# Oral cavity cancer (mouth and tongue)

Source: https://onco.cc/cancers/oral-cavity-cancer/  
OnCo record `oral-cavity-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer of the mouth and tongue is caused mainly by tobacco, alcohol and betel quid and is usually visible or feelable early, yet often diagnosed late. Surgery is the mainstay, with radiotherapy or chemoradiation after operation for higher-risk disease, and reconstruction to restore speech and swallowing.

## Summary

Oral cavity squamous cell carcinoma arises on the tongue, floor of mouth, gums, buccal mucosa, palate and lips, often from a white or red patch (leukoplakia or erythroplakia). Unlike oropharyngeal cancer it is rarely HPV-driven; tobacco, alcohol and, in South and South-East Asia, betel quid with areca nut are the causes, and a screening trial in Kerala showed that visual inspection by trained health workers reduces mouth cancer deaths in high-risk people. Treatment is surgical resection with neck dissection and free-flap reconstruction, with postoperative radiotherapy or cisplatin chemoradiation for advanced stage, positive margins or nodal spread with extranodal extension. Depth of invasion now determines stage and the need to treat the neck. Recurrent or metastatic disease is treated as for other head and neck cancers with pembrolizumab-based therapy, and metronomic methotrexate-celecoxib from Tata Memorial Hospital offers a low-cost option.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Oral cancer; Mouth cancer; Tongue cancer; Oral squamous cell carcinoma
- Tags: subtype-page
- Group: head-and-neck
- Burden: About 390,000 new cases a year worldwide, with the highest rates in South Asia from betel quid and tobacco chewing; it is the commonest cancer among men in India, and five-year survival is around 60 percent overall but far lower for late-stage disease.
- Subtypes: Oral tongue; Floor of mouth; Buccal mucosa and gingiva (betel-quid related); Lip (sun-related); Hard palate and retromolar trigone
- Biomarkers: Depth of invasion (staging and elective neck dissection); Extranodal extension and margin status; TP53 mutation; PD-L1 combined positive score (recurrent disease)

## Standard of care

- Screening in high-risk populations: Visual oral examination by trained workers reduced mouth cancer deaths in the Kerala trial; opportunistic examination by dentists elsewhere. ([Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/))
- Early disease: Wide excision with elective neck dissection when depth of invasion exceeds about 3 to 4 mm; sentinel node biopsy in selected cases. ([Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/))
- Locally advanced disease: Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for positive margins or extranodal extension. ([Cisplatin](https://onco.cc/drugs/cisplatin/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- Recurrent or metastatic: Pembrolizumab with or without chemotherapy (KEYNOTE-048); low-cost metronomic methotrexate and celecoxib where access is limited. ([Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [KEYNOTE-048](https://onco.cc/trials/keynote-048/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)](https://onco.cc/trials/metronomic-vs-cisplatin-tmh/))
- Prevention: Tobacco and betel quid cessation, alcohol reduction, treatment of premalignant patches. ([Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/))

## State of the art

- Elective neck dissection improves survival even in early tongue cancer (D'Cruz, Tata Memorial, 2015).
- Free-flap reconstruction has made function-preserving resection routine.
- India's low-cost trials have set standards for resource-limited care, from metronomic chemotherapy to screening.

## Open problems

- Late presentation remains the norm in the highest-incidence countries.
- Betel quid use is still rising in parts of Asia.
- Field cancerisation causes second primaries in a fifth of survivors.
- Speech and swallowing after large resections.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Oral_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Oral_cancer

## Connected records

- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- cancers: [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/)
- trials: [KEYNOTE-048](https://onco.cc/trials/keynote-048/), [Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)](https://onco.cc/trials/metronomic-vs-cisplatin-tmh/)

---
JSON: https://onco.cc/api/v1/entities/oral-cavity-cancer.json