Head and neck cancers can develop in the mouth, tongue, throat, tonsils, voice box and other structures of the head and neck. Some may cause noticeable symptoms early, while others can initially present as subtle changes that are easy to overlook.

A persistent mouth ulcer, unexplained lump, change in the tongue or ongoing throat discomfort does not necessarily mean cancer. Many of these symptoms have benign causes. However, when a change does not resolve as expected, it should be assessed by a healthcare professional.

For people in Singapore, regular dental examinations and timely assessment by an ENT specialist can help investigate persistent symptoms and determine whether further testing is needed.

Early symptoms of tongue cancer dentists should look for

The tongue is an important site to examine during routine oral examinations. Tongue cancer can develop on different parts of the tongue, with the sides and underside being areas that require careful inspection.

Early signs may include:
– A mouth ulcer that does not heal
– A lump or thickened area on the tongue
– A persistent red or white patch
– Unexplained bleeding
– Ongoing tongue pain or tenderness
– Numbness or altered sensation
– Difficulty moving the tongue
– Difficulty chewing or swallowing
– Persistent changes in speech

Not every tongue lesion is cancerous. Trauma from a sharp tooth, dental appliance or accidental biting can cause ulcers and other changes. Infections and inflammatory conditions can also produce similar findings.

The duration and behaviour of a lesion are therefore important. If an obvious source of trauma is identified and removed, the area would generally be expected to improve. If it remains unchanged or continues to worsen, further evaluation may be appropriate.

During an oral examination, a dentist can assess the lesion’s location, size, colour, surface and consistency, as well as examine the surrounding tissues. A neck examination may also be considered when there are findings that raise concern.

Patients should also report changes they notice between dental appointments. A sore or patch that persists should not be repeatedly ignored simply because it is painless. Some oral cancers can initially cause little or no pain.

Persistent mouth ulcers and when to consider a biopsy

Mouth ulcers are common, and most resolve without treatment within one to two weeks. They can occur because of minor trauma, irritation, infections, nutritional deficiencies, medications and several inflammatory conditions.

A mouth ulcer that persists for more than two weeks, however, should be professionally assessed, particularly when there is no clear cause.

Features that may warrant closer investigation include an ulcer that is:
– Persistent or progressively increasing in size
– Firm or indurated around the edges or base
– Irregular in appearance
– Associated with unexplained bleeding
– Accompanied by a red or white patch
– Associated with numbness or persistent pain
– Located on the side or underside of the tongue
– Associated with a lump in the neck
– Accompanied by difficulty swallowing or speaking

A healthcare professional may initially look for an identifiable cause, such as repeated trauma from a tooth or dental appliance. If the lesion does not resolve after the suspected irritant has been addressed, referral to an appropriate specialist or consideration of a biopsy may be necessary.

A biopsy involves taking a small sample of tissue for examination under a microscope. It can help determine whether a persistent lesion is benign, precancerous or cancerous.

Importantly, pain is not a reliable way to determine whether an ulcer is concerning. A persistent painless ulcer can also require investigation. Patients should therefore avoid relying solely on pain or discomfort to decide whether a lesion needs medical attention.

A head and neck cancer specialist or otolaryngologist may become involved when a lesion requires further assessment, particularly when the abnormality extends beyond the areas routinely assessed during dental care.

HPV-related throat cancers and rising incidence

Human papillomavirus (HPV) is a very common viral infection. Certain high-risk HPV types can cause cellular changes that, in some people, eventually contribute to cancer.

HPV is now recognised as an important cause of some oropharyngeal cancers, particularly cancers affecting the tonsils and base of the tongue. The incidence of HPV-associated oropharyngeal cancer has increased in several countries, making awareness of these cancers increasingly important.

HPV-related throat cancer can occur in people who do not have the traditional risk factors associated with some other head and neck cancers. Tobacco and alcohol remain important risk factors for many head and neck cancers, but their absence does not completely eliminate the possibility of cancer.

Symptoms that warrant assessment may include:

A persistent sore throat
Difficulty or pain when swallowing
A lump in the neck
Persistent enlargement of one tonsil
Ear pain without an obvious ear problem
Persistent voice changes
Unexplained weight loss

A neck lump can sometimes be one of the first noticeable signs of an oropharyngeal cancer. Because parts of the oropharynx, including the base of the tongue and tonsils, are not easily examined at home, persistent symptoms may require assessment.

It is also important to distinguish HPV infection from HPV-related cancer. HPV infection is extremely common, and most infections do not result in cancer. Persistent infection with certain high-risk HPV types is the concern, rather than simply having been exposed to HPV.

When should you see an ENT specialist?

Many symptoms associated with head and neck cancer have causes that are not cancerous. A sore throat may result from an infection, a mouth ulcer may follow minor trauma, and a neck lump may have several possible explanations.

The important factor is often persistence.

If a symptom continues beyond the period in which it would normally be expected to resolve, repeatedly returns without an obvious explanation or progressively changes, medical assessment is appropriate.

An ENT doctor can assess symptoms involving the ear, nose, throat, mouth and neck. Depending on the symptoms and examination findings, further investigations may include endoscopy, imaging, tissue sampling or referral to another specialist.

Patients should consider seeking professional assessment for:
– A mouth ulcer lasting more than two weeks
– A persistent red or white patch in the mouth
– An unexplained lump or thickened area
– Persistent tongue pain or numbness
– Difficulty moving the tongue
– Difficulty swallowing or chewing
– A persistent sore throat
– An unexplained neck lump
– Persistent hoarseness or voice changes
– Unexplained bleeding
– Unexplained weight loss

Seeking an assessment does not mean that cancer is suspected in every case. Rather, it provides an opportunity to identify the cause of a persistent symptom and determine whether further investigation is necessary.

Why early detection matters

Head and neck cancer can sometimes be identified before symptoms become extensive, particularly when persistent abnormalities are recognised and investigated promptly.

Dentists have an important role in detecting suspicious changes in the mouth and tongue during routine examinations. Patients also play an important role by paying attention to changes between appointments and reporting symptoms that do not resolve.

Regular dental care can provide opportunities to identify oral abnormalities, while an otolaryngologist can assess persistent symptoms involving the throat, tonsils, voice and neck.

The goal is not to assume that every ulcer, lump or sore throat represents cancer. It is to recognise when a symptom falls outside the usual pattern and should be investigated.

Early attention to persistent symptoms can help ensure that patients receive the appropriate examination, investigation and treatment without unnecessary delay. If you notice an unexplained change in your mouth, tongue, throat or neck that persists, speak with your dentist or...

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