The most common type of oral cancer tends to spread quickly, but progression depends on several factors, including location. Early diagnosis and treatment are key.

Oral cancer refers to cancer that starts in the oral cavity (mouth). Oral cancer tumors usually begin in the lips or tongue. This type of cancer can also affect the floor or roof of the mouth, cheek lining, or gums.

Doctors refer to cancer that starts in the oropharynx as oropharyngeal cancer. The oropharynx contains the throat, tongue, soft palate, and tonsils.

With early diagnosis, oral cancer is highly treatable. When not caught early, oral cancer can grow and spread (metastasize).

This article will explore how oral cancer progresses, including where and how quickly it spreads.

Early signs and symptoms of oral cancer

There is no screening test for oral cancer, so it’s important to be aware of the early signs and symptoms of this disease. They include:

  • lip or mouth sores that don’t heal
  • mouth or jaw pain or swelling
  • lumps or thickened areas on the lips or anywhere within the oral cavity
  • red or white patches in the mouth
  • changes in the way your dentures fit
  • tooth pain or loose teeth
  • problems with swallowing or chewing
  • numb areas in the mouth or lips
  • ear pain
  • feeling like something is stuck in your throat
  • changes in the way your voice sounds to yourself or others
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Oral cancer progression varies by person. In some people, oral cancer may spread rapidly. In others, it may progress at a more moderate pace.

Cancer type

The type of oral cancer you have, the location of the tumor, and the stage it was in when you started treatment will be key factors in determining how quickly it may spread.

More than 90% of oral cancers are squamous cell carcinomas. This type of cancer originates in thin, flat cells called squamous cells.

Progression of oral squamous cell carcinomas (OSCCs) can be rapid and spread to nearby or even distant regions of the body. About 3–7% of oral squamous cell carcinomas spread to a secondary location each year, according to a 2021 review.

In a 2017 study, it took a median of 10–12 months for OSCC, even after treating the primary tumor, to spread either locally, regionally, or to distant structures. Some metastases developed in only 3 months.

But some OSCCs can develop slowly. Verrucous carcinoma, an OSCC subtype, typically grows slowly and is unlikely to spread.

Other types of oral cancer include:

Cancer location

The primary site of your oral cancer may also determine how likely it is to spread and how far.

According to a 2016 study, about 1 in 15 gum cancers had spread to distant structures, compared to 1 in 25 tongue cancers.

Lip cancers, the most common oral cancers, spread to nearby lymph nodes 3–29% of the time, but distant metastasis was rare.

Doctors classify oral cancer growth and spread using stages 0 through 4. They can further divide stage 4 into three substages (4A, 4B, and 4C) depending on where the cancer has spread. The higher the stage, the more advanced the cancer.

When oral cancer starts to spread, it infiltrates nearby lymph nodes in the neck on the same side as the primary (first) tumor. This typically occurs during stage 3.

Moderately advanced disease occurs during early stage 4A. The cancer may spread to nearby areas, including:

  • jaw or facial bones
  • the nerve to the jawbone (inferior alveolar)
  • the skin of the chin or nose
  • tongue muscles
  • maxillary sinus
  • voice box

Very advanced local disease (stage 4B) involves continued spread to nearby structures, including:

  • the base of the skull or nearby bones
  • the structures surrounding the carotid artery

The cancer is in stage 4C if it has spread to distant organs, such as the lungs, liver, or heart. The lung is the most common site for distant metastasis of OSCC.

How likely is oral cancer to spread?

If oral cancer diagnosis and treatment occurs in its early stages, the cancer is less likely to spread. Advanced disease is more likely to spread to nearby structures or distant organs.

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Oral cancer that has spread may cause symptoms in the areas of metastasis. These symptoms can often indicate other conditions, so it can be difficult to determine whether the symptoms are due to oral cancer.

If oral cancer has spread to the lymph nodes in your neck, you may notice a lump or swollen area. You may also feel neck pain or pain when you swallow.

If it has spread to the lungs, you may have a continual cough. You may also have chest pain or shortness of breath.

Oral cancer that spreads to your bones may weaken them, causing them to break more easily. You may feel pain in your back or other areas of the body.

Advanced cancer can cause overall feelings of fatigue (low energy) or nausea.

If you have oral cancer, your healthcare team will work with you on treatment options.

The earlier your diagnosis, the more optimistic your outlook. The site of the primary tumor and other factors, such as your overall health, will play a role.

The 5-year relative survival rate is the percentage of people with the condition who are still alive 5 years after diagnosis compared with people without the condition. The American Cancer Society lists these 5-year relative survival rates for oral cancer:

Localized (no spread)Regional (nearby spread)Distant spread
Floor of mouth73%42%23%

Keep in mind that the survival rates are averages based on previous data. Each situation is unique, and advances in diagnosis and treatment may lead to higher current and future survival rates.

Can mouth cancer spread to the brain?

Metastasis of oral cancer to the brain can occur but is extremely rare and unlikely.

Can mouth cancer spread to another person?

No. HPV-16, a subtype of the human papillomavirus (HPV) causes some oral and oropharyngeal cancers. HPV is contagious, but cancer is not.

How long can someone live with untreated mouth cancer?

It’s hard to say how long someone will live with untreated oral cancer. Many people do far better than expected.

A 2018 study notes that people with early-stage untreated oral cancer had a 5-year survival rate of 31.1%. People with stage 4 untreated oral cancer had a 5-year survival rate of 12.6%.

Oral cancers usually spread at a moderate-to-fast pace. The location of the primary tumor and the type of cancer you have will influence how quickly it spreads.

Since there’s no screening test for oral cancer, you may not realize you have it until it has reached a later stage. While your outlook is best the earlier you detect it, oral cancer is treatable at any stage.