Oral Cancer

                                         ORAL CANCER

 

Oral cancer is a cancer that occurs in any part of the mouth; on the tongue's surface, in the lips, inside the cheek, in the gums, in the roof and floor of the mouth, in the tonsils, and also the salivary glands.

Signs and Symptoms

Early stages of oral cancer does not show much detectable symptoms.. Smokers and heavy drinkers are more prone to have oral cancer. Most commonly seen signs and symptoms are:

• Red or white patches on the mouth or tongue.
• Mouth ulcers and mouth sores.
• Painful tongue
• Jaw pain and stiffness.
• Sore throat.
• A swelling in the mouth that persists for over three weeks. 
• Pain when swallowing.
• Loose teeth.
• Irritating sensation in the throat.
• A hoarse voice.
• Pain in the neck.

Risk factors for mouth cancer

. The risk factors for mouth cancer include:

• Smoking

• Tobacco(chewing and smoking).

• Heavy alcohol consumption  

• Diet -red meat and junk foods are the main cause of oral cancer.

• Radiotherapy in the head and/or neck area. .

• Exposure to certain chemicals - especially asbestos, sulphuric acid and formaldehyde.

• Sun exposure on the lips

• HPV(human papilloma virus) infection

Diagnosis:

• Biopsy - Under anesthetic sample of tissues is collected from the mouth to see if there are cancerous cells.

Tests for staging:

• Endoscopy - A lighted scope is lowered down the patient's throat to see whether the cancer has spread beyond the mouth.

• Imaging tests like:
• X-rays
• Computerized tomography (CT) scans
• Magnetic Resonance Imaging(MRI) scans
• PET (positron emission tomography) scans

 

 Stages of cancer of the lip and oral cavity

Staging the cancer (identifying its stage) provides a universally understood definition of a particular cancer's progress. It helps in the planning of treatment protocol for that particular cancer, helps in determining prognosis (predicting likely outcomes), and also allows accurate end-results reporting.

• Stage I - the tumor is below 2cm in diameter and has not reached nearby lymph nodes.

• Stage II - the tumor is between 2cm and 4cm in diameter and has not reached nearby lymph nodes.

• Stage III - The tumor is above 4 cm in diameter and has spread to the nearby lymph nodes on the same side of the neck.

• Stage IV - The cancer has spread to 2 or more lymph nodes either on the same side of the neck or to the opposite side of the neck. Sometimes the cancer may also spread to other parts of the body.

Treatment

Treatment will depend on position and stage of the cancer as well as the patient's general health and personal preferences.

Surgery  include:

• Surgical removal of the tumor
• Surgical removal of cancer that spread to the neck - mouth cancer tends to spread to the lymph nodes in the neck. The surgeon may perform a neck dissection - cancerous lymph nodes and related tissue in the neck are surgically removed.
• Mouth reconstruction - Surgeons may transplant grafts of skin, muscle or bone form other parts of the body to reconstruct the face if there is a change in the appearance or patient’s ability to talk during the surgery.
• Radiotherapy (radiation therapy) - It involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells.
• Internal radiotherapy (brachytherapy) - often used to treat patients with early stages of cancer of the tongue.
  
  Radiation therapy applied to the mouth may have the following side effects:

-Tooth decay

-Mouth sores

-Bleeding gums

-Jaw stiffness

-Fatigue

-Skin reactions (similar to burns)

• Chemotherapy – used in advanced stages of oral cancer.

Chemotherapy involves using powerful medicines that kill cancer; they damage the DNA of the cancer cells, undermining their ability to reproduce. Chemotherapy medications can sometimes damage healthy tissue, and patients may experience the following side-effects:

-Fatigue

-Vomiting

-Nausea

-Hair loss

-Weakened immune system (higher vulnerability to infection)

Side effects are temporary.

• Medication using monoclonal antibodies - this involves drugs that change aspects of cancer cells that help them grow. Cetuximab (Ebitux) is used for some head and neck cancers - it stops the action of a protein found in many kinds of healthy cells, but is more prevalent in the surface some cancer cells. The protein is called epidermal growth factor receptors (EGFR).

Cetuximab may have the following mild side effects:

-Nausea

-Diarrhoea

-Breathlessness

-Inflammation of the eyes

Complications of oral (mouth) cancer

• Difficulty swallowing
• Speaking problems
• Depression. 

Prevention

Oral cancer is sometimes associated with known risk factors for the disease. Many risk factors can be modified but not all can be avoided.

• Tobacco and alcohol use: Tobacco use (cigarettes, pipes, cigars, and smokeless tobacco) is responsible for most cases of oral cancer. Alcohol, particularly beer and hard liquor, are associated with an increased risk of developing oral cancer. The risk of developing oral cancer is higher in people who use both tobacco and alcohol. Avoiding or stopping the use of tobacco decreases the risk of oral cancer.


• Sun exposure: Exposure to sunlight may increase the risk of lip cancer, which occurs most often on the lower lip. Avoiding the sun and/or using a sunscreenor colored lipstick on the lips may decrease the risk of lip cancer.


• Other factors: Some studies suggest that being infected with the human papillomavirus (HPV) may increase the risk of oral cancer.


• Chemoprevention: Chemoprevention is the use of drugs, vitamins, or other agents to prevent or delay the growth of cancer or to keep it from coming back. Tobacco users who have had oral cancer often develop second cancers in the oral cavity or nearby areas, including the nose, throat, vocal cords, esophagus, and windpipe. Studies of chemoprevention in oral cancer are under way, including chemoprevention of leukoplakia and erythroplakia.

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