Mouth cancer: Disease that could steal John Farnham’s voice explained

The shock news of John Farnham’s mouth cancer diagnosis has prompted doctors to issue a health alert. See what signs to look for.

In the wake of singer John Farnham’s mouth cancer diagnosis doctors are urging people who have ulcers or sores in their mouths that have not healed after several weeks to see their GP.

Around 700 Australians a year develop mouth cancer which can have devastating consequences if it is not picked up early.

A sore (like an ulcer) or lump in the mouth that doesn’t go away after several weeks, a persistent pain in the mouth or ear, white or red patches on the gums, tongue or mouth and unusual bleeding or numbness in the mouth are all symptoms of mouth cancer and should be checked by a GP.

“It’s sort of a hidden condition because a lot of our patients who have major surgery don’t go out a lot, because they’re concerned about how they might look or how they might be perceived,” said Head and Neck surgeon Associate Professor Bruce Ashford.

Until recently there was a dearth of information available about the cancer but a new charity, Head and Neck Cancer Australia, has set up a website to help educate patients about signs of the conditions and explain how to cope with it.

“It’s a registered charity and its whole purpose is to give people information and educate them about mouth cancer, the short term impacts, the long term impacts and how to cope with those and what things you should be asking and trying to get help with,” he said.

“It’s such a dynamic area of the body, it’s a complicated path to recovery for everyone,” he said.

Here we explain what mouth cancer is and how it is treated.

WHAT IS MOUTH CANCER?

Mouth cancer occurs when abnormal cells in the mouth grow in an uncontrolled way. It can occur on the tongue, the cheeks, gums, roof of the mouth, tonsils and salivary glands.

HOW COMMON IS CANCER?

The Cancer Council says mouth cancer is not common. It is estimated that 687 new cases would be diagnosed in Australia in 2021.

WHO IS MORE LIKELY TO GET CANCER?

Men are about three times more likely to develop the cancer than women and nine in 10 people who get the cancer develop it after the age of 50.

Smoking tobacco and drinking alcohol are the key risk factors.

Three in four people who get the cancer have been a smoker or consumed alcohol regularly for a number of years according to Head and Neck Cancer Australia.

Cancer Australia says around 59 per cent of mouth cancers in Australia are caused by smoking. Around 31 per cent are caused by excess alcohol consumption.

However, Canberra head and neck surgeon Associate Professor Ardalan Ebrahimi, who is a director of Head and Neck Cancer Australia, said “you definitely do see it in young patients more and more”

Other risk factors for mouth cancer can include:

• human papillomavirus (HPV)

• Epstein-Barr virus (EBV)

• family history of mouth cancers

• poor oral hygiene and gum disease

• exposure to the sun

• chewing the seed of the areca palm tree (sometimes called areca or betel nut).

• lichen planus – an inflammatory condition that causes white and red patches in the mouth (although less than 1 in 100 people with this condition develop mouth cancer)

• broken and sharp teeth rubbing on the tongue and cheek

The Australian Institute of Health and Welfare (AIHW) says the lifetime risk of developing oral cancer is approximately 1 in 90 for men and 1 in 200 for women.

Most patients with this type of cancer will have a lump or an ulcer in their mouth that does not heal after a few weeks according to Assoc Prof Ebrahimi.

John Farnham is in intensive care after a nearly 12-hour operation to remove a tumour in the mouth.

WHAT ARE THE SYMPTOMS OF MOUTH CANCER?

Head and Neck Cancer Australia and Cancer Australia say common signs and symptoms include:

• a sore (like an ulcer) or lump in the mouth that doesn’t go away

• pain in the mouth or ear

• white or red patches on the gums, tongue or mouth

• unusual bleeding or numbness in the mouth

• trouble chewing or swallowing food, or moving the tongue

• difficulty opening the mouth

• a lump in the neck

• loose teeth or dentures that no longer fit

• pain when swallowing

• a sore throat that doesn’t get better

• changes in speech or trouble pronouncing words

• difficulty chewing or swallowing food or moving the tongue

HOW IS IT DIAGNOSED?

Mouth cancer is often diagnosed by a dentist who will refer you to a medical specialist for tests and treatments including scans, a biopsy which removes a small amount of tissue which is sent to a pathologist to determine if cancer cells are present.

This will usually take place in a specialists office under a local anaesthetic Assoc Prof Ebrahimi said.

A procedure called a nasoendoscopy may be used which involves a doctor inserting a very thin flexible tube with a light and camera on it to look inside your nose and nasopharynx.

“It’s really a way of looking in areas that are a little further back and not visible normally. You can look at the voice box, throat and the area behind the nose. This should be a standard part of the assessment for most patients with head and neck cancer,” Assoc Prof Ebrahimi said.

WHAT IS THE TREATMENT?

For most patient who have mouth cancer the treatment is “pretty profound” said head and neck cancer surgeon Associate Professor Bruce Ashford.

Surgery to remove the tumour is the most common treatment for mouth cancers. Depending on where the cancer is, the doctor may need to remove some of the tongue or jaw bone. For example most patients will also need the lymph glands from the neck removed with an operation called a neck dissection, Assoc Prof Ebrahimi said.

Many patients with oral cancer will also need major reconstruction surgery we take tissue from somewhere else in the body with its blood supply and use it to rebuild the area where surgeons removed the cancer and re-establish its blood supply with microsurgery. This type of surgery usually involves two surgical teams and the procedures are long and complex, often taking at least 10-12 hours.

Most patients will need a temporary tracheostomy to breathe and a feeding tube after surgery, and will spend 10 to 14 days in hospital and months recovering at home. For most patients the tracheostomy and feeding tubes are temporary and are removed before they are sent home.

John Farnham smoked from a very early age. Picture: Getty Images

WHAT TREATMENT WILL YOU NEED AFTER SURGERY?

Most people will spend a week or two in hospital and part of that is getting over the actual operation, re-establishing nutrition, re-establishing speaking and breathing said Assoc Prof Ashford.

“Anyone who has a big operation like this is really got 12 months ahead of them where they're in what we would call the early part of recovery,” he said.

Many patients require further treatment after surgery, with radiotherapy, sometimes in combination with chemotherapy. A typical treatment cycle is around six weeks.

Patients can be fitted with a nasogastric tube that goes through the nose down into the stomach to allow a person to be fed while they recover from the surgery. This is usually removed after a few days or weeks. However, some patients will require a permanent gastrostomy tube that goes through the skin and stomach wall to allow a person to be fed.

CAN YOU TALK OR SING AFTER TREATMENT?

Surgery and treatment for mouth cancer can impact on a patients voice and their ability to speak and swallow According to Head and Neck Cancer Australia. The changes can range from mild to severe.

Cancer Research UK says a patients voice might be huskier, quieter or “sound as though you have a cold all the time” after receiving treatment for mouth cancer. Some people may lose their voice, find it hard to say some words or slur some words. Often this is temporary and may improve when swelling after the surgery gets better.

Many patients will need speech and language therapy for several months after treatment.

“The long term impact (of treatment) can be very, very significant and affect a patients swallowing, their ability to speak and the way they look,” Assoc Prof Ebrahimi said.

“Occasionally, you have patients where it can be devastating and perhaps they can't eat and need a feeding tube for the rest of their life or their speech might become very difficult to understand.

“Our best change of curing patients and minimising long term side effects from treatment is early diagnosis and treatment before tumours become advanced.”

Assoc Prof Ebrahimi said he could not speculate on whether John Farnham would ever be able to sing again as he is not involved in his care.

“The best way to maximise recovery is to be informed and have the best of care and to an extent I'm sure that that's what he's getting,” he said.

“I wouldn't specifically talk about John Farnham, but I understand that that would be on people's mind.

“I think he's in great hands. And he'll have as good and outcome is as absolutely possible because he's got such good people after him. I think that's all you can I think that's all you can sensibly say.”

WHAT IS THE SURVIVAL RATE FOR THIS CANCER?

Sixty per cent of Australians who get mouth cancer will survive for at least five years according to the Australian Institute of Health and Welfare. This compares to the 68.9 per cent five year survival rate for all types of cancer.