Oral Cancer Symptoms

Things you can see

A sore or ulcer that has not healed in three weeks. This is the single most important sign. Ordinary mouth ulcers are common and heal within one to two weeks.

A red patch anywhere in the mouth that does not rub off and does not settle. Red patches deserve particular attention and are worth mentioning even if they cause no discomfort at all.

A white patch on the tongue, gums, cheek lining, or floor of the mouth that cannot be wiped away.

A patch that is a mixture of red and white.

A lump or thickened area on the lip, tongue, cheek lining, gum, or the floor of the mouth. Running your tongue over it, or feeling with a clean finger, often makes it clearer than looking does.

Unexplained bleeding in the mouth that is not coming from the gums when you brush.

Things you can feel

Persistent discomfort or a burning sensation in one part of the mouth.

Numbness or an odd loss of sensation in the tongue, lip, chin, or any part of the mouth.

Loose teeth with no dental cause, or dentures that have suddenly stopped fitting the way they used to.

Difficulty or discomfort chewing, swallowing, or moving your tongue or jaw.

Difficulty opening your mouth as wide as usual.

Things in your throat and neck

A persistent sore throat, or the sensation of something caught in your throat, lasting more than three weeks.

A change in your voice that has not settled.

Ear discomfort on one side, with a normal ear examination. This is a classic sign that is very easily missed, because the ear itself is entirely healthy. The discomfort is referred from elsewhere along a shared nerve.

A painless lump in the neck that has not gone away. For some throat cancers linked to HPV, this is the first thing anyone notices, and the original site can be very small.

Persistent bad breath, or losing weight without trying.

Contact a doctor or dentist within a few days if you notice:

• Any mouth sore, ulcer, or patch that has lasted more than three weeks
• A red patch anywhere in the mouth, whether or not it is uncomfortable
• A lump in the neck that has not settled
• Numbness in the tongue, lip, or chin
• Difficulty opening your mouth, swallowing, or moving your tongue
• One-sided ear discomfort with a normal ear examination

Most mouth changes are caused by something other than cancer:

• Aphthous ulcers, ordinary mouth ulcers, which are very common and heal within one to two weeks
• Trauma, from a bitten cheek, a sharp tooth, a filling, or a denture rubbing
• Oral thrush, a fungal infection producing white patches that usually wipe away, and which treats easily
• Lichen planus, a common condition causing white lacy patterns in the mouth
• Geographic tongue, a harmless variation in the tongue's surface that changes appearance over time
• Cold sores and viral infections
• Gum disease, a common cause of bleeding and loose teeth
• Dry mouth, often from medication, which makes the mouth more prone to soreness

Getting checked is not overreacting. Most people who go in with a mouth sore come away with a sharp tooth smoothed down or a short course of treatment.

• Tobacco in any form, including cigarettes, cigars, pipes, and chewing tobacco
• Betel quid and areca nut, chewed widely in parts of South and Southeast Asia, which raise the chance considerably
• Regular alcohol use, which combines with tobacco to raise the chance far more than either alone
• HPV infection, particularly for cancers at the back of the mouth and throat
• Sun exposure over many years, for cancers of the lip
• A weakened immune system
• Long-standing conditions of the mouth lining such as lichen planus
• Age, though HPV-related throat cancers are increasingly seen in younger adults

Two encouraging points are worth making. Stopping tobacco lowers the chance meaningfully, including for people who have used it for decades. And the HPV vaccine, given in adolescence, prevents the infections behind a growing share of these cancers.

Book an appointment with a dentist or a primary care doctor. A dentist is an excellent choice here, since examining the whole mouth is routine work for them and appointments are often quicker to get.

Write things down before you go. Bring:

• When you first noticed the sore or patch
• Whether it has changed in size, color, or feel
• Whether anything obvious could have caused it, such as a sharp tooth or a bite
• Any numbness, ear discomfort, or difficulty swallowing
• Any neck lumps and how long they have been present
• Your tobacco, betel quid, and alcohol history
• Whether you have had the HPV vaccine

Take a photograph. Mouth changes are hard to describe and easy to see. A clear, dated photograph taken with the flash on is genuinely useful, especially if the appointment is a week or two away.

Knowing what a thorough look involves helps you understand where you are in the process:

• A full examination of the whole mouth, including under the tongue and the floor of the mouth, plus feeling the neck for lumps
• Removing any obvious cause, such as smoothing a sharp tooth or adjusting a denture, and then rechecking
• A biopsy, a small tissue sample, if anything has not healed after that
• A referral to an ear, nose and throat or oral surgery specialist for anything persistent

The point most worth knowing is this: a sore that has not healed after three weeks deserves a biopsy rather than another treatment trial. Treating an obvious cause first is entirely sensible, and it should come with a specific date to come back. If a sore is still there at that follow-up, a small sample is the appropriate next step, and it takes only minutes.

The floor of the mouth and the underside of the tongue are the areas most often missed on a quick look. A good question to ask is: "Have you looked under my tongue and along the floor of my mouth?"

Being told it is just an ulcer is genuinely good news, and it is also completely reasonable to want another set of eyes when something has not healed or has changed since you were seen. You live in your body every day. Nobody knows your normal better than you do.

You do not need a diagnosis in order to ask for a specialist opinion. If you have been evaluated by a dentist or a primary care doctor and something still does not sit right, you can ask for a referral to a medical oncologist who focuses specifically on head and neck cancers, or to an ear, nose and throat specialist. Many centers also accept requests for a second opinion directly, without a referral, and most insurance plans cover one.

When you ask, keep it simple and warm. Something like: "I was told this was an ulcer from a sharp tooth and the tooth was smoothed. It has been eight weeks and the sore is still there, so I would feel more settled having a specialist review it. Could you send a referral?" Good doctors hear that as thoroughness, not as doubt.

Bring your records with you, including any photographs you have taken over time and any biopsy results.

You can find a list of top oral cancer medical oncologists here: Top Oral Cancer Doctors

Lead with how long it has been there, since duration is what changes the plan:

"I have had a sore on the left side of my tongue for about seven weeks. It has not healed and it feels slightly firmer than it did. My ear on that side has been aching too, although my ear itself seems fine. I chewed tobacco for years. I would like this examined properly, and if it has not healed, I would like a biopsy."

• "Have you examined under my tongue and the floor of my mouth?"
• "Given that this has been here more than three weeks, should we take a small sample?"
• "If we treat the obvious cause first, when should I come back to have it rechecked?"
• "Can you feel any lumps in my neck?"
• "Should I be referred to an ear, nose and throat specialist?"

Oral examination. A doctor or dentist looks at every surface of the mouth using a light and a mirror, and feels the tongue, floor of the mouth, and neck. It takes about two minutes and is painless.

Photographs. Some clinicians photograph a patch so that any change can be compared accurately at follow-up.

Biopsy. A small tissue sample taken with numbing medicine, usually in clinic. It takes only a few minutes, you go home immediately, and any soreness afterward settles within a couple of days. This is the test that gives a definite answer.

Nasendoscopy. A very thin flexible camera passed through the nose to look at the back of the throat and the voice box. Numbing spray is used, it takes about a minute, and it is done sitting up in clinic.

Imaging. A CT or MRI scan of the head and neck, and sometimes an ultrasound of the neck with a fine needle sample of any lump.

Head and neck care is one of the areas where specialist experience matters most, because this part of the body governs speaking, eating, swallowing, and appearance. Decisions about how to approach treatment shape all of those, and the difference between a center that does this work constantly and one that does it occasionally is meaningful.

HPV status also matters a great deal here. Throat cancers linked to HPV respond differently and are managed differently from those linked to tobacco and alcohol, and testing for it should be part of the initial workup. A specialist will ensure that testing is done, will involve speech and swallowing therapists and dietitians from the very beginning rather than afterward, and will bring your case to a team of surgeons, medical oncologists, radiation oncologists, radiologists, and pathologists before any plan is set. Cancerify helps you find top head and neck cancer specialists and centers near you, filtered by location and insurance, completely free.