Intended for healthcare professionals

Clinical Review Fortnightly review

Oral cancer

BMJ 1999; 318 doi: (Published 17 April 1999) Cite this as: BMJ 1999;318:1051
  1. Joanna M Zakrzewska, head (
  1. Department of Oral Medicine, St Bartholomew's and the Royal London School of Medicine and Dentistry, London E1 2AD

    The survival of patients with oral cancer remains poor despite recent surgical advances. About 30-40%of patients with intra-oral cancers will survive five years; the short survival time is caused, largely, by late detection.1 Public awareness of oral cancer as compared with other cancers is low and this contributes to delays in diagnosis.2 However, the mouth can be examined by healthcare professionals with much greater ease and accuracy than many other parts of the body. All healthcare workers need to be aware that a patient with an ulcer or white patch that persists beyond three weeks should be referred for further evaluation to an oral physician or to an oral and maxillofacial surgeon. Tobacco use is a major cause of oral cancer and doctors and other health professionals can contribute to primary prevention by making patients aware that tobacco, in all forms, predisposes them to oral cancer.

    Summary points

    The incidence of squamous cell carcinoma of the oral cavity is increasing

    The use of tobacco, in all forms, is major risk factor for squamous cell carcinoma; tobacco acts synergistically with alcohol

    Squamous cell carcinoma presents intra-orally as a non-healing ulcer, or a white or red patch

    A biopsy done under local anaesthesia is the single most important investigation in diagnosing oral cancer

    Five year survival rates for cancer of the lip are good but are low for other forms of mouth cancers, especially if the lesions are large at the time of diagnosis


    The majority of references in this article were obtained from a personal collection built during 10 years of work in this subject and during a study of screening for oral cancer. A Medline search of articles published between 1966 and 1998 using the terms “mouth”and “neoplasms” yielded 20 664 articles. Adding the keywords “systematic” and “review” did not identify any systematic reviews. …

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