Oral Cancer

Risk Factors

• Smoking (strong association, especially age >50)

• Excessive alcohol use

• Poor oral hygiene

• ATSI or migrant background (potential higher prevalence due to healthcare access disparities)

• Chronic dry mouth (Sjögren’s syndrome, head/neck radiotherapy, prolonged dehydration)

• Emerging evidence: HPV (particularly in oropharyngeal cancers, but some overlap in oral cavity involvement)

When to Biopsy

• Lesions persisting >3 weeks without an obvious cause

• Non-healing ulcers with indurated edges

• Leukoplakia (white patch), erythroplakia (red patch), or speckled lesions

• Unexplained lumps or swellings in the oral cavity

• Unilateral neck swelling suspicious for metastatic nodal spread

• Early biopsy is crucial to rule out dysplastic or malignant changes

Management

• Oral Health Measures

  • Daily use of fluoride toothpaste

  • Regular dental reviews to address caries, periodontitis, or ill-fitting dentures

• Lifestyle Modification

  • Smoking cessation programs or pharmacotherapy (significantly lowers recurrence risk)

  • Reduce or cease alcohol intake

  • Address poor nutrition and ensure adequate hydration

• Symptomatic Care

  • Oral lubricants (e.g. artificial saliva) for persistent dryness

  • Treat oral infections promptly (thrush, bacterial superinfection)

• Referral

  • ENT, oral/maxillofacial surgeons, or head and neck oncology team for biopsy and definitive management

  • Urgent referral if suspicious lesion or cervical lymphadenopathy

• Follow-Up

  • Close surveillance in high-risk individuals (smokers, previous oral cancer, immunosuppressed)

  • Regular assessment to detect recurrence or new lesions

Notes:

• Squamous Cell Carcinoma (SCC) is the most common oral malignancy

• Early detection significantly improves survival rates (localised disease more amenable to surgical resection or radiotherapy)

• Patients with dry mouth (xerostomia) secondary to radiotherapy or systemic disease require careful oral care to reduce caries and infection risk

• Any delay in diagnosis can markedly worsen prognosis, highlighting the importance of prompt biopsy of suspicious lesions