When are oral ulcers a cause for worry?

Published on 21 February 2023

Ulcers in the mouth are common. However, knowing when these ulcers are a cause for concern can save lives.

Most of us – both adults and children – have experienced oral ulcers at some point in their lives. Often, these oral ulcers dissipate with the application of topical medication. 

There are, however, instances where a seemingly harmless ulcer in the mouth becomes a serious cause for concern.

Specifically, these ulcers can be a symptom of a more serious condition: oral cancer – the third most common head and neck cancer in Singapore.

“There are approximately 250 new cases of oral cancer per year in Singapore. It accounts for approximately 100 cancer-related deaths per year,” shared Dr Lim Wei Sian, a Consultant at the Division of Surgical Oncology, National University Cancer Institute, Singapore (NCIS). Dr Lim is also a Consultant at the Department of Otolaryngology - Head & Neck Surgery,  National University Hospital (NUH) and Department of Otolaryngology - Head & Neck Surgery,  Alexandra Hospital (AH).

Oral cancers can occur anywhere in the mouth, with the most common areas being the tongue followed by the floor of the mouth. Oral cancers can be divided into four stages, depending on the size, location, and extent of local, regional, and if tumour has spread to other areas of the body. More advanced stage cancers carry a worse prognosis. Some of the common symptoms of oral cancer include: 

• Ulcer in the mouth that does not heal 

• A lump in the mouth which may be painful or causes bleeding 

• A lump in the neck when the cancer spreads to the lymph nodes 

The primary treatment for oral cancer is often surgery. Dr Lim explained, “The surgery may sometimes be complex if the tumours are large. Other than removing the primary tumour, the lymph nodes in the neck will usually need to be removed as well. For more extensive tumours, it may be necessary to reconstruct the surgical defect with tissues from elsewhere in the body.”

Advanced oral cancers (Stage 3 and above) may require additional treatment with post-operative radiotherapy and possibly chemotherapy. 

“Post-treatment, patients may at times also require voice and swallowing rehabilitation with speech therapists before they can speak intelligibly and swallow normal food,” Dr Lim added. 

The good news is that oral cancer is not known to be directly hereditary. This means that by making healthy lifestyle choices, oral cancer can often be avoided, with the main risk factors of the disease being smoking and drinking. Other risk factors include betel nut chewing, smokeless tobacco consumption, and ill-fitting dentures.

“Smoking and consuming alcohol each increases the risk of cancer by five to eight times,” Dr Lim elaborated. “However, in patients who smoke and drink, the risk of cancer is multiplied, up to 35 times as compared to the normal population.”