Jaw Cancer

Overview

Jaw cancer is a rare kind of cancer that starts in the bones of the jaw — the lower jaw (mandible) or the upper jaw (maxilla). Some jaw cancers begin in the bone itself, such as osteosarcoma (a cancer of bone-forming cells). Others start in the gums, the lining of the mouth, or the salivary glands and then grow into the jaw bone. Sometimes cancer from another part of the body spreads to the jaw. Because the jaw sits close to the teeth, mouth and sinuses, jaw cancer can cause problems that at first look like everyday dental issues — which is why a dentist is often the first person to notice something is wrong.

No, jaw cancer is rare. Cancers that start in the jaw bone itself are very uncommon. Cancer that spreads into the jaw from the mouth or elsewhere is seen more often, but it is still not a common problem. Most people who see a doctor about a jaw swelling will not have cancer.

Jaw cancer can affect anyone, but it is more often diagnosed in adults over 50. It is more common in men than in women. People who smoke, chew tobacco or areca nut (betel nut), drink a lot of alcohol, or have poor mouth hygiene have a higher risk. It can also occur in children and teenagers, especially the bone-type cancers, but this is very rare.

Symptoms

Common symptoms

• A lump or firm swelling in the jaw, cheek or gum that does not go away
• Pain in the jaw or face that keeps coming back or does not improve
• Teeth that become loose for no clear reason, or a denture that suddenly stops fitting
• Numbness or tingling in the lip, chin, cheek or lower face
• A sore or ulcer in the mouth that does not heal within a few weeks
• Bleeding from the mouth or gums without an obvious cause
• Difficulty opening the mouth fully, or a feeling that the jaw is stiff
• Bad breath or an odd taste that does not settle
• A lump in the neck
• Unexplained weight loss or feeling very tired

Symptoms in children

• Swelling or unevenness on one side of the face or jaw
• Pain in the jaw that does not get better
• Teeth that shift position or come through in an unusual place
• A child who is reluctant to chew or open their mouth wide
• Numbness around the lip or chin
• In rare cases, a visible lump that grows over weeks

Symptoms in older adults

• A denture that no longer fits comfortably, or gums that become sore under it
• Loose teeth, especially when several become loose at once
• Numbness or a 'dead' feeling in the lower lip or chin
• A painless hard lump in the jaw found by chance
• Long-standing mouth ulcers that do not heal
• Weight loss, tiredness, or difficulty eating that is put down to age

Causes

Main causes

• In most cases the exact cause is not known. Cancer develops when cells in the jaw bone or nearby tissues start to grow out of control because of changes (mutations) in their genetic material.
• Some jaw cancers start in the lining of the mouth or gums and grow into the jaw bone over time.
• Some are cancers that began somewhere else in the body and spread (metastasised) to the jaw.
• Some are linked to long-term irritation or inflammation, or to earlier radiotherapy to the head and neck.

Risk factors

• Smoking or using other tobacco products
• Chewing tobacco, areca nut (betel nut) or paan
• Drinking a lot of alcohol regularly
• Poor mouth hygiene and untreated dental problems
• Previous radiotherapy to the head or neck, especially in childhood
• Long-term mouth inflammation or certain long-standing jaw conditions
• Some rare inherited conditions that affect bone growth
• Being over 50 and being male

When to see a doctor

See a doctor urgently if:

• A hard lump or swelling in the jaw that is new or growing
• Numbness or tingling in the lip, chin or cheek
• A mouth ulcer or sore that has lasted more than 3 weeks
• Teeth that have become loose without an obvious reason
• Bleeding from the mouth or gums that keeps returning
• Difficulty opening your mouth or swallowing

Book a routine appointment if:

• Jaw or face pain that has not settled after a few weeks
• A denture that no longer fits well
• A clicking or catching jaw, or jaw stiffness
• A lump in the neck that you can feel
• Any change in your mouth that worries you

Diagnosis

Your dentist or doctor will start by asking about your symptoms and examining your mouth, jaw, face and neck. They may feel for lumps and check how your jaw moves. If anything looks unusual, you will usually be referred to a specialist, often at a hospital head and neck clinic. There, a team will arrange scans and usually take a small sample of tissue (a biopsy) to look at under a microscope. Only a biopsy can confirm whether a lump is cancer, and which type it is.

Tests that may be done

• A full examination of the mouth, jaw, face and neck
• Dental X-rays, which may show changes in the jaw bone
• A CT scan, which uses X-rays to build detailed pictures of the jaw and surrounding areas
• An MRI scan, which uses magnets and radio waves to show soft tissue clearly
• A PET scan or bone scan, sometimes used to check the whole body
• A biopsy — a small tissue sample taken with a fine needle or during a short procedure — examined in a laboratory
• Blood tests to check your general health

What to expect at your appointment

Being referred for tests can feel worrying. The process usually takes a few weeks, and you may have more than one appointment. Some tests are quick and painless; a biopsy may cause brief discomfort and is usually done with local anaesthetic (numbing medicine). You are welcome to bring someone with you, to write down questions, and to ask for things to be explained again. Nothing will be done without your consent, and you can ask what each test is for.

Treatment

Treatment depends on the type of jaw cancer, its size, whether it has spread, and your general health. A team of specialists — including surgeons, cancer doctors, dentists, and speech and swallowing therapists — will plan your care together and discuss the options with you. The aim is usually to remove the cancer while keeping as much normal function and appearance as possible.

Self-care at home

• Keep your mouth as clean as you can — gentle brushing and any mouth rinse your team recommends
• Stop smoking if you smoke; your team can offer support and nicotine replacement options
• Cut down on alcohol, especially during treatment
• Eat soft, nourishing foods if chewing is uncomfortable, and ask about a dietitian
• Keep up gentle jaw exercises if your team advises them
• Attend all follow-up appointments, even when you feel well
• Write down questions before appointments so you do not forget them

Medical treatments

Treatment is planned by a specialist team and may combine several approaches. Surgery is the most common main treatment, aiming to remove the cancer and a small margin of healthy tissue around it. Radiotherapy (high-energy rays that damage cancer cells) may be used before or after surgery, or on its own. Chemotherapy (medicine that attacks fast-growing cells) may be used for certain types of jaw cancer or if the cancer has spread. Some people are offered targeted therapy or immunotherapy, which work in specific ways against particular cancer cells. You may also be offered help with pain, nutrition, dental repair, speech and swallowing. Your team will explain the benefits and downsides of each option so you can decide together.

When is surgery considered?

Surgery is often the main treatment for jaw cancer. The surgeon removes the tumour along with a margin of healthy tissue to reduce the chance of it coming back. If part of the jaw is removed, it can often be rebuilt at the same time using bone from another part of the body or man-made materials, and missing teeth can later be replaced with dental implants or a prosthesis (an artificial replacement). Surgery may be followed by radiotherapy. Your team will explain what is involved, the likely effects, and what rehabilitation — such as speech therapy, physiotherapy or dental work — can help.

Living with this condition

Life after treatment for jaw cancer often involves adjustments, at least for a while. Eating, speaking, and how your face looks may change, and this can take time to get used to. Most people find that things improve steadily with rehabilitation and support. Regular follow-up appointments help your team catch any problems early. It is normal to have good days and harder days — ask for help when you need it.

Lifestyle tips

• Stay smoke-free — this lowers the risk of the cancer returning
• Keep alcohol to a minimum
• Keep your mouth and any dentures or implants very clean
• Attend dental check-ups regularly
• Build gentle activity into your day, such as short walks — this helps energy and mood
• Protect your face and lips from strong sun
• Keep up speech, swallowing and jaw exercises as advised
• Get enough rest, especially in the weeks after treatment

Diet and exercise

Good nutrition really matters. Treatment can make chewing and swallowing harder and can change how food tastes, so a dietitian can help you find soft, high-energy foods you enjoy — such as soups, mashed meals, smoothies, yoghurt, eggs and soft fish. Aim to eat little and often if big meals feel difficult, and keep drinking fluids. Gentle exercise, like walking or light stretching, helps your energy, mood and recovery. Build up slowly and check with your team before starting anything strenuous.

Mental health and emotional wellbeing

A cancer diagnosis, and changes to your face, speech or eating, can bring up a lot of feelings — fear, sadness, anger, frustration, or worries about how others see you. These feelings are normal and very common. Talking helps: to family, friends, your specialist nurse, a counsellor or a support group. If you feel low for more than a couple of weeks, or if you have thoughts of harming yourself, please reach out straight away — contact your doctor, your local emergency number, or a crisis support line in your country. You do not have to cope alone.

Prevention

There is no guaranteed way to prevent jaw cancer, and many people who develop it have no obvious risk factors. But some healthy choices clearly lower the risk of cancers in and around the mouth: not smoking, avoiding tobacco and areca nut (betel nut) products, keeping alcohol low, looking after your teeth and gums, and having regular dental check-ups so any changes are spotted early.

Vaccines

There is no vaccine against jaw cancer itself. Vaccines against HPV (human papillomavirus) help protect against several cancers linked to HPV, including some cancers of the mouth and throat. Ask your doctor or local health service whether HPV vaccination is recommended for you or your children.

Screening programmes

There is no routine screening programme specifically for jaw cancer. In many countries, dentists check the mouth, head and neck during normal dental visits, which is one good reason to keep up regular check-ups — especially if you smoke or chew tobacco. If you notice a lump, a sore that will not heal, or numbness in your jaw or lip, get it checked rather than waiting for your next appointment.

Complications

If left untreated

• The cancer can grow larger and damage more of the jaw bone, teeth and surrounding tissue
• It can spread to lymph nodes in the neck, or to other parts of the body such as the lungs
• Eating, drinking and speaking can become difficult, leading to weight loss and poor nutrition
• There is a higher chance of pain, infection, or of the jaw bone weakening or breaking
• Treatment becomes more extensive and more difficult the later the cancer is found

Long-term outlook

The outlook for jaw cancer varies a lot depending on the type of cancer, how large it is, whether it has spread, and your general health. When jaw cancer is found early, treatment is often simpler and works well, and many people do very well. Modern surgery and reconstruction, plus rehabilitation, can restore eating, speech and appearance to a good level. Your specialist team is the best source of information about your own situation, and it is always reasonable to ask them what to expect and what support is available.

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