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What is Mouth & Tongue Cancer?

Mouth and tongue cancers are a group of cancers that develop in the oral cavity, including the tongue, floor of gum, and inner cheek. Most are squamous cell carcinomas arising from the lining of the mouth. They often present as non-healing ulcers, lumps, or persistent red or white patches. These cancers are classified under head and neck cancers.

How Common is Mouth & Tongue Cancer in Singapore?

Mouth and tongue cancers are less common in Singapore compared with major cancers such breast, colorectal, and lung cancer. Local sources estimate around 250 new oral cancer cases per year, with tongue cancer forming a smaller proportion.

Symptoms of Mouth and Tongue Cancer

Mouth and tongue cancer symptoms commonly include non-healing ulcers or sores, red or white patches, unexplained lumps, neck swelling, persistent pain, and difficulty swallowing or moving the tongue. These symptoms, particularly those that do not heal or improve within 2–3 weeks, may also include loose teeth, persistent earaches, or numbness.

Key Symptoms of Mouth & Tongue Cancer

Non-healing sores/ulcers: A sore or ulcer in the mouth or on the tongue that lasts for more than 2–3 weeks.
Persistent Pain: Pain in the mouth, tongue, or throat that does not go away.
Lumps or Thickening: A lump, node, or thickening of the mouth lining or tongue.
Color Changes: Red (erythroplakia) or white (leukoplakia) patches on the tongue, gums, or lining of the mouth.
Difficulty with Movement/Function: Pain or trouble with chewing, swallowing, or moving the tongue and jaw.
Numbness: A feeling of numbness in the tongue, lips, or other areas of the mouth.
Unexplained Bleeding: Frequent bleeding from a sore or growth in the mouth.
Voice Changes: Hoarseness or changes in voice.
Neck Lump: A lump in the neck, which may indicate the spread of cancer to lymph nodes.
Dental Issues: Loose teeth or dentures that suddenly stop fitting properly.
Ear Pain: A persistent earache, which can sometimes be a symptom.

How Is Mouth & Tongue Cancer Diagnosed?

Mouth and tongue cancers are diagnosed through a combination of biopsy, and imaging tests. Early evaluation is important, especially for ulcers or patches in the mouth that do not heal within 2–3 weeks.

Medical Examination

A doctor will examine the mouth, tongue, and neck to check for persistent ulcers, lumps, red or white patches, or swelling of nearby lymph nodes. If an abnormal area is found, further tests are arranged.

Biopsy (Confirming the Diagnosis)

A biopsy is required to confirm mouth or tongue cancer. During this procedure, a small sample of tissue is taken from the suspicious area and examined under a microscope to determine whether cancer cells are present. This is the only way to make a definitive diagnosis.

Ujian Pengimejan

If cancer is confirmed, imaging scans help determine the stage of the cancer and whether it has spread. These may include:

CT scan to assess tumour size and nearby lymph nodes
MRI scan to evaluate soft tissue involvement
PET-CT scan in selected cases to check for spread to other parts of the body

Endoscopy

In some cases, a small flexible camera (endoscope) may be used to examine deeper areas of the throat and surrounding structures. This helps doctors assess the full extent of the cancer and plan treatment.

What Are the Stages of Mouth & Tongue Cancer?

Mouth and tongue cancers are staged to describe the size and extent of the tumour, whether nearby lymph nodes are involved, and whether the cancer has spread to other parts of the body. Doctors use the internationally recognised TNM staging system (Tumour, Node, Metastasis) to determine the stage. Staging helps guide treatment decisions and prognosis.

Stage 0 (Carcinoma in situ)

Abnormal cells are confined to the surface lining of the mouth or tongue and have not invaded deeper tissues.

Peringkat I

The tumour is small (2 cm or less in greatest dimension) and has not spread to lymph nodes or distant organs.

Peringkat II

The tumour is larger than 2 cm but not more than 4 cm, without spread to regional lymph nodes or distant sites.

Peringkat III

The tumour may be larger than 4 cm, and/or cancer has spread to a single nearby lymph node on the same side of the neck.

Peringkat IV

Stage IV disease indicates more advanced cancer and may include one or more of the following:

Spread into nearby structures such as the jawbone, skin, or deeper tissues
Spread to multiple or larger lymph nodes in the neck
Spread to distant organs such as the lungs

Treatment for Mouth & Tongue Cancer

Treatment for mouth and tongue cancer depends on the stage, exact tumour location, and a patient’s overall health and preferences. Care is usually planned by a multidisciplinary team experienced in head and neck cancers.

Pembedahan

For many mouth and tongue cancers (oral cavity cancers), surgery is often the main treatment, especially for early-stage disease. The goal is to remove the tumour with an appropriate margin of surrounding tissue. Depending on the risk of spread, doctors may also recommend treatment of lymph nodes in the neck (for example, neck dissection). Reconstruction may be performed to help restore speech, swallowing and appearance when needed.

Radiation Therapy (Radiotherapy)

Radiation therapy uses high-energy beams to destroy cancer cells. It may be used:

After surgery to reduce the risk of recurrence, sometimes with or without chemotherapy, depending on tumour features
As a main treatment in selected situations
Together with chemotherapy (chemoradiotherapy) for certain locally advanced cancers

Kemoterapi

Chemotherapy uses anti-cancer medicines to treat cancer cells. In mouth and tongue cancer, it is most commonly used:

With radiation therapy (chemoradiotherapy) in selected locally advanced settings
As part of systemic treatment for recurrent or metastatic disease, depending on individual clinical factors

Terapi yang disasarkan

In selected patients particularly for recurrent or advanced disease, doctors may recommend targeted therapy or immunotherapy. One example of targeted therapy used in head and neck cancers is cetuximab, which targets EGFR. Immunotherapy is also an established treatment type for head and neck cancers in appropriate clinical scenarios.

Imunoterapi

Immunotherapy is typically used in recurrent and advanced disease. It can be combined with chemotherapy or used on its own. A newer indication is currently approved for early, resectable head and neck cancer. Immunotherapy should be used in perioperative setting meaning that immunotherapy should be started before surgery and continued after surgery for about a year in selected suitable cases to improve patient's survival.

Rehabilitation and Supportive Care

Because treatment can affect speech, swallowing, taste, dental health and nutrition, supportive care is often part of the treatment plan. This may include speech therapy, dietitian support and dental assessment before or after treatment. The final treatment plan is individualised and may depend on tumour pathology, imaging findings, and detailed staging.

Temui Doktor Kami

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