Cancer of the Mouth Explained
Introduction This leaflet tells you about the condition known as cancer of the mouth, or oral cancer. We hope it will answer some of the questions that you or those who care for you may have. It is not meant to replace the discussion between you and your consultant, but helps you to understand more about what is discussed.
What is cancer? There are many different kinds of cancer. They all behave differently, and are treated in many different ways. Cancers are ‘malignant tumours’; which means that they grow uncontrolled and invade our normal body structures. They sometimes spread to other parts of the body too as ‘metastases’ or ‘secondary tumours’. What is cancer of the mouth? The vast majority of mouth cancers are called ‘Squamous Cell Carcinomas’ and arise from the microscopic cells lining the mouth. Mouth cancer can occur anywhere in the mouth from the lips to the part of the throat you can see behind your tongue. The tongue and the floor (bottom) of the mouth are most commonly affected in the U.K., but it can occur anywhere in the mouth and can also involve the jaw bones. What causes cancer of the mouth? Cancer of the mouth is the sixth commonest cancer in the U.K., it is much more common in some other countries such as Pakistan, Bangladesh and some parts of India. It is most common in men and the elderly, but now increasingly affects women and younger people. We do not know all the causes of mouth cancer, but smoking, alcohol, and chewing paan or tobacco are known common causes. Lip cancer is also associated with prolonged sun exposure. What are the signs that a cancer is developing? The first sign of a mouth cancer is usually an ulcer or lump, whether painful or not, which does not heal within a few weeks. As it grows it may cause difficulty in chewing, swallowing or some slurring of speech, depending on where it is. Sometimes, it may not be noticed at all and may be discovered during a dental examination for 1
instance. Sometimes the lymph nodes (also called glands) in the neck can also become enlarged. These lymph nodes are a part of the body’s natural defence against infection. If you have enlarged nodes in your neck it may just be due to inflammation, but might also suggest that cancer cells may have spread into these nodes as well, and this may influence what treatment is suggested to you. What tests or investigations might I need to have? If you have been referred to us because of a suspected cancer, certain tests or investigations will be necessary to arrive at a firm diagnosis. Most commonly, a biopsy will need to be performed, when a small piece of the suspected cancer is removed and sent for examination under the microscope (you may well have already had this done) to confirm the diagnosis. Often, other tests or investigations may be required, and will be explained to you. These may include: • CT (Computerised Tomography) scan – a high definition three dimensional scan using x-rays. • MRI (Magnetic Resonance Imaging) scan – a three dimensional scan that uses radio waves. • PET (Positron Emission Tomography) scan – sometimes useful to locate a hidden cancer. • Fine needle aspiration – just like an injection, but used to remove a tiny amount of fluid, usually from a neck lump, for microscopic examination to discover whether cancer cells are present. Tests to assess your fitness for treatment such as blood tests, a chest X-ray and a heart monitoring also known as electrocardiogram (ECG) may also be carried out. More information about these investigations can be found in the leaflet ‘Head and Neck Investigation Explained’ which you should already have received. However, if you need a copy please ask your nurse who will be happy to provide one. What are tumour staging and grading? All the investigations you may have will tell us at what stage and grade your cancer is. This will help us decide on the most appropriate treatment to suggest for you. 2
• The tumour stage is an indication of how advanced it is. This stage is given a number, with stage 1 being the least advanced and stage 4 the most advanced. This number is calculated from the size of the cancer, whether it has spread into adjacent tissues, whether it is thought to have spread already to the local lymph nodes, or by the bloodstream to distant organs such as the lungs. • The tumour grade is a term used to describe how the cancer cells look under a microscope which gives the doctors an idea of how quickly your cancer may develop. If you want to know more about mouth cancer staging and grading, please ask your consultant. What happens after my diagnosis? When a diagnosis of mouth cancer is made, and after all the initial investigations have been performed, each individual case is discussed at a multi-disciplinary team (MDT) meeting to consider which treatment(s) may be the best option. The members of the team may consist of: • • • • • • • • • •
Maxillofacial surgeons ENT surgeons Consultant oncologists (cancer specialists) Consultant radiologists (doctors who interpret X-rays and scans) Consultant pathologists (doctors who examine tissues under a microscope to assist diagnosis) Consultant restorative dentists Head and neck nurse specialists in cancer Speech and language therapists Dieticians Head and neck counsellors.
Following the MDT meeting your consultant surgeon and other members of your care team will meet with you and discuss the results of your investigations and the treatment options that should be considered in your case. Your consultant will also answer any questions you have on the benefits and risks of these treatments.
Every person diagnosed with cancer is very different and a number of factors will influence which treatment is appropriate for you. These include the type and size of the tumour, whether it has spread to other local or distant areas, your age and your general health. These factors as well as your lifestyle will also influence how effective your treatment will be in dealing with your cancer and will be discussed with you by your consultant. Once a treatment plan has been agreed with you, you should be able to start your treatment within 31 days. What treatments are available? Surgery, radiotherapy and chemotherapy are the three main options for treatment. They can be given alone as a treatment or a combination can be used to treat the cancer. Your care team is there to provide you with the important information you need to make an informed decision about your treatment options. The diagnosis of cancer nearly always brings with it worry, fear and anxiety, and unforeseen practical problems. The team will also be keen to help you with these. Although it is essential that you are given certain information to enable you to make your decisions, we respect your right to receive as much or as little information about your illness and treatment as you wish. We all find that we forget things very easily when we are anxious, so it is useful to write down any medication that you are on and bring the list to your clinic appointments. When you think of a question you want to ask, write that down too, so you will remember to ask your consultant or nurse. It often helps to bring someone else with you to your clinic appointments, so please feel free to do so.
Local support groups Please visit on our website for details of local support groups: http://www.birminghamcancer.nhs.uk/
Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: 0121 424 2280 Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: 0121 424 9486 Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: 0121 507 3792 Fax: 0121 507 3816 University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: 0121 697 8417 NHS Walsall Community Health Cancer and Palliative Care Services Walsall Palliative Care Centre Goscote Lane Goscote Walsall WS3 1SJ Freephone: 0800 783 9050 5
About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: http://www.birminghamcancer.nhs.uk/ This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of Macmillan in producing this information. © Pan Birmingham Cancer Network 2010 Publication Date: November 2010 Review Date: November 2013