Oral Cancer: What it is, Causes, Treatment & More

What is Oral Cancer?

Oral cancer, or mouth cancer, develops when abnormal cells grow in any part of the mouth uncontrollably. This is a head and neck cancer that can affect the lips, gums, tongue, inner cheeks, the inside of the mouth, and even the back of the throat, including the tonsils.

Oral cancer is generally classified into four stages based on the size of the tumour, how deep it has grown, and whether it has spread.

• Stage 1: The cancer is small, typically smaller than 2 cm and not deeper than 5 mm. It has not spread to surrounding tissue, lymph nodes, or other organs.

• Stage 2: At this stage, the tumour is up to 4 cm large, or it is small but deeper than 5 mm. But there is still no spread.

• Stage 3: The tumour is bigger than 4 cm in this phase. In some cases, the cancer spreads to a lymph node on the same side of the neck.

• Stage 4: The cancer is at this stage when it has spread to nearby areas such as the jawbone, facial skin, sinuses, or tongue. The tumour size does not matter. At this stage, the cancer has usually spread widely throughout the head and neck but may not have spread to other parts of the body.

What are the Types of Oral Cancer?

Oral cancer is classified based on the specific type of cell in which it originates. Here are the main types:

How Common is Oral Cancer in India?

Oral cancer is one of the most prevalent types of cancers in India, with around 19 cases per 1,00,000 people. Oral squamous cell carcinoma accounts for just 3% of cases in the United States, but a staggering 30% in India. The country records more than 1 lakh new cases of oral cancer every year, and the condition is now the most common cancer among men and the third most common among women. In India, these cases account for 13-16% of all cancer cases nationwide. India also recorded the highest annual increase in oral cancer cases among men, rising by approximately 1.20% each year.

The primary driver behind this crisis is tobacco. As much as 95% of all oral cancers in India are linked to tobacco use, whether through smoking cigarettes and bidis or using smokeless products like gutka, khaini, and chewing tobacco. States like Maharashtra, Tamil Nadu, and Uttar Pradesh have the highest prevalence of oral cancers. Despite these alarming numbers, doctors continue to report a troubling pattern of late diagnosis, underscoring just how urgently India needs stronger awareness campaigns and early detection efforts.

What are the Symptoms of Oral Cancer?

Mouth cancer can affect the lips, gums, tongue, and inner cheeks, or any other part of the mouth. Its symptoms can vary depending on where it develops.

Here are some of the most common signs to watch out for:

• A mouth ulcer or sore that lasts for more than three weeks without healing.

• Red or white patches inside the mouth or on the tongue.

• A lump or growth inside the mouth or on the lip.

• Persistent pain inside the mouth, jaw, or ear.

• Pain while chewing, swallowing, or speaking.

• A hoarse or croaky voice that does not resolve.

• Pain or discomfort while opening the mouth fully or moving the jaw.

• Loose teeth without an obvious dental cause.

• A lump or persistent swelling in the neck or throat.

• Swollen lymph nodes in the neck.

• Unexplained and unintentional weight loss.

• Noticeable changes in taste sensation.

• Increased difficulty tolerating spicy foods.

• Excessive salivation.

What Causes Oral Cancer?

The cause of oral cancer is not known. At its core, it begins with changes in the DNA of cells in the lips or mouth. The DNA has the instructions that tell cells how to grow, multiply, and eventually die. In healthy cells, this process follows a controlled cycle. In cancer cells, however, the altered DNA causes cells to grow and multiply uncontrollably, and instead of dying off as they normally would, these abnormal cells continue to accumulate.

Over time, they can form a mass known as a tumour, which may grow into and damage surrounding healthy tissue. In more advanced stages, cancer cells can break away from the original site and spread to other parts of the body, a process known as metastasis.

Risk Factors of Oral Cancer

The exact cause of oral cancer may not be known, but scientists have discovered several factors that increase the chances of getting oral cancer. Here's a detailed overview:

• Tobacco Consumption: People who use tobacco are six times more likely to develop head and neck cancer, and approximately 75% of mouth and throat cancers occur among tobacco users.

• Drinking Alcohol: Regular and heavy alcohol use raises the risk considerably, and the risk increases even further when alcohol is combined with tobacco use.

• Poor Oral Hygiene: Studies have found that over 85% of oral cancer patients did not follow proper oral hygiene.

• Excessive Sun Exposure: Prolonged exposure to sunlight or tanning lamps, particularly on the lips, increases the risk of cancer developing in that area.

• HPV Infection: Human papillomavirus, a common virus transmitted through sexual contact, can sometimes cause cellular changes in the mouth that lead to cancer, even though it resolves without issue in most people.

• Weak Immune System: If the immune system of certain people has become weak due to illnesses such as HIV or medications taken after an organ transplant, they face a higher risk of developing oral cancer.

• Family History and Genetic Factors: A family history of oral cancer, along with certain genetic changes, may also make a person more susceptible to developing the condition.

• Previous Cancer Diagnosis: People who have battled with any type of cancer before have higher chances of developing oral cancer as well.

What are the Complications of Oral Cancer?

If left untreated, oral cancer can spread beyond its original site, invading nearby structures within the mouth and throat. Eventually, it can also extend to other areas of the head and neck. In more advanced stages, cancer cells can break away entirely and travel through the body, a process known as metastasis, allowing the disease to affect distant organs as well.

This progression not only makes the cancer significantly harder to treat but also increases the risk of complications affecting essential functions such as eating, speaking, and breathing, depending on which structures are involved.

When Should I See My Healthcare Provider?

Since early-stage oral cancer can closely resemble harmless mouth ulcers, it is always better to get any unusual or persistent changes checked promptly rather than waiting to see if they improve on their own.

It is important to consult a doctor or dentist if you notice any of the following signs:

• A mouth ulcer that has lasted more than three weeks.

• A lump in your mouth, lip, neck, or throat.

• A red or white patch inside your mouth that does not go away.

• Constant pain in the mouth.

• Difficulty swallowing or speaking.

• A hoarse voice that does not resolve over time.

How is Oral Cancer Diagnosed?

Diagnosing oral cancer usually involves a physical examination, specialised tests, and imaging to confirm a diagnosis and understand its extent.

How is Oral Cancer Treated?

The treatment for mouth cancer is decided based on its stage, location, the age of the patient, and whether the cancer has spread. Here are the treatment options:

• Surgery: The doctors can remove the tumour via surgery. In some cases, the surrounding tissue is also removed to reduce the chances of recurrence. If a large portion of the jaw or tongue is removed, reconstructive surgery using tissue from another part of the body may be needed to restore the mouth's normal shape and function.

• Radiotherapy: This treatment destroys cancer cells. If the cancer is at an early stage, this treatment alone may be sufficient. Doctors also use this therapy after surgery to eliminate any remaining cancer cells.

• Chemotherapy: This treatment uses powerful medicines to destroy cancer cells and is often administered after surgery to target any remaining cells. It can also help control the cancer if it has spread to other parts of the body.

• Immunotherapy: This therapy helps the body's own immune system recognise and destroy cancer cells.

• Targeted Therapy: Targeted medicines are designed to specifically attack cancer cells based on certain characteristics or genetic changes, helping to destroy them while minimising damage to healthy cells.

Can Oral Cancer be Prevented?

While there is no guaranteed way to completely prevent oral cancer, here are some things you can do to reduce the risk:

• Avoid Tobacco in All Forms: Tobacco continues to be one of the biggest risk factors. Avoiding it altogether or seeking support to quit can reduce risk, even for long-term users.

• Limit Alcohol Intake: Drinking in moderation lowers the risk of cancer. Avoiding both alcohol and tobacco will greatly reduce the risk of oral cancer.

• Protect Lips from Sun Exposure: Limiting time outdoors during peak sun hours, wearing a wide-brimmed hat, and using a lip balm or sunscreen with adequate SPF can help protect against UV-related damage that increases the risk of lip cancer.

• Get Vaccinated Against HPV: HPV infection is linked to a significant number of oral and throat cancers. Getting vaccinated against HPV, ideally at a younger age before becoming sexually active, can meaningfully reduce this risk.

• Eating Healthy: Eating more vegetables, fruits, and whole grains, rather than processed and red meats, supports overall health and can also lower cancer risk.

• Schedule Regular Dental and Medical Checkups: Routine dental visits allow for early detection of pre-cancerous changes such as leukoplakia or erythroplakia.

What is the Prognosis of Oral Cancer?

The outlook for oral cancer depends on several factors, including the stage of the tumour, whether it has spread to tissues around the affected area or other parts of the body, and the person's age and overall health. If it gets detected in the early stages, oral cancer is highly treatable, and timely treatment can increase the chances of recovery. If the cancer is diagnosed after it has spread extensively, treatment becomes more challenging and, in some cases, a complete cure may not be possible.

Even after successful treatment, regular follow-up visits are important. One in 3 patients treated for oral cancer may develop another oral cancer or a new cancer in the head and neck area later in life. Regular checkups help detect any recurrence or new cancer early.

Does Health Insurance Cover Oral Cancer?

Yes, health insurance policies cover the treatment of oral cancer. Most standard health insurance plans cover hospitalisation, surgery, prescribed medicines, diagnostic tests, ambulance charges, and eligible pre- and post-hospitalisation expenses.

You can also get critical illness insurance, which provides coverage for serious illnesses like cancer. These plans pay a lump-sum amount after the diagnosis, which you can use for treatment costs. Keep in mind that the coverage is subject to a waiting period of 90 to 180 days and a survival period of 7 to 30 days.

In addition, many insurers offer specialised cancer insurance plans specifically designed for cancer-related treatment and care. Depending on the insurer and policy terms, some of these plans may also provide coverage for pre-existing cancer after the specified waiting period has been completed.

To understand the exact scope of your health insurance policy, you must go through the policy documents carefully.

How Much Health Insurance is Required for Oral Cancer?

In general, it is advisable to have a health insurance cover of at least ₹10 lakh to ₹20 lakh to manage cancer treatment expenses. Oral cancer treatment can be expensive, particularly if it involves surgery, radiation therapy, chemotherapy, targeted therapy, prolonged hospitalisation, or long-term follow-up care.

A higher sum insured provides better financial protection, especially for the elderly, people with a family history of cancer, or those with other cancer-related risk factors.