Oral Ulcer and Cancer

Oral ulcer is fairly common.  It may be periodic.  It comes and goes almost every month.  It is painful.  We usually call it canker sore.  It may have no obvious reason.

Some types of ulcer may have obvious reason.  Mr. Wang goes to see a dentist for a crown.  There must be a lot of poking during the procedure.  Furthermore, a few days later, Mr. Wang has a barbecue party.  He heavily and suddenly bites on a piece of hot and juicy steak as well as a piece of his own cheek meat.  It causes a large ulcer (Fig.1 black arrowhead) and an awful swelling of surrounding tissue (*).  Since Mr. Wang used to be a heavy smoker and drinker, we advice him to return to office for follow-up in two weeks.  If the ulcer does not heal by that time, we have to do biopsy to rule out whether it is a cancer or not.

Fortunately, two weeks later, he feels much better.  The ulcer and swelling are much smaller (Fig.2).  We do not have to do biopsy.  In fact the big ulcer may be caused by a sharp tooth in the bottom (Fig.1 red arrowhead).  In brief, oral ulcer is a benign lesion.  It will heal soon.

On the other hand, oral cancer will not heal in two weeks.  It looks like an ulcer (Fig.3,4; Fig.4 is a mirror image of Fig.3).  Oral cancer is usually not painful.  The patient usually feels that it is not a big deal.  In fact, it is a severe mistake and a bad idea. In this case, the ulcer is initially thought to be caused by eating something hot (burning).  However, it does not heal in two weeks.  Biopsy is ignored.  It does not heal in six or twelve months months.  Finally cancer cells metastasize to the neck.  The prognosis is poor.

In summary, we should see a dentist if oral ulcer does not heal in two week.  Biopsy may be necessary.

Xin Wei, DDS, PhD, MS 1st edition 04/22/2012, last revision 04/22/2012