السرطان الشفهي

Oral cancer is cancer of the mouth: the tongue, floor of the mouth, gums, inner cheeks, lips and hard palate. More than nine in ten are squamous cell carcinomas arising from the lining. Cancers of the tonsil and tongue base belong to the oropharynx and behave somewhat differently.

Found early, mouth cancer can often be treated with a single modality and with limited effect on speech and eating. Found late, it needs combined treatment and reconstruction. The practical message is that any mouth ulcer, lump or patch lasting more than three weeks should be examined, not watched.

Symptoms

• An ulcer that has not healed in three weeks
• A red, white or mixed red and white patch
• A lump or thickening in the mouth, lip or neck
• Persistent pain or soreness in one spot
• Unexplained bleeding or numbness
• A loose tooth or a socket that does not heal with no obvious reason
• Difficulty chewing, swallowing or moving the tongue
• Ear pain on one side with a normal ear

Causes and risk factors

Tobacco in any form and alcohol are the main causes, and together they multiply risk. Chewing areca (betel) nut or paan is a major cause in South Asian communities. Sun exposure causes lip cancer. Human papillomavirus type 16 drives many oropharyngeal cancers but few true oral ones. Other factors are age over 50, a weakened immune system, previous head and neck cancer and potentially malignant conditions such as leukoplakia, erythroplakia, oral lichen planus and submucous fibrosis.

How it is diagnosed

• Examination by a dentist, oral surgeon or ENT specialist: Inspection and palpation of the mouth and neck. Dentists detect many cases at routine check-ups.
• Biopsy: A small sample under local anaesthetic is the only way to confirm the diagnosis.
• MRI or CT of the head and neck: Shows depth of invasion, bone involvement and lymph nodes.
• Ultrasound with fine needle aspiration: Assesses suspicious neck nodes.
• CT of the chest or PET-CT: Checks for spread in more advanced disease.
• Endoscopy of the throat: Looks for a second tumour elsewhere in the airway or gullet.

Treatment options

• Surgery: The main treatment for most oral cancers: removal of the tumour with a margin of healthy tissue.
• Neck dissection or sentinel node biopsy: Removes or samples lymph nodes, because spread to the neck is common even when nothing is felt.
• Reconstruction: Tissue from the forearm, thigh or fibula, with microsurgery, rebuilds the tongue, floor of mouth or jaw.
• Radiotherapy: Used after surgery when risk features are found, or as primary treatment in selected cases. Typically daily for about 6 weeks.
• Chemoradiotherapy: Cisplatin given with radiotherapy for high-risk or inoperable disease.
• Immunotherapy: Pembrolizumab or nivolumab for recurrent or metastatic disease.
• Rehabilitation: Speech and swallowing therapy, dietetic support, dental restoration including implants, and help to stop smoking and drinking.

When it is urgent

Heavy bleeding from the mouth, difficulty breathing, rapidly increasing swelling of the tongue or neck, or being unable to swallow fluids need emergency care locally. These are not situations for arranging travel.

Travelling to Türkiye for treatment

Treatment should be decided by a multidisciplinary head and neck team and started without undue delay. A trip can realistically offer a second opinion with review of your biopsy and scans, or a planned operation with reconstruction, which needs roughly 3 to 4 weeks including recovery. Six weeks of daily radiotherapy far from home is demanding, and follow-up examinations every few months for five years need a team near you. Agree beforehand who provides each part.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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