Clinical Review ABC of oral health

Oral cancer

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7253.97 (Published 08 July 2000) Cite this as: BMJ 2000;321:97

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  1. Crispian Scully,
  2. Stephen Porter

    Most mouth cancer is oral squamous cell carcinoma. This is uncommon in the developed world, except in parts of France, but is common in the developing world, particularly South East Asia and Brazil. It is mainly seen in men over middle age (though it is increasing in younger people), tobacco users, and lower socioeconomic groups.

    Oral malignant neoplasms

    Common
    • Squamous cell carcinoma

    Uncommon
    • Malignant salivary gland tumours

    • Malignant melanoma

    • Lymphomas

    • Neoplasms of bone and connective tissue

    • Some odontogenic tumours

    • Maxillary antral carcinoma (or other neoplasms)

    • Metastatic neoplasms (from breast, lung, kidney, stomach, or liver cancer)

    • Langerhans' cell histiocytoses

    • Kaposi's sarcoma

    Aetiological factors (acting on a genetically susceptible individual) include tobacco use (75% of people with oral cancer smoke), betel use (Bidi leaf, and often tobacco, plus spices, slaked lime, and areca nut), alcohol consumption, a diet poor in fresh fruit and vegetables, infective agents (Candida, viruses), immune deficiency, and (in the case of lip carcinoma) exposure to sunlight.

    Carcinoma of tongue presenting as a lump

    Additional primary neoplasms may arise mainly in the aerodigestive tract. This occurs in up to 25% of people who have had oral cancer for over three years, and in up to 40% of those who continue to smoke. Similarly, patients with lung cancer are at risk from second primary oral cancers.

    Potentially malignant lesions or conditions may include some erythroplasias, dysplastic leucoplakias (about half of oral carcinomas have associated leucoplakia), lichen planus, submucous fibrosis, and chronic immunosuppression. Rare causes of oral cancer include tertiary syphilis, discoid lupus erythematosus, dyskeratosis congenita, and Plummer-Vinson syndrome (iron deficiency and dysphagia).

    • Oral squamous cell carcinoma is mainly a disease of men over middle age, but its prevalence is increasing

    • Tobacco use and alcohol consumption are the main aetiological factors

    • Patients are at risk from second primary neoplasms

    Diagnosis

    Too many patients with oral cancer …

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