# Oral cavity cancer (mouth and tongue)

Source: https://onco.cc/cancers/oral-cavity-cancer/  
OnCo record `oral-cavity-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer of the mouth and tongue, a head and neck cancer, 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.

## Summary

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.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Oral cancer; Mouth cancer; Tongue cancer; Oral squamous cell carcinoma
- Tags: subtype-page
- Group: head and neck
- Burden: 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.
- Subtypes: Oral tongue; Floor of mouth; Buccal mucosa and gingiva (betel-quid related); Lip (sun-related); Hard palate and retromolar trigone
- Biomarkers: Depth of invasion (staging and elective neck dissection); Extranodal extension and margin status; TP53 mutation; PD-L1 combined positive score (recurrent disease)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/oral-cavity-cancer/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/oral-cavity-cancer/#overview [3 subtypes, 3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/oral-cavity-cancer/#what-it-is [8 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/oral-cavity-cancer/#finding-it [4 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/oral-cavity-cancer/#treating-it [5 settings, 2 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/oral-cavity-cancer/#evidence [12 trials, 2 trials in the subtypes, 5 key papers, 4 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/oral-cavity-cancer/#science [12 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/oral-cavity-cancer/where-you-are/ [25 centres in the subtypes]
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/oral-cavity-cancer/#living-with-it [17 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/oral-cavity-cancer/coming/ [5 medicines, 3 medicines in the subtypes, 12 trials, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/oral-cavity-cancer/data/ [45 connected records]

## Standard of care

- Screening in high-risk populations: Visual oral examination by trained workers reduced mouth cancer deaths in the Kerala trial; opportunistic examination by dentists elsewhere. ([Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/))
- Early disease: Wide excision with elective neck dissection when depth of invasion exceeds about 3 to 4 mm; sentinel node biopsy in selected cases. ([Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/))
- Locally advanced disease: Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for positive margins or extranodal extension. ([Cisplatin](https://onco.cc/drugs/cisplatin/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/))
- Recurrent or metastatic: Pembrolizumab with or without chemotherapy (KEYNOTE-048); low-cost metronomic methotrexate and celecoxib where access is limited. ([Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [KEYNOTE-048](https://onco.cc/trials/keynote-048/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)](https://onco.cc/trials/metronomic-vs-cisplatin-tmh/))
- Prevention: Tobacco and betel quid cessation, alcohol reduction, treatment of premalignant patches. ([Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/))

## 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.

## Open problems

- Late presentation remains the norm in the highest-incidence countries.
- 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.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Oral_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Oral_cancer

## Connected records

- cancers: [Buccal mucosa and gingivobuccal cancer (oral cancer in India)](https://onco.cc/cancers/buccal-mucosa-cancer/), [Head and neck squamous cell carcinoma](https://onco.cc/cancers/head-and-neck/), [HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer)](https://onco.cc/cancers/hpv-negative-head-and-neck-cancer/), [Laryngeal and hypopharyngeal cancer](https://onco.cc/cancers/laryngeal-cancer/), [Lip cancer](https://onco.cc/cancers/lip-cancer/), [Oral tongue and floor of mouth cancer](https://onco.cc/cancers/oral-tongue-cancer/), [Oropharyngeal cancer (tonsil and base of tongue)](https://onco.cc/cancers/oropharyngeal-cancer/), [Recurrent or metastatic head and neck squamous cell carcinoma](https://onco.cc/cancers/recurrent-metastatic-hnscc/)
- drugs: [Celecoxib](https://onco.cc/drugs/celecoxib/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Nivolumab](https://onco.cc/drugs/nivolumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- terms: [Depth of invasion (DOI)](https://onco.cc/terms/depth-of-invasion/), [Extranodal extension (ENE)](https://onco.cc/terms/extranodal-extension/)
- key papers: [Effect of screening on oral cancer mortality in Kerala, India](https://onco.cc/key-papers/paper-sankaranarayanan-oral-screening-lancet-2005/), [Elective versus therapeutic neck dissection in node-negative oral cancer](https://onco.cc/key-papers/paper-dcruz-elective-neck-dissection-nejm-2015/), [EORTC 22931: postoperative irradiation with or without concomitant cisplatin for locally advanced head and neck cancer](https://onco.cc/key-papers/paper-bernier-eortc-22931-nejm-2004/), [KEYNOTE-048: pembrolizumab, alone or with chemotherapy, as first treatment for recurrent or metastatic head and neck cancer](https://onco.cc/key-papers/paper-keynote-048-lancet-2019/), [RTOG 9501: postoperative concurrent radiotherapy and chemotherapy for high-risk head and neck squamous cell carcinoma](https://onco.cc/key-papers/paper-cooper-rtog-9501-nejm-2004/)
- technologies: [Head and neck reconstruction: the free flap, and what it gives back](https://onco.cc/technologies/rejuv-recon-head-neck/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/)
- trials: [A Study Evaluating the Safety and Efficacy of PRV111, PRV211, and PRV131 in Subjects With Oral and Lung Cancers](https://onco.cc/trials/nct05893888/), [CheckMate 141](https://onco.cc/trials/checkmate-141/), [Comparing Sentinel Lymph Node (SLN) Biopsy With Standard Neck Dissection for Patients With Early-Stage Oral Cavity Cancer](https://onco.cc/trials/nct04333537/), [Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)](https://onco.cc/trials/elective-neck-dissection-tmh/), [Evaluation of Sentinel Lymph Nodes in Head and Neck Squamous Cell Carcinoma](https://onco.cc/trials/nct00911326/), [Kerala oral cancer visual screening trial (Trivandrum)](https://onco.cc/trials/kerala-oral-screening/), [KEYNOTE-048](https://onco.cc/trials/keynote-048/), [Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)](https://onco.cc/trials/metronomic-vs-cisplatin-tmh/), [Personalized Neck Radiation Therapy Directed by Sentinel Lymph Node Biopsy for the Treatment of Oral Cavity Squamous Cell Carcinoma, PRECEDENT Trial](https://onco.cc/trials/nct07121595/), [Pilocarpine in Preventing Mucositis and Dry Mouth in Patients Receiving Radiation Therapy for Head and Neck Cancer](https://onco.cc/trials/nct00003139/), [RRx-001 for Reducing Oral Mucositis in Patients Receiving Chemotherapy and Radiation for Head and Neck Cancer](https://onco.cc/trials/nct05966194/), [Safety and Efficacy of APG-157 in Head and Neck Cancer](https://onco.cc/trials/nct05312710/)
- targets: [CHCHD7](https://onco.cc/targets/chchd7/), [CRTC1](https://onco.cc/targets/crtc1/), [CRTC3](https://onco.cc/targets/crtc3/), [HMGA2](https://onco.cc/targets/hmga2/), [MAML2](https://onco.cc/targets/maml2/), [MYB](https://onco.cc/targets/myb/), [NFIB](https://onco.cc/targets/nfib/), [PLAG1](https://onco.cc/targets/plag1/), [TCEA1](https://onco.cc/targets/tcea1/), [WIF1](https://onco.cc/targets/wif1/)

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JSON: https://onco.cc/api/v1/entities/oral-cavity-cancer.json