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, incidence is rising, and most cases occur in men over 55. The tongue is the commonest site.
The single most important rule in primary care: 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 (the formal name for the 2-week-wait, 2WW, referral) 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) | Within 2 weeks |
| Persistent, unexplained neck lump | Suspected cancer pathway referral (by GP) | Within 2 weeks |
| 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, and patients with a previous head and neck cancer. Where local pathways give the GP direct access to a 2-week 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
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.