Cancer is a serious and growing health problem globally; it is one of the leading causes of death after cardiovascular disease and COVID-19. Cancers can develop anywhere in the body; those affecting the head and neck area are one of the most prevalent cancers in developing countries, especially in Southeast Asia. Mouth cancer, also known as oral cancer, refers to cancer occurring in any part of the mouth, including the lips, gum, tongue, inner lining of the cheek, roof and floor of the mouth, and the back of the throat. In Thailand, just as in the rest of the world, the number of people diagnosed with mouth cancer continues to climb and is becoming increasingly prevalent in younger age groups.

According to published data from the National Cancer Institute of Thailand, approximately 4,440 new cases of mouth cancer are detected each year -- roughly 12 new cases a day with higher burdens in the Northeast of Thailand. This observation is likely linked to betel nut chewing. Moreover, males and older individuals (>45 years of age) are more commonly affected by mouth cancers. As is true for many cancers, major risk factors for mouth cancer are excessive tobacco and alcohol consumption, human papillomavirus (HPV) infection, and regular use of betel nut.

Despite significant advancements in cancer treatment modalities over the past decades, the prognosis of mouth cancer remains very poor; less than 50% of affected individuals survive more than five years after their diagnosis. This is because mouth cancer may go unnoticed during the early stages; the vast majority of mouth cancer are discovered in an advanced stage invading nearby tissues and structures or after metastasis to other sites become apparent. Hence, it is less likely to be cured. Even if it is curable, advanced-stage patients usually require more aggressive treatments. As they go through cancer treatment, many cancer patients experience several functional and aesthetic impairments such as restricted mouth opening, lack of saliva, speech, and swallowing impairment leading to deterioration in patients’ quality of life. Therefore, early detection of mouth cancer is crucial as treatments of early stages of mouth cancer could increase the chances of beating the disease and minimize the side effects of cancer treatments, especially for high-risk individuals.

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What are the signs and symptoms of mouth cancer?
Mouth cancer can present in several ways depending on stages and disease locations. People with mouth cancer frequently present with a non-healing ulcer or unexplained soreness/pain in the mouth that does not go away within two weeks. However, there are other “warning signs and symptoms” that might indicate the development of 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 bleed 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 feeling like something is stuck in the throat or a change of your voice (hoarseness)
• Difficulty moving the tongue or jaw

If you experience any of these symptoms for more than two weeks, it is worth having them checked by your dentist or doctor. Having any of these symptoms does not necessarily mean you have mouth cancer. Other health conditions can present with similar symptoms.

Is it necessary to screen for mouth cancer? And how often should we do it?
Early detection and treatment of mouth cancer can improve not just the long-term survival of patients but also reduce the intensity of cancer treatments. Mouth cancer, especially in its early stage, can be hard to detect as it is often painless with minimal changes to the lining of the patient’s mouth. Dentists can play a vital role in identifying early signs of mouth cancer as they are typically the first clinician who spots any suspicious changes during a routine dental examination. Systematic examination of the mouth as part of regular dental check-ups and oral cancer screening takes only minutes to perform. Therefore, you must visit the dentist regularly, at least twice a year, for professional teeth cleaning and oral cancer screening. 

“The earlier the cancer diagnosis, the higher the curative treatment outcome”

Article by
Dr Kununya Pimolbutr
Oral Medicine
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Dr Chakkapan Samphaiboon
Oral & Maxillofacial Surgery
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