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Oral Cancer

Overview

Oral cancer or mouth cancer is a collective term that includes cancers of lips, cheeks, tongue, gums, the floor of the mouth, and palate. It can originate within the oral cavity or metastasize from an extra-oral origin. The most common form of oral cancer is known as squamous cell carcinoma. Oral cancer can begin as a small growth or ulcer within the oral cavity that persists for a long time and does not heal with medication or treatment. Early diagnosis of oral cancer can prevent it from spreading to extra-oral regions.

Causes

The most well-known cause of oral cancer is the extensive use of tobacco or smoking. Tobacco is a potent carcinogen that can alter your cells’ DNA to convert them into cancerous cells. Tobacco use is common in various forms, but it is frequently inhaled in the form of smoking. Chewing tobacco or keeping it within the oral cavity for long periods can also lead to oral cancer. The second common cause of this disease is alcohol. If a person consumes both tobacco and alcohol, the risk of oral cancer becomes marginally higher. Chewing of betel leaf (paan) or areca is another cause. The human papillomavirus (HPV) has also been considered a causative factor for oral cancer. Other causes include genetic history, excessive UV radiation exposure, stem cell transplantation, and premalignant lesions such as oral leukoplakia.

Risk Factors And Epidemiology

The most common factors that can make a person susceptible to oral cancer are tobacco and alcohol. Both of these factors are capable of causing oral cancer even if used individually. However, if a person is a habitual consumer of both tobacco and alcohol, they are at a notably higher risk. Betel nut or areca nut chewers are at risk as well. Patients infected with Human Papilloma Virus (HPV), particularly HPV-16, are at high risk. Pre-existing oral lesions such as erythroplakia or leukoplakia that persist for a long time can convert into a malignant lesion if not addressed. Other risk factors include low socioeconomic status, exposure to sunlight, candidiasis, nutritional deficiencies, weakened immune systems, and a family history of oral cancer.

Oral cancer has been declared the 11th most common cancer around the globe. It is much more predominant among males than females. This is associated with higher tobacco and alcohol consumption among males. Research indicated that oral cancer usually occurs in adults over 55 years of age. On a global scale, under-developed countries have been noticed to have a higher rate of oral cancer.

Signs And Symptoms

The most common symptom of oral cancer is a lesion or lump on the lips, cheeks, tongue, floor of the mouth, gums, or palate region. It can vary in size, color, thickness, and consistency depending on the severity of cancer. Some patients might not notice any lesion or lump formation until a very late stage. This lesion or lump can present with a persistent ache that causes difficulty eating, chewing, and swallowing food. If a person has dentures, they may become ill-fitted or loose as the lump grows. If the lump grows beneath a tooth surface, it can resorb its roots and make the tooth loose in the oral cavity. Difficulty opening and closing mouth, bleeding from gums, swelling, numbness of lips, tongue, or throat, unilateral pain in ears, and unexplained weight loss are other symptoms of oral cancer.

Diagnosis

The first step towards a diagnosis of oral cancer is obtaining a detailed history and clinical evaluation. This is followed by a soft tissue biopsy in which either the whole lump or a small section of it is taken and examined under a microscope. This is used to identify the cancerous cells and their histopathologic classification. Confirmed diagnosis of oral cancer by a biopsy is followed by a CT scan, MRI, and chest x-ray to evaluate the size, severity, and extent of cancer to lymph nodes and other regions. Biopsy and radiographic findings are studied collectively for the staging of oral cancer. A PET scan may also be performed to visualize whether cancer has spread to any other part of the body. Other tests, such as endoscopy, bone scan, barium swallow, etc., might be performed if your doctor feels the need for an accurate diagnosis.

Differential Diagnosis

Other diseases that might present with similar symptoms as oral cancer include actinic keratosis, lichen planus, oral candidiasis, erythroplasia, leukoplakia, erythroplakia, condyloma, and lesions associated with viral or bacterial infections. It is suggested to perform a biopsy on a lesion existing for more than two to three weeks that has not shown any sign of healing or improvement.

Treatment

The treatment of oral cancer is similar to the treatment of any other cancer. It depends on the size, stage, severity, and extent of this disease. The primary treatment methods are surgical resection, chemotherapy, and radiotherapy. An initial stage of oral cancer may be cured with surgical resection alone. Cancer that has crossed stage I require adjunctive chemotherapy or radiotherapy, especially in cases where the cancerous cells have reached the surrounding lymph node. The chemotherapy drugs and radiation dosage are entirely decided by the specialist who is dealing with your case. Successful treatment is followed by rehabilitation to help the patient regain the functions of their oral cavity to its maximum possible extent.

Medication

No medication is required to treat oral cancer except for symptomatic care such as oral analgesics containing diclofenac etc., to reduce pain if present.

Prognosis

The prognosis of the patient affected with oral cancer depends on the stage and extent of cancer. Stage I cancer can be entirely cured in up to 90% of cases. If diagnosed early, the five-year survival rate for oral cancers is 75%, and it lowers down to 20% if diagnosed at a much later stage.

Prevention

Primary prevention methods to reduce the risk of oral cancer include:

  • Limiting tobacco and alcohol consumption
  • HPV vaccination
  • Use of sunscreens
  • practicing safe sex
  • intake of a balanced diet
  • Regular dental checkups to diagnose any lesion at an early stage.