Floor of the mouth cancer or Mouth Floor Cancer is a type of head and neck cancer which starts in the cells in the floor of the mouth (the area under the tongue). The cells of this area multiply out of control and form tumors or lesions. This cancer is generally neglected, thinking that it is just a canker sore.

This cancer starts from squamous cells that line the inside of the mouth, tongue, inside of the cheeks, in the lining of the respiratory and digestive tracts etc. It is also called squamous cell carcinoma of the foot of the mouth.

Dentists are generally the first ones to notice floor of the mouth cancer during routine examination.

Mouth Floor Cancer – Causes

Like any other cancer, the causes of floor of the mouth cancer are also unknown. However, any of the following can increase the risk of suffering from floor of the mouth cancer:

• Use of tobacco products; chewing and smoking
• Excessive use of alcohol
• being infected with human Papillomavirus (HPV), a sexually transmitted disease
• Personal history of suffering from squamous cell carcinoma
• Family history of mouth cancer
• History of organ transplant
• Suffering from HIV
• Chewing betel nut
• Exposure to asbestos and perchloroethylene
• Exposure to radiation
• Poor dietary factors
• Poor oral hygiene

Floor of the mouth Cancer – Symptoms

The most common symptom of the cancer is the sore which doesn’t cure and keeps on growing.

• During later stages of the disease, symptoms may include:
• A sore that continues to grow larger
• White, red or dark patches inside the mouth
• Difficulty in moving your jaw
• Painless lump or ulcer in the mouth
• Jaw pain or swelling
• Severe ear pain
• Loose teeth or pain around your teeth
• Lump in your neck

It is not necessary that these symptoms could lead to a diagnosis of cancer; however, it is always safe to visit your doctor if these symptoms last long.

Floor of the mouth Cancer – Diagnosis

Physical Examination

In the early stage of the cancer of the oral cavity, the investigations tend to be normal.

To look at the floor of the mouth, doctor uses tongue depressor to move the tongue. Inside of the mouth and the neck region is examined for any tumors that might be present. Ears, neck, throat and nose are also examined to check the spread of the cancer and presence of any tumors in these regions. Doctor might advise for blood test. Investigations might show anaemia or abnormal liver function tests if the disease is advanced.

Image Testing

Image testing helps in determining if the cancer has invaded nearby organs and tissues. These may include:

• Orthopantomography (Panorex): It gives the panoramic x-ray image from ear to ear of the skull, and indicates if the tumor has spread into the jawbone
• Computerised Tomography (CT) Scan: Images of the inside of the mouth and neck by an x-ray machine connected to a computer. Patient is given a pill to swallow or a dye is injected into the vein to highlight the tissues and organs on the X-ray. This procedure is also sometimes referred to as computerised axial tomography
• Magnetic Resonance Imaging (MRI): Magnets, computer and radio waves generate detailed images of the area of inside of the mouth and neck
• Positron Emission Tomography (PET) Scan: Scanner produces computerised images of the areas inside the body. A small amount of radioactive glucose (sugar) is injected into a vein. Tumor absorbs the radioactive sugar more and thus gets highlighted on the computerised images
• X-rays: To check if cancer has spread to lungs and other parts of the body

Biopsy

Biopsy is done generally to confirm the presence of cancer. In this method cells from the lump site are seen under microscope to ascertain the presence of cancerous cells from the site.

Incision biopsy is the most common kind of biopsy where doctor removes a small piece of the suspected tumor. This is generally done at doctor’s office under the effect of local anaesthesia. Other well-known biopsy procedure is fine needle aspiration biopsy where a thin needle is placed in the mouth and cells are collected by suction of the needle.

The cells thus collected are sent to pathology to be studied under the microscope to identify presence of cancerous cells at the site.

Cancer Stage

Cancer is often categorised into the following stages:

Stage-1: The tumor dimension is under 1 inch across and not reached nearby lymph nodes

Stage-2: The tumor dimension is 1 to 2 inches across and has to spread to nearby lymph nodes

Stage-3: The tumor dimension is over 2 inches across, but has not spread, or it has spread to nearby lymph nodes on the same side of the neck as the tumor and is no more of 1 inch in dimension across.

Stage-4: The cancer affects mouth, lips and possible nearby lymph nodes; or has spread to rest of the body. The stage of cancer determines the treatment approach and the likelihood of the recovery.

Floor of the mouth Cancer – Treatment

Floor of mouth cancer if diagnosed early is highly curable. The objectives of the treatment of cancer are as under:

• Cure the problem
• Preserve the function and appearance of the mouth
• Prevent the cancer from recurring on the same site or other part of the body

Surgery or radiation is generally employed for early stage floor of mouth cancer. Advanced stage of cancer generally requires combination of surgery, radiation and chemotherapy.

Surgery

Surgery proves to be an effective mode of treatment for early stage floor of the mouth cancer. For adequately removing the tumor from the floor of the mouth, 1.5 cm (3/4 of an inch) of normal tissue should surround the tumor. The surgeon can remove the tissues up to the bone if the tumor is not attached with the bone. If the tumor is attached to the jawbone, surgical procedure will involve removing part of the affected bone (mandibulectomy).

Reconstructive surgery can replace the part of the bone that is surgically removed. Lymph nodes of the neck are also removed by surgical procedure if they are affected.

If the cancer is in advanced stage, the surgery is complemented by radiation therapy and chemotherapy to prevent the recurrence of cancer on the same site and sometimes as palliative measure to reduce the symptoms of the cancer.

Radiation Therapy

Doctor will administer targeted doses of radiation to the affected site with the use of technology to separate healthy cells from cancerous cells.

Radiation therapy limits the growth of cancerous cells and reduces its size. Sometimes it is used in combination with surgery where radiation reduces size of the tumor, and also reduces the chances of cancer recurrence on the same site again.

Intensity modulated radiation therapy is also used to limit the growth of the tumor. This method is more effective than conventional radiotherapy techniques as it allows for more targeted doses while reducing the chances of side-effects.

Chemotherapy

Doctor administers chemotherapy if the cancer is spread to other organs and lymph nodes. The medicine disrupts the growth of the cancerous cells. Chemotherapy medications are administered though mouth or given through a vein over a period of many months.

Chemotherapy is mostly used in combination of surgery to reduce the size of the tumor. It is also used to slow the growth of the tumor and control the symptoms for palliative purpose when the cancer cannot be cured.

Treatment Side-Effects

Surgical removal of tumour and part of your jawbone can affect various functions like speech and talking, swallowing the food and breathing. Reconstructive surgery and speech therapy help in coping with the side-effects of the surgery.

Radiotherapy administered in the head and neck area can cause side-effects including dry and sore mouth, it also changes the taste of the mouth.

Chemotherapy side-effects are listed as under:

• Losing weight
• Loss of appetite
• Feeling very tired
• Feeling sick
• Less resistance to infections
• Bleeding and bruises

Conclusion

Horseshoe-shaped area under the tongue and between the sides of the lower jawbone (the mandible) is commonly known as floor of mouth. Men are prone to be diagnosed with floor of mouth cancer three to four times more often than women. Tobacco and alcohol use are the most significant risk factors for floor of mouth cancer. The cancer can be treated with surgery or radiation or chemotherapy or a combination of all three approaches. Shalby Hospitals’ Cancer & Research Institute at Ahmedabad and other centres in the country are well manned and equipped with the latest equipment for diagnosis and treatment of all cancer types. Our team of expert oncologists, onco-surgeons, radiologists and other cancer specialists diagnose and design a treatment plan; keeping in mind your overall health and progression of the cancer.