Oral Cancer

Oral Cancer

Oral Cancer

What is Oral Cancer?

The uncontrolled growth of mutated cells in the oral region is called Oral Cancer. The term Oral Cancer includes cancers of the mouth and the pharynx. It encompasses the lips, the inside lining of the lips and cheeks, the teeth, the gums, most of the tongue, the bottom of the mouth, and the bony roof of the mouth, or hard palate.

  • Squamous cell carcinoma: The throat and mouth are lined with flat and scale-like squamous cells. Cancer in this region is called squamous cell carcinoma and it accounts for more than 90 percent of the Oral Cancers.
  • Verrucous carcinoma: About 5 percent of all oral cavity tumors are verrucous carcinoma, which is a type of very slow-growing cancer made up of squamous cells.
  • Minor salivary gland carcinomas: This includes several kinds of Oral Cancer that can develop on the minor salivary glands, found throughout the lining of the mouth and throat. It includes:
    • Adenoid cystic carcinoma,
    • Mucoepidermoid carcinoma,
    • Polymorphous low-grade adenocarcinoma.

Lymphomas: Oral Cancers that develop in lymph tissue are known as lymphomas. The tonsils and base of the tongue both contain lymphoid tissue.

Anatomy of Mouth

Oral Cancer

What are the general symptoms of Oral Cancer?

The symptoms of oral cancer may include:

  • A persistent red or white patch on the gums, tongue, tonsil, or lining of the mouth.
  • Constant pain in the mouth.
  • Having a sore throat or mouth sore for a long time.
  • Difficulty in swallowing or chewing.
  • A lump or thickening in the cheek or neck.
  • Numbness in the mouth.
  • Unexplained bleeding.
  • Frequent pain in the ear (rare).
  • Persistent bad breath.
  • Weight loss.
  • Difficulty moving the jaw or tongue.
  • Irregular Voice changes.
What are the general causes of Oral Cancer?

Oral Cancer may at times develop in patients without any prominent causative. But the following risk factors increase the probability of occurrence of the disease.

  • Smoking – 60 % of the cases of Oral Cancer are caused by smoking. Smoking highly increases the risk of developing mouth and oropharyngeal cancer.
  • Alcohol – Drinking alcohol increases risk of mouth and oropharyngeal cancer, especially when combined with smoking. 30 % of Oral Cancers are caused by drinking alcohol.
  • Human papillomavirus (HPV) – It is a sexually transmitted disease. HPV 16 and HPV 18 highly increase the risk of Oral Cancer.
  • Chewing tobacco or betel quid – Chewing tobacco or betel quid (gutkha) is known to cause mouth and oropharyngeal cancer.
  •  Diet – Lack of vitamins and minerals, such as iron or folic acid, in the diet may result in the development of Oral Cancer.
  • Family history – Geneticconditions and earlier instances of the disease in the family increases the risk.
  • Gender – Men are twice as likely to develop Oral Cancer as women.
  • Ultraviolet light: Excessive sun exposure increases the risk of lips cancer.
  • Age – Oral cancers are more common among people above 50 years.
  • Immune system– Immune systems weakened by certain medications can easily be attacked.
Can Oral Cancer be prevented?

Not all cases of Oral cavity and oropharyngeal Cancer can be prevented, but the risk of developing these Cancers can be greatly reduced by avoiding certain risk factors.

  • Avoid the use tobacco in any form.
  • Limit the use of alcohol.
  • Stay out of the sun.
  • Eat lots of fruits and vegetables and maintain a healthy diet.
  • Avoid HPV infection.
  • Treat pre-cancerous growths.
What are the stages of Oral Cancer?

The most common system used for staging Oral Cancer is TNM staging.

  • Tumor (T) describes the size of the original tumor.
  • Node (N) indicates whether the cancer is present in the lymph nodes.
  • Metastasis (M) refers to whether cancer has spread to other parts of the body.

A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. The letter X means the information could not be assessed. Once the T, N and M scores have been assigned, an overall stage is assigned. The stages range from 0 to 4:

  • Stage 0: The tumor has not invaded tissue beyond you the origin and is not more than 2cm long.
  • Stage 1: The tumor is less than 4 cm.
  • Stage 2: The tumor is slightly larger than 4 cm, but still limited to the area of origin.
  • Stage 3: The tumor has grown and spread to nearby tissues and organs.
  • Stage 4: The tumor has spread to your lymph nodes or distant organs.
Survival rates of Oral Cancer?

The survival rate and diagnosis usually go hand in hand. If the symptoms and stage of throat cancer are discovered earlier, the individual will have a greater chance of survival. The 5-year relative survival rates for Oral Cancers are:

  • 83% for cancer that has not spread
  • 62% for cancer that has spread to nearby lymph nodes
  • 38% for cancer that has spread to distant parts of the body
Can Oral Cancer be detected early?

With the development of science and technology, today there are several tests that aid in the diagnosis of Oral Cancer. These tests include:

  • Physical exam: The lips and mouth areas are examined to look for abnormalities — areas of irritation, such as sores and white patches.
  • X-rays of the mouth and throat, including CAT (computed tomography) scans
  • PET scans (positron emission tomography) - It uses radioactive materials to identify excessive activity in an organ.
  • Biopsy: A small sample of tissue is removed from a tumor to diagnose cancer. Oral Cancer usually requires a biopsy. There are different methods to obtain a biopsy:
    • Fine Need Aspiration (FNA) biopsy. A thin needle is inserted into the tumor mass and a sample is aspirated (drawn out by suction) into a syringe.
    • Incisional biopsy. A sample is removed with a scalpel (surgical knife).
    • Punch biopsy. A small circular blade removes a round area of tissue.
  • Image Testing: A variety of imaging tests may help determine whether cancer has spread beyond your mouth. Imaging tests may include X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, among others.
What are the Treatments available?

Today there are several treatments that can cure Oral Cancer and increase the life expectancy of the patients. Some of the common treatments are surgery, radiation therapy.

Surgery

Tumor resection involves an operation to remove the entire tumor. Minimally invasive surgical techniques are used to treat the cancer. Neck dissection removes any cancer cells that may have spread to the lymph nodes. Once the surgery is done, a surgery to reconstruct the mouth might be conducted.

Radiation Therapy

Radiation therapy stops cancer cells from dividing and slows the growth of the tumor. Radiotherapy also destroys cancer cells and can shrink or eliminate tumors. Radiation therapy involves 5-6 weeks of daily treatments.

Chemotherapy

Chemotherapy uses anticancer drugs to destroy cancer cells throughout the body. It may be an option if the cancer has spread to nearby lymph nodes. Chemotherapy is prescribed for different reasons:

  • Chemoradiation – A combination of chemotherapy and radiotherapy as an alternative to surgery.
  • After surgery to decrease the risk of the cancer returning
  • Palliative treatment - To slow the growth of a tumor and control symptoms when the cancer cannot be cured.

Targeted drug therapy

Targeted drug therapy targets cancerous cells to interfere with cell growth on a molecular level. Cetuximab is one targeted therapy approved for treating head and neck cancers in certain situations. Cetuximab stops the action of a protein that's found in many types of healthy cells, but is more prevalent in certain types of cancer cells. Targeted drugs can be used in combination with chemotherapy or radiation therapy.   

How frequently should one visit doctor for early diagnosis?

Visiting a doctor for regular mouth check up is recommended. If you spot any of the symptoms or have high risks of the disease then periodic diagnosis aids in detecting the cancer at early stage.

How can I as a patient know it early?

Being aware of the causatives and symptoms helps in identifying the signs of the disease.

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