GPAtlas🧭 When to suspect
Oral cancer is malignancy of the lip and oral cavity – the great majority are squamous cell carcinoma (SCC).
• Around 12,400 new mouth and throat cancers are diagnosed in the UK each year, and incidence is rising.
• Most cases occur in men over 55.
• The tongue is the commonest site.
An unexplained mouth ulcer lasting more than 3 weeks is oral cancer until proven otherwise.
Early disease is frequently painless, so both patient and clinician are easily falsely reassured – persistence, not pain, is the warning sign.
There are two referral decisions:
• Refer a persistent ulcer or a persistent, unexplained neck lump yourself on the suspected cancer pathway (previously the two-week wait) to the local head and neck team – oral and maxillofacial surgery (OMFS) or ear, nose and throat (ENT).
• Route a lip or oral-cavity lump or a red/red-and-white patch for urgent dental assessment.
| Presenting feature | Referral route | Timeframe |
|---|---|---|
| Unexplained oral-cavity ulceration > 3 weeks | Suspected cancer pathway referral (by GP) | Diagnosis or cancer ruled out within 28 days |
| Persistent, unexplained neck lump | Suspected cancer pathway referral (by GP) | Diagnosis or cancer ruled out within 28 days |
| Lump on the lip or in the oral cavity | Urgent referral for assessment by a dentist | Within 2 weeks |
| Red or red-and-white patch (erythroplakia/erythroleukoplakia) | Urgent referral for assessment by a dentist | Within 2 weeks |
Raise suspicion further in:
• Heavy smokers or tobacco/betel-quid chewers
• Heavy drinkers
• Those with HPV-related risk
• Patients with a previous head and neck cancer
Where local pathways give the GP direct access to an urgent head and neck clinic, suspicious lumps and patches are often referred there directly – follow your local pathway.
|
⚠️ Common pitfall • Re-labelling a persistent ulcer as “traumatic” or “denture-related” and watching it. • It is reasonable to remove the obvious cause (smooth a sharp tooth, adjust a denture) – but you must set a healing deadline. • If the ulcer has not healed at 3 weeks despite removing the cause, refer on the suspected cancer pathway rather than re-issuing the same explanation. |
Source: NICE NG12
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