythroplakia lesions can become cancerous. If you have dysplasia, there is a risk that you may go on to develop mouth cancer. But if your doctor removes the dysplasia, your risk of mouth cancer usually disappears. The most common causes of erythroplakia and leukoplakia are smoking or chewing tobacco. Or you may develop it because you have badly fitting dentures that are always rubbing on your gums, the inside of your cheeks or your tongue. So it is important that you get regular dental check ups if you have dentures. The usual treatment for leukoplakia is getting rid of the source of irritation. For most people, stopping smoking or correcting dental problems clears the condition. If that doesnt work, or if the lesions show early signs of cancer, your doctor may choose to remove the patches using a laser or scalpel. Researchers are trying a group of drugs called retinoids on leukoplakia. Retinoids are made from vitamin A. They are used to treat severe acne and other skin conditions. Although retinoids seem to help to treat leukoplakia, they can cause serious side effects.

Beta carotene is an antioxidant that is converted to vitamin A in your body. It may also completely or partially reduce leukoplakia patches. This type of treatment is still experimental and it is not generally prescribed on the NHS. If you develop either of these conditions and you smoke, there is a greater risk that they will come back. Your doctor will strongly advise you to give up smoking.
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Grade of mouth and oropharyngeal cancers

When you have a cancer removed, or if you have a biopsy, the specialist examining the cells under a microscope will usually grade them. This means that they look at how different they are from normal cells. Cells that are very like normal cells are called low grade (well differentiated). Cells that look quite abnormal are called moderate grade. Cells that look very abnormal are called high grade (poorly differentiated).

Tests for mouth cancer

This page tells you about tests to diagnose mouth and oropharyngeal cancers. You can find information about
A quick guide to what's on this page Seeing your GP At the hospital Biopsy Scalpel biopsy Nasoendoscopy Fine needle aspiration Panendoscopy Getting the results

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Seeing your GP
If you are worried about symptoms that could be due to mouth or oropharyngeal cancer, you usually begin by seeing your GP. Your doctor will examine you and ask about your general health and about your symptoms. They will ask when you get the symptoms and whether anything you do makes them better or worse. Your doctor will examine your mouth and throat. They may also feel the lymph nodes (glands) in your neck and under your arms. After examining you, your doctor may refer you to hospital for tests and X-rays or directly to a specialist. The specialist is usually a head and neck surgeon.
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At the hospital
If you see a specialist, they will ask you about your medical history and symptoms. They will then examine you and may look at the back of your throat using a small mirror that they put into your mouth. This is called indirect laryngoscopy. You may have blood tests and a chest X-ray to check your general health. Then your specialist will arrange for you to have tests in the outpatient department. You may have a biopsy, nasoendoscopy,fine needle aspiration, or panendoscopy.
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Biopsy
To make a definite diagnosis of any mouth or oropharyngeal cancer your doctor needs to take a sample of tissue from the affected area (a biopsy) and look at it under a microscope for signs of cancer. If the area is easy to get at (for example, in your mouth) your doctor will be able to remove a very small amount of tissue and send it to the laboratory. There are different ways of taking a biopsy to diagnose mouth and oropharyngeal cancers. They include scalpel biopsy and panendoscopy. Your doctor may take a sample of cells using fine needle aspiration.
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Scalpel biopsy
A scalpel biopsy means cutting out a circle of tissue from the affected area. Your doctor will inject some local anaesthetic into the area to numb it. Then the doctor cuts round the biopsy area, gently

lifts the piece of tissue using a pair of tweezers and cuts it off. This is uncomfortable but only lasts a short time. For many people, the most uncomfortable part is the local anaesthetic injection.
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Nasoendoscopy
A nasoendoscopy (sometimes spelt nasendoscopy) or laryngoscopy allows your specialist to look at all your upper air passages. This includes the back of your throat (the pharynx). The specialist passes a narrow, flexible telescope (a nasoendoscope) up your nose and down your throat. It can be a bit uncomfortable, so your doctor may use an anaesthetic spray to numb your throat first. But if you have the anaesthetic spray you cant eat or drink until it wears off so you may choose not to have it. If the specialist sees any abnormal area in your throat, they will need to take a biopsy from that area.
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Fine needle aspiration

Fine needle aspiration is also called FNA. If your doctor can feel a lump in your neck, you may need to have a fine needle aspiration. This means putting a thin needle into the lump. The specialist will first feel the lump, so that they know where to put the needle. Once the needle is in the lump, the doctor draws out cells and fluid. The doctor sends the cells to the laboratory, where a specialist called a pathologist examines them to see if they are cancerous. Your doctor may also use a fine needle biopsy to see if the cancer has spread to the lymph nodes in your neck. The doctor puts the needle into one of the large lymph nodes and draws out fluid and cells for testing.
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Panendoscopy
Your doctor may ask you to go into hospital to have a panendoscopy. This is usually if they can't get a good view using the mirror or nasoendoscope, or if they see something abnormal and need to take a biopsy. The nasoendoscope is too fine to use for a biopsy. But a panendoscope is thicker so your specialist can use it to remove a sample of the affected tissue. A panendoscope is a series of connected tubes that a head and neck surgeon uses to look at your upper airways. There is a camera and light at one end, and an eyepiece at the other.

You have this test while you are under general anaesthetic. The doctor gently puts the panendoscope up your nose and down into your throat. They will look at all parts of your pharynx, as well as the larynx (voicebox), food pipe (oesophagus), windpipe (trachea) and breathing tubes (bronchi). This is because people with mouth and oropharyngeal cancers are at a greater risk of developing cancers in other areas of the head and neck.
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Getting the results

Your doctor will ask you to go back to the hospital when your test results have come through. But this is bound to take a little time, even if only a few days. This is a very anxious time for most people. You may have contact details for a cancer specialist nurse and you can contact them for information if you need to. While you are waiting for results it may help to talk to a close friend or relative about how you are feeling. You may want to contact a cancer support group to talk to someone who has been through the same experiences. You can phone the Cancer research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. Our mouth and oropharyngeal cancer organisations page gives details of other people who can help and support you. You can find details of counselling organisations in ourcounselling section. Our mouth and oropharyngeal cancer reading list has information about books and leaflets about mouth and oropharyngeal cancers and their treatment. If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.

Grade and stage of mouth cancers

This page has information about the stages and grades of mouth andoropharyngeal cancers. You can find information about

A quick guide to what's on this page What staging is Staging systems for mouth and oropharyngeal cancers

TNM stages of mouth and oropharyngeal cancers Number stages of mouth and oropharyngeal cancers The grades of mouth and oropharyngeal cancer

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What staging is
The stage of a cancer means how big it is and whether it has grown or spread. The staging information helps your doctor to decide on the best treatment. The tests and scans that you had to diagnose your cancer give some staging information. But if you need surgery your doctor may not be able to tell you the exact stage until after the operation.
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Staging systems for mouth and oropharyngeal cancers

There are different ways of staging cancers. The two main systems are the TNM system and number system. Understanding your cancer stage may help you understand why your specialist has recommended a particular treatment for you. If you don't understand and would like to know more, you can ask your doctor. There is a list of questions for your doctor at the end of this section that may help you. There is also more information about staging cancers in the about cancer section.
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TNM stages of mouth and oropharyngeal cancers

TNM stands for Tumour, Node and Metastasis. The system describes
The size of a primary tumour (T) Whether the cancer has spread to the lymph nodes (N) Whether the cancer has spread to a different part of the body (M)

T stages
There are 4 main T stages of mouth and oropharyngeal cancer

 T1 means the tumour is contained within the tissue of the mouth or oropharynx and is no

larger than 2cm ( inch) T2 means the tumour is larger than 2cm, but smaller than 4cm (about 1 inches) T3 means the tumour is bigger than 4cm T4a means the tumour has grown further than the mouth or oropharynx and into nearby body tissues such as bone, tongue, the air cavities of the face (sinuses) or the skin T4b means the tumour has spread into nearby areas such as the space around and behind the jaws, the back of the upper jaw where the large jaw muscles attach, the base of the skull, or the area of the neck that surrounds the main arteries (carotid arteries)

N stages
There are 4 main lymph node stages in cancer of the mouth and oropharynx. One of these, stage N2, is broken down into 3 sub stages. The important points here are whether there is cancer in the lymph nodes in the neck and if so, the size of the node and which side of the neck it is on.
N0 means there are no cancer cells in the lymph nodes N1 means there are cancer cells in 1 lymph node on the same side of the neck as the

cancer, but the node is less than 3cm across N2a means there is cancer in 1 lymph node on the same side of the neck, and the node is more than 3cm across but less than 6cm across
N2b means there is cancer in more than 1 lymph node, but none of these nodes are more

than 6cm across. All the affected nodes are on the same side of the neck as the cancer. N2c means there is cancer in nodes on the other side of the neck, or in nodes on both sides, but none of these nodes are more than 6cm across N3 means that at least 1 node containing cancer is more than 6cm across

M stages
There are two M stages for cancers of the mouth and oropharynx
M0 means there is no cancer spread to other parts of the body M1 means the cancer has spread to other parts of the body, such as the lungs

Together, the T, N and M stages give a complete description of the stage of your cancer. For example, if you have a T2, N0, M0 cancer, you have a tumour larger than 2cm but not larger than 4cm. There are no cancer cells in the lymph nodes and there is no spread of your cancer to other parts of the body.
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Number stages of mouth and oropharyngeal cancers

There are four main stages in this system stages 1 to 4. Some doctors also refer to stage 0.

Stage 0 or carcinoma in situ (CIS)

If you have CIS or stage 0 cancer of the mouth or oropharynx, you have a very early stage cancer. Some doctors prefer to call this pre cancer. There are cancer cells but they are all contained within the lining of the mouth or oropharynx. So they have not spread. As the cells have not spread, this is not yet a true cancer. If the pre cancer is not treated, there is a high chance of this condition going on to develop into an invasive cancer.

Stage 1
This is the earliest stage of invasive cancer. It means that cancer has begun to grow through the tissues lining the mouth or oropharynx and into the deeper tissues underneath. The cancer is no more than 2 cm across and has not spread to nearby tissues, lymph nodes or other organs.

Stage 2
If you have stage 2 cancer, the tumour is larger than 2cm across, but less than 4cm. The cancer has not spread to lymph nodes or any other organs.

Stage 3
Having stage 3 mouth or oropharynx cancer can mean one of two things. Either the cancer is bigger than 4cm but has not spread to any lymph nodes or other parts of the body. Or the tumour is any size but has spread to one lymph node on the same side of the neck as the cancer. In this case the lymph node involved is no more than 3cm across.

Stage 4
Stage 4 means the cancer is advanced. It is divided into 3 stages
Stage 4a means the cancer has grown through the tissues around the lips and mouth

lymph nodes in the area may or may not contain cancer cells
Stage 4b means the cancer is any size and has spread to more than 1 lymph node on the

same side of the neck as the cancer, or to lymph nodes on both sides of the neck, or any lymph node is bigger than 6cm Stage 4c means the cancer has spread to other parts of the body such as the lungs or bones
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The grades of mouth and oropharyngeal cancer

The grade of a cancer tells you what the cells look like under a microscope. The cells are graded according to how normal or abnormal they appear. There are 4 grades of oral and oropharyngeal cancer cells
Grade 1 (low grade) the cancer cells look very much like normal mouth or oropharyngeal

cells

 Grade 2 (intermediate grade) the cancer cells look slightly different to normal mouth or

oropharyngeal cells Grade 3 (high grade) the cancer cells look very abnormal and not much like normal mouth or oropharyngeal cells Grade 4 (high grade) the cancer cells look very different to normal mouth or oropharyngeal cells Differentiation means how developed or mature (differentiated) a cell is. So doctors may describe grade 1 cancer cells as well differentiated. Grade 2 cancer cells are moderately differentiated. Grade 3 cancer cells are poorly differentiated. Grade 4 cells are undifferentiated.

Treatments used for mouth cancer

This page has information about treatments for mouth or oropharyngealcancer. You can find out about
A quick guide to what's on this page Head and neck cancer treatment teams How your doctor decides on your treatment Choosing your treatment Surgery Radiotherapy Chemotherapy Chemoradiation Biological therapy Treating cancer that has spread

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Head and neck cancer treatment teams

NHS guidelines state that everyone who has head and neck cancer should be under the care of a multi disciplinary team (MDT). An MDT is a team of health professionals who work together to decide on the best treatment and care for each patient. Even if you have only seen one specialist,

the team will still have got together with your test results and case notes to discuss the best treatment options for you. The MDT includes a variety of doctors and other health professionals who specialise in different aspects of treatment, such as
Head and neck surgeons Medical oncologists specialists in treatment with cancer drugs Clinical oncologists specialists in radiotherapy treatment Restorative dentistry consultant Head and neck clinical nurse specialist Other health professionals

Head and neck surgeons

Head and neck surgeons may include ear, nose and throat surgeons (ENT), oral and maxillofacial surgeons, and plastic surgeons. They are described below. ENT doctors are specialists trained in treating conditions of the ear, nose, throat and neck. They are always qualified surgeons and are also called otolaryngologists. Oral and maxillofacial surgeons are highly qualified, and are trained both as doctors and dentists. They specialise in the surgical treatment of a wide variety of conditions affecting the mouth, jaw, face and neck, including reconstructive surgery and facial plastic surgery. These surgeons remove the cancer and also rebuild tissue lost due to the cancer or operation. Sometimes a plastic surgeon will carry out reconstruction. Plastic surgery means the moulding of the surface and sometimes deep structures of the human body. It can include rebuilding an area where a cancer has been removed. Plastic surgery is common after surgery to remove a cancer of the head or neck.

Medical oncologist
A medical oncologist is a doctor who specialises in treating cancer with cancer drugs such as chemotherapy or biological therapies.

Clinical oncologist
A clinical oncologist treats cancer with radiotherapy. They work closely with a team of people to plan and give the treatment.

Restorative dentistry consultant

A restorative dentist is a specialist in replacing lost tissues and teeth. They are also called prosthodontists. They assess your teeth before you have treatment. They may recommend that you have some teeth removed, for example if they are decaying or loose, so that they don't cause problems later on. The restorative dentist will also advise you on how to look after your mouth and

teeth during and after your treatment, and they may send you to a dental hygienist for more help. It is important to keep your teeth and mouth clean to reduce the risk of infection. The dentist will help to plan your recovery with your surgeon, so that you can speak and eat as well as possible afterwards. They may suggest using special false teeth, or a replacement part (prosthesis) for missing teeth or any structure in the mouth. For example, some people with mouth cancer need to have surgery to remove part of their jawbone. The consultant rebuilds the missing piece with a piece of bone from another part of the body. A restorative dentist can fit a prosthesis with teeth to attach to the new jaw bone using dental implants. A prosthesis will also help to make yourfacial appearance as normal as possible after major surgery.

Head and neck clinical nurse specialist

A head and neck clinical nurse specialist is a qualified nurse who has specialist knowledge of head and neck cancers. One of their roles is to help to organise care between doctors and the other health professionals you need to see. They will also help to support you through your treatment and make sure you have the information you need to understand the treatment.

Other health professionals

You may also need help and support from other health specialists, for example a dietician or speech therapist. There is also usually a social worker who can advise you about any benefits and grants you may qualify for.
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How your doctor decides on your treatment

Mouth and oropharyngeal cancers can be treated with
Surgery Radiotherapy Chemotherapy A combination of chemotherapy and radiotherapy (chemoradiation)

For advanced cancer you may have biological therapy in combination with chemotherapy. You may have one of these treatments alone or a combination of treatments. Your doctor will plan your treatment according to
The type of mouth or oropharyngeal cancer you have Whether the cancer has spread (the stage) What the cells look like under a microscope (the grade) The impact your treatment will have on your speech, chewing and swallowing Your general health and fitness

There is detailed information about surgery, radiotherapy for mouth cancer, chemotherapy for mouth cancer, chemoradiation for mouth and oropharyngeal cancer and biological therapy for mouth cancerin this section. Surgery alone cures some tumours, but others respond better to radiotherapy, or radiotherapy with chemotherapy or biological therapy. A Cochrane review in 2010 found that adding chemotherapy to surgery or radiotherapy for oropharyngeal cancer works better than just one of these treatments on their own. On the next page, there are links to descriptions of the most common treatments for each type and stage of mouth and oropharyngeal cancer.
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Choosing your treatment

Your specialist may advise that surgery is the best treatment for you because of the stage or position of your cancer. In other circumstances, they may suggest radiotherapy (with or without chemotherapy) as your main treatment. In some situations you may have a choice between types of treatment. In controlling your cancer, radiotherapy can work as well as surgery for early stage cancer of the mouth or oropharynx. Making the choice can be difficult but your doctor and specialist head and neck cancer nurse will be able to help you decide which is best for you. You may want to get a second opinion before you have your treatment. A second opinion may confirm what your own specialist has said, but can give you more information and help you to feel more confident about your treatment plan. Most doctors are happy to refer you to another specialist for a second opinion if you want one. Remember that a second opinion doesn't mean that the second doctor will definitely take over your care. Your original specialist may still manage your treatment.
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Surgery
Surgery is a common treatment for mouth and oropharyngeal tumours. How much surgery you have depends on the size and depth of the cancer when it is found. It also depends on whether there is a risk that the cancer has spread into lymph nodes around your mouth or in your neck. You are most likely to have an operation under general anaesthetic. Surgery works very well for early stage mouth cancer.

For some very early stage cancers of the mouth and oropharynx, you may be able to have laser surgery under local or general anaesthetic, although this is not common. In laser surgery, the surgeon uses a narrow, intense beam of light to cut out the cancer. The laser beam works like a surgical knife (scalpel). But if you have an early cancer, your specialist team may recommend that you have radiotherapy instead of surgery. For information about specific operations that you may have, you can look in the surgery for mouth and oropharyngeal cancer section.

Surgery to the neck and lymph nodes

If you have surgery, your surgeon will examine the area around your tumour during your operation. They may remove some of the lymph nodes from around your tumour to see if they contain cancer cells. They do this to help find the stage of your cancer. If your cancer has already spread to lymph nodes in your neck, your surgeon is likely to remove all the nodes on one or both sides of your neck. They may also remove other structures. They call this aneck dissection. Neck dissections are also sometimes done for people with no signs of cancer in the lymph nodes. Your surgeon is most likely to suggest this if you have a tumour that is larger than 4mm. The aim is to get rid of any remaining cancer cells, and lower the chance of the cancer coming back in the lymph nodes. Even if cancer cells cant be seen in the nodes there could be a few cancer cells there that will keep on growing if the surgeon doesnt take the lymph nodes out. Checking the nodes also helps your doctors to decide if radiotherapy will be helpful for you. Your surgeon will need to do a neck dissection if they plan to rebuild (reconstruct) part of your mouth or throat with tissue taken from another part of the body. This surgery is called a free flap. To attach the tissue the surgeon uses microsurgery to join tiny blood vessels in the neck to tiny blood vessels in the new piece of body tissue. A neck dissection allows the surgeon to reach the blood vessels in the neck. There is detailed information about removing lymph nodes and neck dissection in the surgery for mouth and oropharyngeal cancer section.
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Radiotherapy
Radiotherapy alone is used to treat some types of mouth and oropharyngeal cancers that have not spread.

If you have surgery your doctor may recommend that you have radiotherapy afterwards. The treatment aims to kill off any cancer cells that might have been left behind. This lowers the risk of the cancer coming back. Radiotherapy may be combined with chemotherapy for people whose cancer has spread into surrounding areas (locally advanced cancer). There is detailed information about radiotherapy and side effects to the mouth and oropharyx area in this section.
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Chemotherapy
You may have chemotherapy in the following situations
If your cancer has come back after surgery and radiotherapy To treat a mouth and oropharyngeal cancer that is locally advanced or has spread to other

parts of the body There is information about chemotherapy and the different chemotherapy drugs and side effects in this section.
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Chemoradiation
Chemotherapy may be combined with radiotherapy and is called chemoradiation. It may be used instead of surgery for some oropharyngeal cancers that have spread into surrounding tissues or into nearby lymph nodes. For some people this may get rid of the cancer completely. This treatment may also be used for very small mouth cancers but this is rare. We have detailed information about chemoradiation for mouth and oropharyngeal cancers in this section.
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Biological therapy
Biological therapies are treatments made from naturally occurring body substances or that affect how cancer cells divide and grow. A biological therapy called cetuximab (also known as Erbitux) is used for some mouth and oropharyngeal cancers. It may be used alongside radiotherapy for locally

advanced squamous mouth or oropharyngeal cancer. It is also used in clinical trials in combination with platinum based chemotherapy or radiotherapy. There is information about biological therapies for mouth and oropharyngeal cancer in this section.
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Treating cancer that has spread

If your cancer has already spread to another part of your body, using surgery just to remove the tumour in your mouth or oropharynx will not cure it. But surgery may still help to control your symptoms and disease. For example, if your tumour is large and beginning to block your airway, your doctor may recommend surgery to remove all or part of the tumour to make your breathing easier. They may also suggest the following treatments.
Surgery combined with radiotherapy Chemotherapy alone or with radiotherapy (chemoradiation) or biological therapy

Treatments that are still in development may be an option for you. This will mean taking part in aclinical trial. There is information about new treatments in the section about mouth and oropharyngeal cancer research. If your cancer has spread your doctor is likely to refer you to a palliative care team. Palliative care is treatment aimed at improving your symptoms and making life easier for you. Some people feel very upset when their doctor suggests this. They assume that it must mean that their doctors cant do any more for them, but this isnt the case. Palliative care involves helping to
Control any symptoms such as pain, sickness or breathing problems Support you with your diet and physical care Rehabilitate you you may just need some time to get your strength back before going

home from hospital Palliative care also includes looking after people in the terminal stages of their illness.

Treatment by stage for mouth cancer

This page describes the treatment for particular stages of cancer of the mouth and oropharynx. You can read about

A quick guide to what's on this page About the information on this page Treating stage 0 mouth cancers (CIS) Treating stage 1 and 2 mouth cancers Treating stage 3 and 4 mouth cancers Treating advanced mouth cancer that is unlikely to get better (palliative treatment)

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About the information on this page

Because saying mouth and oropharyngeal cancer is a bit long, we've tended to just say mouth cancer in the text on this page. Stage means the size of the cancer and whether it has spread into surrounding tissues or to other parts of the body.
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Treating stage 0 mouth cancers (CIS)

Stage 0 is really a precancerous stage. Doctors call this carcinoma in situ or CIS. There are cancer cells but they are all contained within the lining of the mouth or oropharynx. If the precancerous cells are not treated, there is a high chance of the cells developing into a cancer that could then spread into surrounding tissues. If the affected area is very small, your doctor may completely remove it during a biopsy. Or you may need to have minor surgery. Your doctor will remove the cancer cells by taking a thin layer of tissue from the affected area. Most people who have this stage of mouth cancer will never need major surgery. If you have this early stage mouth or oropharyngeal cancer your dentist or doctor will keep a very close eye on you after treatment. If the precancerous cells come back, your doctor may suggest a course of radiotherapy. If you smoke and continue to do so, it is much more likely that you will develop cancerous cells again in the future.
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Treating stage 1 and 2 mouth cancers

The treatment for early stage mouth and oropharyngeal cancers depends on which part of your mouth or oropharynx your cancer is in. It also depends on the likely side effects of treatment in that area. Your doctors may recommend surgery or radiotherapy or surgery followed by radiotherapy. Sometimes chemotherapy is given alongside the radiotherapy and this is called chemoradiation. Your doctors will take several things into account when deciding which treatment is best for you. For example, surgery to some parts of the mouth or oropharynx may cause speech changes and affect your ability to swallow. Radiotherapy may cause long term side effects such as a dry mouth. If you have radiotherapy you may need to go to the hospital every weekday for treatment lasting several weeks. This may not be easy for some people and you and your doctor may then consider surgery a better option in your particular case.
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Treating stage 3 and 4 mouth cancers

If you have stage 3 or 4 mouth cancer your doctor may recommend one of the following treatments
Surgery to remove the cancer followed by radiotherapy Radiotherapy alone or combined with biological therapy Chemotherapy combined with radiotherapy (chemoradiation) Surgery, radiotherapy and chemotherapy

If you have surgery it will usually include removing some of the lymph nodes in the neck during an operation called a neck dissection. This is because there is a high risk that the cancer has spread to the lymph nodes. If the cancer has spread into the nodes, you will usually also have radiotherapy to the neck after your surgery. This is to try and kill off any remaining cancer cells. Researchers and doctors are looking into giving chemotherapy, radiotherapy or both of these before surgery. Doctors call this neoadjuvant therapy. The aim is to shrink the tumour before you have your surgery. The idea is that you will then be able to have a smaller operation and so the after effects of the operation will be less severe. If your cancer is too big or cannot be removed using surgery you are most likely to have radiotherapy. Your doctors may recommend chemotherapy or biological therapy alongside the radiotherapy. Researchers are developing more drugs for these types of cancer. So you may have new chemotherapy drugs or biological therapies as part of a clinical trial. There are different ways of giving radiotherapy to people with stage 3 and 4 cancers. You can haveinternal radiotherapy or external radiotherapy depending on the part of the body involved.
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Treating advanced mouth cancer that is unlikely to get better (palliative treatment)
Palliative treatment aims to control symptoms caused by a disease. The treatment won't cure your cancer but it may slow its growth or shrink it for a while. For example, if your mouth or oropharyngeal tumour is large and beginning to block your airway, your doctor may recommend surgery to remove all or part of the tumour to make breathing easier. They may also suggest
Surgery combined with radiotherapy Chemotherapy alone or with radiotherapy (chemoradiation)

Treatments that are still in development may be another option for you. This will mean taking part in aclinical trial. There is information about new treatments under development in the section about mouth and oropharyngeal cancer research. If your cancer has spread, your doctor is also likely to refer you to a palliative care team to help control your symptoms and support you.

Chemoradiation for mouth and oropharyngeal cancer

This page tells you about the combination treatment of chemotherapy and radiotherapy for cancer of the mouth or oropharynx. You can find the following information
A quick guide to whats on this page Combination treatment Side effects of combination treatment Getting more information

A quick guide to whats on this page

Chemoradiation for mouth and oropharyngeal cancer Doctors may use a combination of chemotherapy and radiotherapy to treat oropharyngealcancers. Combining chemotherapy and radiotherapy is called chemoradiation. This treatment may be used for very small mouth cancers but this is rare as surgery is more often used. Chemoradiation treatment is a way to try to increase the effects of the radiotherapy. It can be quite a tough treatment to get through. You will need to have some tests to see if you are fit enough to cope with it. Your exact treatment plan will depend on what your doctor thinks is best for you. The most common treatment uses the drug cisplatin. You have it during the radiotherapy course, usually every 3 or 4 weeks, or sometimes weekly. Usually you have radiotherapy every day, from Monday to Friday, for

about 7 weeks. If there are still signs of cancer after the chemotherapy treatment, you will have surgery to remove it. Side effects of chemoradiation The side effects of chemoradiation will be the same as those with radiotherapy and chemotherapy. But having both treatments, at the same time, means the side effects can be more severe. You may get very tired, and have a very sore mouth. If your mouth is very sore, it is important to tell your doctor or nurse, so that you can have the right painkillers. For some people, the mouth is so sore that it is difficult to swallow. If this happens to you, you are likely to need to have liquid food through a tube into your stomach or bloodstream so that you can get enough liquid and calories. It is important that you do not get an infection in your mouth. Your nurse will explain what you need to do to keep your mouth clean and avoid an infection.

You can view and print the quick guides for all the pages in the treating mouth cancer section.

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Combination treatment
Having chemotherapy and radiotherapy at the same time is called chemoradiation or synchronous therapy. Researchers have found that chemoradiation works better than radiotherapy alone for people whose oropharyngeal cancer has grown beyond the place where it first started. It may also be used instead of surgery for small mouth cancers but this is not common. Some chemotherapy drugs help to make the cells more sensitive to the radiotherapy. The most common drug used is cisplatin. You have it during the radiotherapy course, usually every 3 or 4 weeks, or sometimes weekly. Chemoradiation can be quite tough treatment to get through. You will need to have some tests to see if you are fit enough to cope with it. Your exact treatment plan will depend on what your doctor thinks is best for you. The radiotherapy course usually lasts about 7 weeks. Although it is usual to avoid delay, occasionally you may need to stop the treatment for a short time because of the side effects. But treatment can usually start again after a few days rest. Research has found that a short delay doesnt affect how well the treatment works.

If there are still signs of cancer after the chemotherapy treatment, you will have surgery to remove it. If the cancer comes back in the future, you may be able to have surgery to remove it then. Some other drugs are being researched in combination with radiotherapy and you may have them as part of clinical trials.
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Side effects of combination treatment

It is likely that you will have some side effects from your treatment. These are the same as those described in the radiotherapy and chemotherapy sections. But when you have both treatments together some of the side effects can be more severe. In particular, you are likely to get a very sore mouth and throat. For some people, the mouth is so sore that they have a lot of difficulty swallowing. If this happens to you, you are likely to need afeeding tube so that you can get enough liquid and calories. You will also have painkillers. If needed, you can have a strong painkiller, such as morphine, to help make your mouth more comfortable. When you have a very sore mouth and throat, it is important that you are very careful about infection. Try to keep your mouth clean and follow the advice of your nurse and dentist. Contact the hospital at the first sign of infection, particularly a high temperature with chills, a sore chest, or a cough. It is likely that you will need to go to the hospital and have antibiotics through a drip.
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Getting more information

We have more information on this website about radiotherapy and chemotherapy treatments. You can ask your doctor or specialist nurse for written information. You can also phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. Our mouth cancer organisations page has details of people who can give information about chemoradiation. Some organisations can put you in touch with a cancer support group. Our mouth cancer reading list has information about books and leaflets about mouth cancer treatments. If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or you can go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.

Combination treatment

Having chemotherapy and radiotherapy at the same time is called chemoradiation or synchronous therapy. Researchers have found that chemoradiation works better than radiotherapy alone for people whose oropharyngeal cancer has grown beyond the place where it first started. It may also be used instead of surgery for small mouth cancers but this is not common. Some chemotherapy drugs help to make the cells more sensitive to the radiotherapy. The most common drug used is cisplatin. You have it during the radiotherapy course, usually every 3 or 4 weeks, or sometimes weekly. Chemoradiation can be quite tough treatment to get through. You will need to have some tests to see if you are fit enough to cope with it. Your exact treatment plan will depend on what your doctor thinks is best for you. The radiotherapy course usually lasts about 7 weeks. Although it is usual to avoid delay, occasionally you may need to stop the treatment for a short time because of the side effects. But treatment can usually start again after a few days rest. Research has found that a short delay doesnt affect how well the treatment works. If there are still signs of cancer after the chemotherapy treatment, you will have surgery to remove it. If the cancer comes back in the future, you may be able to have surgery to remove it then. Some other drugs are being researched in combination with radiotherapy and you may have them as part of clinical trials.
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Side effects of combination treatment

It is likely that you will have some side effects from your treatment. These are the same as those described in the radiotherapy and chemotherapy sections. But when you have both treatments together some of the side effects can be more severe. In particular, you are likely to get a very sore mouth and throat. For some people, the mouth is so sore that they have a lot of difficulty swallowing. If this happens to you, you are likely to need afeeding tube so that you can get enough liquid and calories. You will also have painkillers. If needed, you can have a strong painkiller, such as morphine, to help make your mouth more comfortable. When you have a very sore mouth and throat, it is important that you are very careful about infection. Try to keep your mouth clean and follow the advice of your nurse and dentist. Contact the hospital at the first sign of infection, particularly a high temperature with chills, a sore chest, or a cough. It is likely that you will need to go to the hospital and have antibiotics through a drip.
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Getting more information

We have more information on this website about radiotherapy and chemotherapy treatments. You can ask your doctor or specialist nurse for written information. You can also phone the Cancer Research UK nurses on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday. Our mouth cancer organisations page has details of people who can give information about chemoradiation. Some organisations can put you in touch with a cancer support group. Our mouth cancer reading list has information about books and leaflets about mouth cancer treatments. If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or you can go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.

Biological therapy for mouth cancer

This page is about biological therapies for mouth and oropharyngeal cancer. There is information about

A quick guide to what's on this page What biological therapy is Cetuximab (Erbitux) Other biological therapies Side effects of biological therapies More information about biological therapy

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What biological therapy is

Biological therapies are treatments that act on processes in cells. They can control or destroy cancer cells.
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Cetuximab (Erbitux)
Cetuximab (Erbitux) is a type of biological therapy known as a monoclonal antibody. It is designed to block areas on the surface of cancer cells that can trigger growth. These are called epidermal growth factor receptors (EGFR). Blocking these receptors can stop the signals that tell the cancer to grow. Trials have shown that cetuximab combined with radiotherapy can help people with locally advanced head and neck cancer to live longer than radiotherapy on its own. The National Institute for Health and Clinical Excellence (NICE) and the Scottish Medicines Consortium (SMC) have approved the use of cetuximab, with radiotherapy, for locally advanced squamous cell head and neck cancer. They have approved it for people when platinum based chemotherapy (such as cisplatin or carboplatin) is not working, or cannot be used. Locally advanced cancer means cancer that has spread into the areas close to the mouth or oropharynx. But the cancer has not spread to other areas of the body such as the bone or distant lymph nodes. Cetuximab is also used in combination with platinum based chemotherapy. It is for people with squamous cell head and neck cancer that has come back or has spread. The decision to approve cetuximab in this situation was based on the results of a large international trial called EXTREME. The trial compared cetuximab and chemotherapy to chemotherapy alone. Patients on this trial hadn't been treated before with chemotherapy. The results suggested that adding cetuximab to chemotherapy helped people to live between 2 and 3 months longer than if they just had chemotherapy on its own. But the SMC in Scotland and NICE in England decided not to recommend cetuximab for this group of patients on the NHS because it is not cost effective, so it is not widely used.
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Other biological therapies

Newer biological therapies are being used in trials for head and neck cancer, including mouth and oropharyngeal cancer. The therapies include gefitinib (Iressa), zalutumumab, everolimus (Afinitor),erlotinib (Tarceva), gene therapy and vaccine therapies. You can find information about these on themouth and oropharyngeal cancer research page.
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Side effects of biological therapies

The side effects depend on which biological therapy you have but may include
Tiredness (fatigue) and weakness Diarrhoea

 Skin changes (rashes or discolouration) rashes may be severe for some people A sore mouth Loss of appetite Low blood counts Swelling of parts of the body, due to fluid build up

Tell your doctor or nurse if you have any of these effects. You can have medicines to help to control them.
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More information about biological therapy

Look at the main biological therapy section for detailed information. You can ask your doctor or specialist nurse to write down the names of the drugs you will have. You can then look them up in ourspecific cancer drug section. There are pages there for all the most commonly used biological therapy drugs. Each page has information about the side effects of that drug. You can phone the Cancer Research UK nurses on freephone 0808 800 4040. The lines are open from 9am to 5pm, Monday to Friday. Our mouth and oropharyngeal cancer organisations page gives details of other people who can give you information about biological therapies. Some organisations can put you in touch with a cancer support group. Our mouth and oropharyngeal cancer reading listhas information about books and leaflets on cancer treatments. If you want to find people to share experiences with online, you could use CancerChat, our online forum. Or you can go through My Wavelength. This is a free service that aims to put people with similar medical conditions in touch with each other.

Definite risks for mouth and oropharyngeal cancer

This page is about the factors that are known to play a part in causing mouth and oropharyngeal cancers. There is information below about
A quick guide to what's on this page How common mouth cancer is Smoking and alcohol Chewing tobacco or betel quid Diet

 Human papilloma virus (HPV) Low immunity Sunlight and sunbeds Previous cancer Family history Mouth conditions Genetic conditions

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How common mouth cancer is

Cancers of the mouth and oropharynx are relatively rare. Including cancers of the lip, tongue, mouth and oropharynx, there are about 6,500 people diagnosed in the UK each year. Overall, about 2 out of every 100 cancers diagnosed (2%) are mouth or oropharynx cancers. As with most cancers, mouth and oropharyngeal cancers are more common in older people. There are few cases in people under 50 but the number of young and middle aged people developing them is increasing. They are twice as common in men than in women. But rates of these cancers in women have been increasing in recent years. This is because women took up smoking in large numbers much later than men and we are now seeing the delayed effects of that.
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Smoking and alcohol

Smoking tobacco (cigarettes, cigars and pipes) and drinking a lot of alcohol are the main risk factors for mouth and oropharyngeal cancers in the western world. If you smoke you are at a higher than average risk of developing these types of cancers. A study in 2011 estimated that more than half of mouth and throat cancers in the UK are caused by smoking. Pipe smokers or people who hold the cigarette for a long time on the lip have an increased risk of cancer of the lip. People exposed to secondhand smoke at home or in the workplace have a small increase in their risk of mouth or oropharyngeal cancer. Smokeless tobacco can also increase cancer risk and may not be a safe alternative to cigarettes. The amount of risk varies according to the type of smokeless tobacco used in different countries. In the UK and Europe (except for Sweden) smokeless tobacco is rarely used except in minority ethnic groups.

Drinking alcohol increases the risk of oropharyngeal cancer and may increase mouth cancer risk when combined with smoking. A large Cancer Research UK study looking at lifestyle factors that cause cancer found that about a third of cancers of the mouth and throat (30%) were caused by drinking alcohol. Current guidelines in the UK suggest that people should drink no more than 21 units of alcohol per week for men, and 14 units per week for women. Cigarettes and alcohol contain nitrosamines and other chemicals that are known to cause cancer. The nitrosamines in alcohol pass over the mouth, throat and top of the larynx (the epiglottis) as you swallow. When you smoke, the smoke passes through your mouth, throat and the larynx on its way to your lungs. Your risk increases the longer you smoke. Remember that if you smoke, you are much more likely to develop cancer of the mouth or oropharynx. If you smoke and regularly drink more than the recommended amounts your risk is especially high. Cancers of the mouth or oropharynx do sometimes occur in people who have never smoked or drunk much but this is rare. There is more about cancer risk and smoking and about cancer risk and alcohol on our News and Resources website.
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Chewing tobacco or betel quid

Chewing tobacco or betel quid (gutkha) is known to cause mouth cancer and oropharyngeal cancer. It is very common in parts of Asia. It is also popular in some immigrant groups in Europe, North America and Australia. The term quid means a substance or mixture of substances put in the mouth and chewed, usually for long periods. It usually contains tobacco, either on its own or mixed with areca nut (from the Areca catechu tree) and slaked lime and sometimes spices. You wrap the mixture in a leaf called a betel leaf, which is where the name betel quid (also called paan) comes from. The harmful substances in tobacco and betel quid can cause cancer if they are in contact with your gums and tongue over long periods. Chewing betel quid without tobacco increases the risk of mouth cancer but chewing mixtures containing tobacco increases the risk even more. People chew tobacco and betel quid for many reasons. It can make you feel good, prevent hunger and sweeten your breath. But more important is that it is a cultural and social habit in many parts of Asia. Mouth cancer is much more common in parts of the world where people chew betel quid. Of the estimated 400,000 cases of oral cancer worldwide each year, around two thirds occur in developing countries. In some parts of India, it is the most common type of cancer.

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Diet
A poor diet may increase your risk of certain types of mouth and oropharyngeal cancer. This may be due to a lack of zinc, or other vitamins and minerals. If you eat a well balanced diet, with plenty of protein, you are unlikely to be short of zinc. A diet high in fresh fruit and vegetables seems to reduce the risk of developing cancer of the mouth. This may be because these foods contain a lot of antioxidant vitamins and other substances that help prevent damage to body cells. Vitamin A deficiency increases your risk of developing cancer of the mouth and oropharynx. Poor eating patterns are common in people who drink a lot of alcohol. Poor diet in people who drink heavily may help to explain why alcohol increases the risk of some cancers.
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Human papilloma virus (HPV)

Viruses can help to cause some cancers. But this doesn't mean that you can catch these cancers like an infection. The virus can cause genetic changes in cells that make them more likely to become cancerous in the future. Mouth and oropharyngeal cancers have been linked to the human papilloma virus (HPV), especially type 16. There are more than 100 different types of (HPV). Some types are called the wart virus, because they cause warts on the genital area or skin. Other types of HPV are known to increase the risk of some types of cancer. These include cancer of the cervix, vaginal cancer, vulval cancer andanal cancer. HPV can be passed on during sexual contact. Most sexually active adults will be infected with at least one type of HPV at some time during their life. For many people, the virus causes no harm and goes away without treatment. Only a very small percentage of people with HPV develop oropharyngeal cancer. HPV infection of the mouth is more common in men than in women. The risk of HPV infection in the mouth and throat is linked to certain sexual behaviours, such as open mouth kissing and oral sex. The risk increases with the number of sexual partners a person has. Smoking also increases the risk of HPV infection in the mouth.
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Low immunity
Research has found that people have an increased risk of mouth cancer if they have a reduced immunity due to HIV or AIDS. Taking medicines to suppress immunity after organ transplants also gives a higher risk of mouth cancer than in the general population.
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Sunlight and sunbeds

Skin cancers are relatively common on the face and neck, as these areas are often exposed toultraviolet light (UV). Both the sun and tanning beds give off UV rays. These rays can cause skin cancers in unprotected skin. Some studies have shown an increase of skin cancer in people who regularly use sunbeds. Melanoma is the most serious type of skin cancer and can occur on the lip. More than 30 out of every 100 people (30%) diagnosed with cancer of the lip work outdoors and have been exposed to the sun for long periods.
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Previous cancer
People who have had mouth or oropharyngeal cancer have an increased risk of getting a second one. Women have a higher risk of a second oral cancer than men. People who have had some other types of cancer also have an increased risk of mouth cancer. These include
Cancer of the food pipe (oesophagus) Squamous cell skin cancer Cervical, anal or genital cancer in women Cancer of the back passage (rectum) in men
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Family history
People often worry that they are at a higher risk of cancer because someone in their family has it. There does seem to be a slightly higher risk of getting mouth cancer if you have a close relative (a parent, brother, sister or child) who has had mouth cancer. We don't know the reason for this.
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Mouth conditions
Sometimes changes can happen in the cells of the lining of the mouth and they cause red or white patches to appear. These changes are called leukoplakia and erythroplakia. In some people these changes may develop into cancer over some years. Dentists can see these changes during dental checks so it is important to have regular dental appointments to find these changes early.
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Genetic conditions
People with certain syndromes caused by inherited changes (mutations) in particular genes have a high risk of mouth and throat cancer. These include
Fanconi anaemia a genetic disorder that can affect children and adults from any ethnic

background. It is also called Fanconi's syndrome. People with Fanconi anaemia are short, have bone changes, and are at risk of developing cancers, leukaemia, and bone marrow failure (aplastic anemia) Dyskeratosis congenita a genetic syndrome that can cause aplastic anaemia, skin rashes, and abnormally shaped fingernails and toenails. People with this syndrome have a high risk of developing cancer of the mouth and throat when they are young