Oral cancer is cancer of the mouth that affects the tissues in the lips, throat, gums, under the tongue, and at its base. This cancer doesn't always cause symptoms in the early stages, but cancer cells can spread quickly. If you develop symptoms, common signs of this condition include the development of growths, sores, or white patches in the mouth.1  

This condition becomes especially dangerous if it spreads (or “metastasizes”) to other parts of the body—which happens in about 3% to 7% of oral cancer cases.2 Fortunately, most cases of oral cancer are treatable, as long as you receive a diagnosis and treatment in a timely manner.3

National Institute of Dental and Craniofacial Research. Oral cancer.

Common Symptoms 

If oral cancer goes untreated, symptoms can get worse. As with other cancers, healthcare providers such as periodontists (dentists specializing in oral disease) or otolaryngologists (specialists in the ears, nose, and throat) stage the disease based on the severity of your condition and how far it’s spread.

Across these stages, the most common warning signs of oral cancer include:4

• Persistent sores on the tissues of the mouth, gums, tongue, throat, or lips
• Red or white patches in the throat
• Numbness in parts of the mouth or tongue
• Bleeding in the gums, tongue, and lips
• Sore throat, hoarseness, or loss of voice
• Pain or difficulty with chewing, swallowing, or talking
• Feeling a lump in your neck
• Difficulty moving the tongue or jaw
• Jaw swelling
• Ear pain

Stage 0 Symptoms

When staging oral cancer, healthcare providers follow classification systems, such as the TNM system set by the American Joint Committee on Cancer (AJCC). This system stages cancer from 0 to 4 (stage 4 being the most severe), based on three criteria: tumor growth (T), the extent of spread to the neck’s lymph nodes (N), and metastasis (M), or whether the cancer has spread to other parts of the body.4   

Also known as carcinoma in situ, stage 0 is a pre-symptomatic stage of oral cancer, and there’s no spread of cancer cells to the lymph nodes (known as metastasic). Though there aren’t symptoms, healthcare providers can detect abnormal squamous cells—the cells that line the mouth, tongue, and throat. These cells have the potential to become cancerous (or “malignant”).        

Stage I Symptoms 

In the first stage of oral cancer, the tumors are less than 2 centimeters (cm) in diameter and are 5 millimeters (mm) or less deep. Malignant cells in this stage are found in the tissues of the mouth, lips, or throat but haven’t spread to surrounding tissues, lymph nodes, or organs in other parts of the body, such as the lungs.4

Stage II Symptoms 

According to the AJCC, there are two definitions of stage II oral cancer. In these cases, the cancerous tumors are either between 2 and 4 cm in diameter and between 5 and 10 millimeters (mm) deep.4 In this stage, cancer cells haven’t started growing into other tissues, so they aren’t present in the lymph nodes or other organs. But you may start noticing symptoms that affect your mouth, throat, or lips.

Stage III Symptoms 

In stage III, oral cancer has advanced considerably, becoming prominent in the mouth and in some cases starting to spread to the lymph nodes.

As with stage 2, there are two definitions:4

• Tumors are larger than 4 cm in diameter in the mouth or the base of the tongue, with no sign of spread to lymph nodes or other parts of the body
• Tumors of any size in tissues surrounding the throat and spreading to one lymph node, which swells to 3 mm or less, but nowhere else  

If the oral cancer spreads to your lymph nodes, it can lead to symptoms like painful swallowing and feeling a lump in the neck.

Stage IV Symptoms 

If you have stage IV—the most advanced stage of oral cancer—the cancer has started to spread to surrounding tissues, lymph nodes, and more distant organs.

In the TNM classification, this stage can cause one or more of the following:4

• Tumors of any size that may or may not actively spread into surrounding tissues, such as the bones of the jaw or face, the voice box (larynx), muscles, sinuses, and skin on the face or nose affected. Swelling in a nearby lymph node is common.
• Tumors spread into tissues as well as one lymph node on the same or opposite side. The lymph node usually swells to over 3 cm in diameter.
• Tumors have spread not only to surrounding structures and lymph nodes but also to other parts of the body, such as the lungs.

When To See a Healthcare Provider 

If you suspect oral cancer, it’s critical to get help as soon as possible, as this disease can progress rapidly. Early detection of this condition vastly improves outcomes. In one study, 90% of those who detected the issue in stage I and got treatment were still alive five years later; this number dropped to 45% among those with stage IV.5

If you experience any symptoms of oral cancer for longer than two weeks, call your healthcare provider.1 Persistent sores or swollen, discolored spots, lumps in the neck, and other typical signs of the condition can mean you need help.

Oral cancer can become a medical emergency due to complications or severe side effects of treatments.

Call 911, if you experience any of the following:

• Fever
• Chills
• Worsening side effects from radiation or chemotherapy, such as nausea and vomiting
• Shortness of breath
• Severe headache
• Neck stiffness
• Bloody urine

Questions To Ask a Provider

When seeking care for oral cancer, think about asking the periodontist or specialist the following questions:

• What stage of oral cancer do I have, and what does that mean for treatment?
• What side effects can I expect from treatment and what I can do about them?
• What lifestyle changes can I adopt to improve my outcome?
• Will I need to change what I eat because of my symptoms?
• Will I need surgery to treat oral cancer?

Frequently Asked Questions

• What is the survival rate for oral cancer?

  Several factors influence the survival rate of oral cancer, such as whether you receive treatment and how severe your condition is. Without treatment, the prognosis is poor.

  In one study, 31% of those who had stage I without treatment survived after five years, something which only 12.6% of stage IV patients managed.6 But with timely treatment, the picture improves. At five years, studies found survival rates after five years were 90% for people in stage I and nearly 50% for stage IV.5

• How long can you have oral cancer without knowing?

  The early stages of this cancer don’t always cause symptoms. Some types, such as verrucous carcinoma, progress more slowly, making it harder to detect earlier signs.7 But squamous cell oral carcinoma, the most common type, moves more quickly, spreading to the lymph nodes or surrounding tissues within as little as three months or less.8

• Can a dentist detect oral cancer?

  Though specialists like periodontists or otolaryngologists (ear, nose, and throat doctors) guide the treatment of oral cancer, dentists can diagnose the condition. During routine cleanings and check-ups, dentists look for tumors, growths, or other symptoms. Dentists may also perform additional screening methods, such as using a screening light or using a dye to detect growths or other signs.9