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    Mouth cancer is a malignant tumour growing inside the mouth. It usually grows on the tongue or floor of the mouth but may grow on the gums, lips, jaw, and roof of the mouth. Most often, this cancer occurs in older men who used tobacco and drank alcohol in excess.

    Cancer of the floor of the mouth occurs when cells under the tongue become abnormal and grow out of control. This usually starts in very thin, flat cells that line the surface of the mouth (squamous cells). Cancer cells can spread and form a mass of cells called a tumour. The cancer may spread deeper into the floor of the mouth, or it may spread to other areas of the body (metastasize).

    When found early, mouth cancer is highly curable with surgery or radiation therapy. Treatment is much less effective if smoking and drinking alcohol continue.

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    Chances of getting mouth cancer are greater with the use of any kind of tobacco—cigarettes, cigars, pipe tobacco, and chewing tobacco. Using alcohol with tobacco greatly increases the chances of getting it. Other causes include anything that irritates the inside of the mouth, poor oral care, poorly fitting dentures, and sun exposure (lip cancer).

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    This condition is more likely to develop in:

    • People who use tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco use is the number-one risk factor of cancer of the floor of the mouth.
    • Men.
    • People who:
      • Are over age 50.
      • Drink alcohol excessively. People who use both tobacco and alcohol are at an even higher risk.
      • Have HPV (human papillomavirus) infection.
      • Do not brush or floss their teeth regularly.
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    Symptoms of this condition may include:

    • A lump or an open sore (ulcer) on the floor of the mouth that does not heal. This ulcer may be painless.
    • An unusual white or red patch on the floor of the mouth.
    • Pain in the mouth, ear, chin, or jaw.
    • Bad breath.
    • Loose teeth. If you wear dentures, they may be painful or no longer fit.
    • Unusual bleeding in the mouth.
    • Numbness in the mouth, chin, or jaw.
    • A lump on the neck.

    In some cases, this condition causes no symptoms, and it may be found during a regular dental exam.

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    This condition may be diagnosed based on:

    • A physical exam of your mouth, throat, and neck. To look at the back of your mouth and your throat, your health care provider may use a thin, long-handled mirror or a thin, flexible tube that has a light and a camera at the end (fiberscope).
    • Removal and exam of a small number of cells (biopsy) from your mouth or a lump on your neck. The cells are checked under a microscope for cancerous formations.
    • Blood tests. These tests may include a complete blood count, an electrolytes test, and tests of your kidney and liver function.
    • Imaging exams of your mouth, neck, and body, such as:
      • X-rays.
      • CT scan.
      • PET scan.
      • MRI.
      • Bone scan.

    If cancer of the floor of the mouth is confirmed, it will be staged to determine its severity and extent. Staging is an assessment of:

    • The size of a tumour.
    • Whether the cancer has spread.
    • Where the cancer has spread.

    The stages of cancer of the floor of the mouth are as follows:

    • Stage 0, carcinoma in situ (CIS). In this stage, abnormal cells that could become cancerous have been found on the floor of your mouth.
    • Stage I. Cancer is the size of a peanut or smaller. It has not metastasized.
    • Stage II. Cancer is larger than a peanut but not larger than a walnut. It has not metastasized.
    • Stage III. Cancer has grown larger than a walnut. It may have spread to a lymph node on the same side of your neck as the cancer. Lymph nodes are part of your body’s disease-fighting (immune) system. Lymph nodes are found in many locations in your body, including the neck, underarm, and groin.
    • Stage IV. This stage is divided into three sub-stages, IVA, IVB, and IVC. Cancer has spread to nearby areas. It may have spread heavily into your lymph nodes or metastasized to other parts of your body.

    Cancer may return (recur) after initial treatment (recurrent cancer). Recurrent cancer can occur in the same location or in another part of the body.

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    Treatment for this condition depends on the stage of the cancer. Treatment may include one or more of the following:

    • Surgery. This removes as much of the cancer as possible.
      • Surgery for stage I and stage II cancers will not change the way you speak or swallow very much.
      • Surgery for stage III and stage IV cancers may permanently change the appearance of your mouth as well as your ability to swallow and talk.
    • Chemotherapy. This uses medicines to kill the cancer cells.
    • Radiation therapy. This uses high-energy rays to kill the cancer cells.
    • Targeted drug therapy. This uses medicines that block cancer from growing and spreading.

    A combination of radiation, chemotherapy, targeted drug therapy and surgery may be used for stage III, stage IV, and recurrent cancers.

    DOs and DON’Ts in managing mouth cancer:

    • DO follow all directions from your health care provider.
    • DO call your health care provider if you have breathing problems, bleeding, or infection.
    • DO avoid tobacco products and heavy alcohol drinking to prevent mouth cancer.
    • DO have poorly fitting dentures repaired so that they don’t irritate the inside of your mouth.
    • DO use your health care provider if you have a new sore in your mouth or on your lip that doesn’t heal. Mouth cancer is highly curable when it’s very small and is found early.
    • DON’T use tobacco or drink alcohol.
    • DON’T drive a car after surgery until your health care provider says you can.

    Follow these instructions at home regarding mouth cancer:

    • Take over-the-counter and prescription medicines only as told by your health care provider.
    • Do not drive or operate heavy machinery while taking prescription pain medicine.

    General instructions

    • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
    • Work with your health care provider to manage side effects of treatment.
    • Maintain a healthy diet.
    • Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. If you need help quitting, ask your health care provider.
    • Do not use alcohol.
    • Keep all follow-up visits as told by your health care provider. This is important.

    Contact a health care provider if:

    • You have mouth or ear pain that does not get better with medicine or gets worse.
    • Your mouth or chin is numb.
    • You have bleeding or swelling in your mouth or neck.
    • Your lower teeth become loose or painful.
    • You have difficulty chewing, swallowing, or talking.
    • You develop new symptoms.

    Get help right away if:

    • You have severe pain in your neck, mouth, or ear.
    • You have difficulty breathing.
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    A personalised cancer screening consultation is a meeting with a qualified consultant medical doctor to explain to you what does cancer screening mean and facilitate your understanding for the genomic and diagnostic tests that are that can help you to achieve your cancer screening and prevention objectives.

    Your consultant doctor will aim to answer all your questions regarding the cancer screening programmes and tests that could be beneficial for your overall health and wellbeing.

    It is recommended that you book a personalised cancer screening consultation with one of our recognised consultant medical doctors if you have a strong family history of cancer or you have one or more risk factors that may increase your risk of developing a specific type of cancer.

    If you are unable to attend to one of our outpatients’ clinics in London for your personalised cancer screening consultation, our consultant medical doctors can arrange to have your personalised cancer screening consultation by secure and encrypted voice conferencing or video conferencing, which can be done from the convenience of your home and using your smartphone.