Oral Cancer
A comprehensive patient guide — symptoms, causes, staging, and treatment options explained in plain language.
What is Oral Cancer?
Oral cancer refers to malignant tumours arising anywhere in the oral cavity — the lips, tongue, cheeks (buccal mucosa), floor of the mouth, hard palate, and gums. The vast majority are squamous cell carcinomas, arising from the lining cells of the mouth.
India has one of the highest rates of oral cancer in the world, accounting for approximately 30% of all cancers in men. This is largely driven by tobacco and betel nut use, which remain widespread. Despite this burden, oral cancer is one of the most preventable and treatable cancers when caught early — five-year survival rates exceed 80% at Stage I.
Any sore, ulcer, or unusual change in your mouth that has not healed after 3 weeks requires specialist evaluation. Do not wait and see — early assessment is always better.
Warning Signs
These symptoms should prompt you to seek specialist evaluation, particularly if present for more than 3 weeks:
Non-healing mouth ulcer
A sore that doesn't heal in 3 weeks — the most common early sign.
White patch (leukoplakia)
A white patch that can't be wiped off — up to 17% are pre-malignant.
Red patch (erythroplakia)
Red or mixed patches — more likely to be malignant than white patches.
⚠️ Neck lump
A painless neck lump — often first sign of lymph node spread.
Difficulty swallowing
Progressive difficulty chewing, opening the mouth, or swallowing.
Loose tooth
Unexplained loosening of a tooth — may indicate jaw bone involvement.
Risk Factors
Smokeless tobacco (gutkha, pan masala, khaini) — the most significant risk factor in India, causing direct mucosal damage and oral submucous fibrosis.
Betel nut (areca nut) — an independent risk factor even without tobacco, causing submucous fibrosis with a 7–13% malignant transformation rate.
Smoking — dose-dependent risk. Bidis carry similar risk to cigarettes.
Alcohol — synergistic with tobacco. Combined use multiplies risk significantly.
Chronic dental trauma — sharp teeth, broken dental restorations, or ill-fitting dentures causing persistent irritation to the oral mucosa over years are an underrecognised risk factor, particularly for tongue and cheek cancers.
Immunosuppression and HIV — patients on long-term immunosuppressive therapy or living with HIV have a significantly elevated risk of oral malignancy and require regular oral surveillance.
Chronic oral infections — persistent fungal infections (oral candidiasis) and chronic inflammatory conditions of the oral mucosa may contribute to malignant transformation, particularly in immunocompromised patients.
Stages of Oral Cancer
Stage I — Tumour ≤2cm, no nodes
Surgery alone. 5-year survival >85%. Short hospital stay, minimal reconstruction.
Stage II — Tumour 2–4cm, no nodes
Surgery ± radiation. 5-year survival ~75%. May require reconstruction.
Stage III — Larger tumour or one node
Surgery + radiation ± chemotherapy. 5-year survival ~55%. Complex reconstruction often needed.
Stage IV — Advanced disease
Combined treatment. Survival varies. Specialist centre essential for best outcomes.
Treatment
Most oral cancers are treated with surgery as the primary treatment, often followed by radiation or chemoradiation depending on pathological findings.
For tumours involving the jawbone, jaw resection and immediate fibula free-flap reconstruction is performed — restoring facial contour and function in the same operation. This is known as jaw-in-a-day surgery.
Neck dissection — removal of lymph nodes — is performed alongside tumour removal to address regional disease.
For detailed information about oral cancer surgery and reconstruction, visit drnarayana.in/oral-cancer-surgery
Dr. Narayana Subramaniam
Concerned about a symptom? Dr. Narayana sees patients within 48–72 hours. WhatsApp your reports for a preliminary opinion within 4 hours.
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