Sigmund Freud and Oral Cancer: A Well-Documented Historical Case

The house on Maresfield Gardens

Sigmund Freud and his family arrived in London in 1938 as refugees from Nazi persecution, according to the Freud Museum London, which occupies the house they moved into. Freud called 20 Maresfield Gardens "our last address on this planet." The museum records that he spent the last year of his life there and died in his study. Britannica notes that he died only a few weeks after the Second World War broke out.

Freud's long illness with cancer of the mouth and jaw has been examined in a large historical and medical literature, which this article does not try to reconstruct. What follows instead is what is understood today about cancers of the lip and oral cavity. They are more common than most people assume, and often visible long before they turn dangerous.

Where these cancers form

The oral cavity runs from the edge of the lips back to where the hard palate meets the soft palate. NCI lists its subsites as the lip, the front two-thirds of the tongue, the cheek lining, the floor of the mouth, the gums, the area behind the last molars, and the hard palate.

Almost all of these cancers are squamous cell carcinomas, arising in the flat cells that line the mouth. NCI notes that they are often preceded by visible warning lesions. Leukoplakia is a white patch. Erythroplakia is a red patch. A mixed patch showing both is called erythroleukoplakia. None of these is cancer, but each can precede it, which is why a dentist or doctor takes them seriously.

American Cancer Society projections, published on SEER's stat facts page, put 2026 in the United States at about 60,480 new cancers of the oral cavity and pharynx, and roughly 13,150 deaths. The median age at diagnosis is 65, men are about twice as likely to be diagnosed as women, and incidence has been rising by about 1.0 percent a year.

The risks, and one that rewrote the picture

NCI is unambiguous on the first two: "Alcohol and tobacco use, including secondhand smoke and smokeless tobacco, are the two most important risk factors for head and neck cancers." NCI also notes that paan, or betel quid, is strongly linked to mouth cancers.

The third factor changed how doctors think about this whole family of disease. Human papillomavirus, especially HPV type 16, causes cancers of the oropharynx, meaning the tonsils and the base of the tongue. NCI reports that about three-quarters of all oropharyngeal cancers are caused by chronic HPV infection. That is a different site from the oral cavity proper, but it sits next door. NCI notes that the vaccine Gardasil 9 has FDA approval to prevent HPV-caused oropharyngeal and other head and neck cancers.

Warning signs in the mouth

The mouth is one of the few places in the body a person can inspect directly. NCI advises seeing a doctor for:

• A sore on the lip or in the mouth that does not heal.
• A lump or thickening on the lips, on the gums, or inside the mouth.
• A white or red patch on the gums, tongue, or lining of the mouth.
• Bleeding, pain, or numbness in the lip or mouth.
• A change in the voice.
• Loose teeth, or dentures that no longer fit.
• Trouble chewing, swallowing, or moving the tongue or jaw.
• Swelling of the jaw.
• A sore throat, or a feeling that something is caught in the throat.

NCI adds that these cancers may cause no symptoms at all, and are sometimes picked up during a routine dental exam.

When to get checked

Use a simple rule: anything in the mouth that has not healed in two weeks needs a professional look, however small it is.

Ask for an appointment if:

• A mouth ulcer or sore has lasted longer than two weeks.
• A white or red patch has been present for two weeks or more, whether or not it hurts.
• A tooth has become loose with no dental cause, or dentures have stopped fitting.
• There is numbness in the lip, chin, or tongue that has no explanation.
• A lump in the neck has been there for three weeks.
• Swallowing has become painful or difficult.

Regular dental visits matter, since a dentist inspects parts of the mouth you cannot see.

Confirming and staging the diagnosis

The workup begins with an examination of the lips and oral cavity, and often endoscopy, in which a thin lighted tube inspects tissues that are hard to view. A biopsy settles the diagnosis by examining cells under a microscope.

Imaging then determines extent. NCI lists CT, MRI, PET scans, bone scans, and barium swallow among the tools.

Staging runs from stage 0, abnormal cells confined to the lining, through stage I, a tumor of 2 cm or less, to stages II and III with larger tumors or node involvement, and stage IV, subdivided by how far the disease has reached.

Two findings carry particular weight. NCI reports that a positive surgical margin, meaning cancer at the cut edge, or a tumor depth greater than 5 mm significantly raises the risk of local recurrence. Cancer that has broken out of a lymph node, called extranodal extension, is also an adverse sign.

What treatment involves

For stage I and II disease, NCI reports that surgery alone and radiation alone give similar results, so the choice turns on function, appearance, and local expertise. Surgery may be a wide local excision, removing the tumor with a margin of normal tissue, sometimes with a neck dissection to take lymph nodes, and reconstruction afterward.

Most stage III and stage IV tumors are treated with a combination of surgery and radiation. Radiation may be delivered from outside the body or placed directly into the tissue, which is called brachytherapy.

When a tumor cannot be removed, chemotherapy given at the same time as radiation is the approach. NCI cites a meta-analysis of 63 trials showing an 8 percent absolute survival advantage for that combination. For disease that has come back or spread, immunotherapy drugs including nivolumab and pembrolizumab are options.

The survival picture

SEER reports five-year relative survival of 69.9 percent overall for oral cavity and pharynx cancers diagnosed from 2016 to 2022. By stage it is 88.7 percent for localized disease, 69.7 percent for regional spread, and 36.0 percent for distant disease.

The distribution explains a lot. Only 26 percent are localized at diagnosis, while 55 percent have already reached regional lymph nodes. For small lip cancers caught early, NCI cites cure rates of 90 to 100 percent.

These are group figures drawn from thousands of people over many years. They describe populations, not individuals, and no reader should read a personal forecast into them.

Sources

• https://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet
• https://www.cancer.gov/types/head-and-neck/hp/adult/lip-mouth-treatment-pdq
• https://www.cancer.gov/types/head-and-neck/patient/adult/lip-mouth-treatment-pdq
• https://seer.cancer.gov/statfacts/html/oralcav.html
• https://www.freud.org.uk/about-us/
• https://www.freud.org.uk/about-us/the-house/
• https://www.britannica.com/biography/Sigmund-Freud/Last-days