Oral cavity cancer (mouth and tongue)
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.
Overview
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.
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.
Anatomy and lymph node drainage
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
- Oral cavity and tongueOral tongue
- Oropharynx: tonsil, base of tongue (HPV)
- Nasopharynx (EBV)
- Larynx and hypopharynx
- Parotid and other salivary glands
- ThyroidHard palate and retromolar trigone
- level I (submandibular)
- level II (upper jugular)
- level III-IV (jugular)
- level V (posterior)
- level VI (central, thyroid)
- retropharyngeal (nasopharynx)
Same organ: Oropharyngeal cancer (tonsil and base of tongue), Laryngeal and hypopharyngeal cancer, Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Follicular thyroid cancer, Medullary thyroid cancer, Anaplastic thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4)
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 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.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
Visual oral examination by trained workers reduced mouth cancer deaths in the Kerala trial; opportunistic examination by dentists elsewhere.
Wide excision with elective neck dissection when depth of invasion exceeds about 3 to 4 mm; sentinel node biopsy in selected cases.
Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for positive margins or extranodal extension.
Pembrolizumab with or without chemotherapy (KEYNOTE-048); low-cost metronomic methotrexate and celecoxib where access is limited.
Tobacco and betel quid cessation, alcohol reduction, treatment of premalignant patches.
Subtypes & biomarkers
top- Oral tongue
- Floor of mouth
- Buccal mucosa and gingiva (betel-quid related)
- Lip (sun-related)
- Hard palate and retromolar trigone
- Depth of invasion (staging and elective neck dissection)
- Extranodal extension and margin status
- TP53 mutation
- PD-L1 combined positive score (recurrent disease)
How often this target appears
- 1906Crile describes radical neck dissection
- 2005Kerala screening trial shows visual inspection cuts oral cancer deaths in high-risk people
- 2015Elective neck dissection improves survival in early oral cancer (Tata Memorial)
- 2017Depth of invasion enters staging (AJCC 8th edition)
What is in development for Oral cavity cancer (mouth and tongue), drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
Late presentation remains the norm in the highest-incidence countries.
and how the field plans to fix it →What is being done about thisFinding cancer earlierAvailable now- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
In trialsIdeas and roadmaps- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
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.
Trials
topTrials recruiting now
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Landmark trials
Expert centres
topExpert centres
- Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer CenterBaltimore, USNewsweek oncology #10NCI comprehensivevia Pembrolizumab
- via Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma, Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)
- Aarhus University HospitalAarhus, DKvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Centre Antoine LacassagneNice, FRvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Centre Oscar LambretLille, FRvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Groote Schuur Hospital / University of Cape TownCape Town, ZAvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Hacettepe University Cancer InstituteAnkara, TRvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Ho Chi Minh City Oncology HospitalHo Chi Minh City, VNvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Hokkaido University HospitalSapporo, JPvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Institut National d'Oncologie, RabatRabat, MAvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Institut Salah AzaïezTunis, TNvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Institute of Oncology LjubljanaLjubljana, SIvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Istanbul University Institute of OncologyIstanbul, TRvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- National Institute of Oncology, HungaryBudapest, HUvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Ocean Road Cancer InstituteDar es Salaam, TZvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Rajiv Gandhi Cancer Institute and Research CentreNew Delhi, INvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Siriraj Hospital, Mahidol UniversityBangkok, THvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Tata Medical Center, KolkataKolkata, INvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- TROG Cancer ResearchNewcastle, NSW, AUvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- UMC Utrecht Cancer CenterUtrecht, NLvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- University of Malaya Medical CentreKuala Lumpur, MYvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Velindre Cancer CentreCardiff, GBvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- Zhejiang Cancer HospitalHangzhou, CNvia Head and neck squamous cell carcinoma, IMRT / IGRT (modern external beam)
- A.C. Camargo Cancer CenterSão Paulo, BRvia Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma
- All India Institute of Medical Sciences, New DelhiNew Delhi, INvia Head and neck squamous cell carcinoma
- Alliance for Clinical Trials in OncologyChicago, IL, USvia Pembrolizumab
- American Society for Radiation OncologyArlington, VA, USvia IMRT / IGRT (modern external beam)
- Apollo Hospitals (Apollo Cancer Centres)Chennai, INvia Head and neck squamous cell carcinoma
- ASST Spedali Civili di BresciaBrescia, ITvia Head and neck squamous cell carcinoma
- Cancer Institute (WIA), AdyarChennai, INvia Head and neck squamous cell carcinoma
- Chang Gung Memorial HospitalTaoyuan, TWvia Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Chris O'Brien LifehouseSydney, AUvia Head and neck squamous cell carcinoma
- Christian Medical College, VelloreVellore, INvia Head and neck squamous cell carcinoma
- Comprehensive Cancer Center Freiburg (CCCF)Freiburg im Breisgau, DEvia IMRT / IGRT (modern external beam)
- Dharmais National Cancer CenterJakarta, IDvia Head and neck squamous cell carcinoma
- European Society for Radiotherapy and OncologyBrussels, BEvia IMRT / IGRT (modern external beam)
- Geneva University Hospitals (HUG)Geneva, CHvia IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma
- GOG FoundationPhiladelphia, PA, USvia Pembrolizumab
- Gunma University Heavy Ion Medical CenterMaebashi, JPvia Head and neck squamous cell carcinoma
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- HealthCare Global EnterprisesBengaluru, INvia Head and neck squamous cell carcinoma
- Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, VaranasiVaranasi, INvia Head and neck squamous cell carcinoma
- Hunan Cancer HospitalChangsha, CNvia IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma
- Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolis, IN, USNCI comprehensivevia Cisplatin
- Institut BergoniéBordeaux, FRvia IMRT / IGRT (modern external beam)
- Institut Jules BordetBrussels, BEvia Pembrolizumab
- Institut PasteurParis, FRvia Head and neck squamous cell carcinoma
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- International Extranodal Lymphoma Study GroupBellinzona, CHvia IMRT / IGRT (modern external beam)
- IRCCS Humanitas Research HospitalRozzano (Milan), ITvia IMRT / IGRT (modern external beam)
- Juravinski Cancer Centre / Escarpment Cancer Research InstituteHamilton, ON, CAvia IMRT / IGRT (modern external beam)
- Kenyatta National HospitalNairobi, KEvia IMRT / IGRT (modern external beam)
- Kidwai Memorial Institute of OncologyBengaluru, INvia Head and neck squamous cell carcinoma
- Koo Foundation Sun Yat-Sen Cancer CenterTaipei, TWvia Head and neck squamous cell carcinoma
- Korle Bu Teaching HospitalAccra, GHvia IMRT / IGRT (modern external beam)
- Lagos University Teaching HospitalLagos, NGvia IMRT / IGRT (modern external beam)
- via Pembrolizumab
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Max Healthcare (Max Institute of Cancer Care)New Delhi, INvia Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma
- Narayana Health (Mazumdar Shaw Medical Centre)Bengaluru, INvia Head and neck squamous cell carcinoma
- National Cancer Center Hospital EastKashiwa, Chiba, JPvia Head and neck squamous cell carcinoma
- National Cancer Centre SingaporeSingapore, SGvia Head and neck squamous cell carcinoma
- National Cancer Institute (NIH)Bethesda, MD, USvia Smoking cessation in cancer patients
- via IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma
- NRG OncologyPhiladelphia, PA, USvia Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma
- via IMRT / IGRT (modern external beam)
- Philippine General HospitalManila, PHvia Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma
- QIMR Berghofer Medical Research InstituteBrisbane, AUvia Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma
- Queen Mary Hospital / University of Hong KongHong Kong, HKvia Head and neck squamous cell carcinoma
- Rambam Health Care CampusHaifa, ILvia IMRT / IGRT (modern external beam)
- Rigshospitalet, Copenhagen University HospitalCopenhagen, DKvia IMRT / IGRT (modern external beam)
- Royal Adelaide HospitalAdelaide, AUvia IMRT / IGRT (modern external beam)
- Shizuoka Cancer CenterNagaizumi, Shizuoka, JPvia Head and neck squamous cell carcinoma
- Sichuan Cancer HospitalChengdu, CNvia Head and neck squamous cell carcinoma
- Tawam HospitalAl Ain, AEvia IMRT / IGRT (modern external beam)
- Tel Aviv Sourasky Medical CenterTel Aviv, ILvia IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma
- via IMRT / IGRT (modern external beam)
- via Head and neck squamous cell carcinoma
- via Head and neck squamous cell carcinoma
Questions to ask
topQuestions to ask your oncologist about Oral cavity cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Depth of invasion, Extranodal extension and margin status, TP53 mutation, PD-L1 combined positive score), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Oral tongue, Floor of mouth, Buccal mucosa and gingiva.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Screening in high-risk populations
- For my situation (screening in high-risk populations), which of the standard options do you recommend and why?Why: Guideline options include: Visual oral examination by trained workers reduced mouth cancer deaths in the Kerala trial; opportunistic examination by dentists elsewhere.
Early disease
- For my situation (early disease), which of the standard options do you recommend and why?Why: Guideline options include: Wide excision with elective neck dissection when depth of invasion exceeds about 3 to 4 mm; sentinel node biopsy in selected cases.
Locally advanced disease
- For my situation (locally advanced disease), which of the standard options do you recommend and why?Why: Guideline options include: Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for positive margins or extranodal extension.
- Am I a candidate for Cisplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Recurrent or metastatic
- For my situation (recurrent or metastatic), which of the standard options do you recommend and why?Why: Guideline options include: Pembrolizumab with or without chemotherapy (KEYNOTE-048); low-cost metronomic methotrexate and celecoxib where access is limited.
- Am I a candidate for Pembrolizumab, Methotrexate, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-048 and Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Prevention
- For my situation (prevention), which of the standard options do you recommend and why?Why: Guideline options include: Tobacco and betel quid cessation, alcohol reduction, treatment of premalignant patches.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Late presentation remains the norm in the highest-incidence countries”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Betel quid use is still rising in parts of Asia”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
5targets
1drugs
3companies
1trials
2Latest papers
topQuery for this cancer: (TITLE:"Oral cavity cancer" OR ABSTRACT:"Oral cavity cancer" OR TITLE:"mouth and tongue" OR ABSTRACT:"mouth and tongue" OR TITLE:"Oral cancer" OR ABSTRACT:"Oral cancer" OR TITLE:"Mouth cancer" OR ABSTRACT:"Mouth cancer" OR TITLE:"Tongue cancer" OR ABSTRACT:"Tongue cancer" OR TITLE:"Oral squamous cell carcinoma" OR ABSTRACT:"Oral squamous cell carcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Oral cavity cancer (mouth and tongue), not a curated reading list.
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