What to Know About Floor of the Mouth Cancer

Floor of the mouth cancer is a type of oral cancer that forms under the tongue. Smoking, tobacco use, and drinking alcohol are some of the main risk factors for this form of cancer.

If you have floor of the mouth cancer, you’ll likely notice changes in how the tissue under your tongue looks and feels. You might have a sore or lump in your mouth.

Like all forms of cancer, early diagnosis is an important factor in the outlook. Treatment options include surgery, radiation, and chemotherapy.

Read on to learn more about floor of the mouth cancer.

Symptoms

One of the primary symptoms of floor of the mouth cancer is a lump or bump under the tongue. It might look like white patches, sores that won’t heal, or raised pink and red bumps.

Often, this lump is fairly prominent and will be visible in the mirror if you lift up your tongue.

Additional symptoms can include :

• mouth pain
• difficulty moving your tongue
• painful or difficult swallowing
• loose teeth
• unintentional weight loss
• a lump or swelling in the neck
• ear pain

Cancer stages

Doctors use stages to discuss the size and spread of cancer tumors.

Floor of the mouth cancer is divided into four stages, and each stage has distinct criteria. The lower the stage, the less severe the cancer.

Stages of floor of the mouth cancer include :

• Stage I: Stage I tumors are less than 2 centimeters (cm) with less than 5 millimeters (mm) deep.
• Stage II: Stage II tumors are deeper in the tissue than stage I but have not spread into the lymph nodes or surrounding tissues.
• Stage III: Stage III tumors are at least 3 cm and 10 mm deep, and they have spread to lymph nodes.
• Stage IVa: Stage IVa tumors have spread to lymph nodes but not other surrounding areas.
• Stage IVb: Stage IVb cancer has spread beyond the lymph nodes and into nearby tissues, membranes, and muscles.
• Stage IVc: Stage IVc cancer has spread to distant areas like the lungs and bones.

Causes and risk factors

As is true for all cancer types, floor of the mouth cancer begins with changes to the DNA of your cells. These mutated cells grow too quickly and overwhelm your healthy cells.

Researchers aren’t sure what causes the specific changes that lead to floor of the mouth cancer. However, all oral cancers have been linked to tobacco use. This includes cigarettes, chewing tobacco, cigars, and pipes.

In addition to tobacco, risk factors for floor of the mouth cancer include:

• Heavy alcohol use: Alcohol use is linked to an increased risk of many types of cancer, including floor of the mouth cancer.
• A weakened immune system: There’s a link between a weakened immune system and a higher risk of floor of the mouth cancer. This includes conditions that weaken the immune system and immunosuppressant medications.
• Human papillomavirus (HPV): HPV is a virus that’s passed through sexual contact. It’s associated with a higher risk of multiple cancer types, including floor of the mouth cancer.

Diagnosis

If your doctor suspects floor of the mouth cancer, they’ll start with an oral examination. They might use a tool such as a tongue depressor to get a look at the floor of your mouth, and they’ll also look at areas such as your nose, throat, and ears.

Additionally, they may order tests including:

• Oral biopsy: A biopsy is a test that can confirm cancer. During a biopsy, healthcare professionals will remove a piece of tissue from the floor of your mouth, and then they’ll test the cells in a lab.
• Imaging tests: Imaging tests such as X-rays, MRIs, and CT scans can help doctors see the size and shape of the tumor and tell whether it has spread to any nearby areas. This information can be used to stage the cancer and plan treatment.

Treatment

Treatment depends on factors such as stage at diagnosis, your overall health, and the exact location of your tumor. Common treatment options include:

• Surgery: Surgery is typically the first step, and it’s sometimes the only treatment needed for early stage cancer. A surgeon might need to remove tissue around the tumor or even parts of the jaw to ensure that the entire tumor is removed.
• Reconstructive surgery: Surgeons sometimes do reconstructive surgery to replace parts of the jaw that were removed during tumor surgery.
• Lymph node removal: This may be necessary if the cancer has spread to surrounding lymph nodes.
• Chemotherapy: Chemotherapy can help kill remaining cancer cells and prevent them from spreading.

Outlook

The outlook for floor of the mouth cancer depends on factors such as the stage of your cancer, where it’s located, and personal factors like your age, genetics, and overall health.

As is true for all cancers, the survival rates are highest when it’s treated at an early stage.

Data shows that floor of the mouth cancer has a 5-year survival rate of about 75% when treated in early stages. Cancer that has spread to distant areas of the body before treatment has a 5-year survival rate of about 25% percent.

The bottom line

Floor of the mouth cancer is an oral cancer that forms beneath the tongue. You might notice a lump or sore under your tongue that is visible in the mirror.

This cancer is most treatable and has a better outlook when diagnosed in its early stages. If you receive a diagnosis of floor of the mouth cancer, you may need surgery and chemotherapy.