Oral Cancer

Oral cancers form when cells in the mouth develop mutations in their DNA which in turn makes the cells to grow and divide abnormally to form a tumour. With time the tumour may spread inside the mouth and the other areas of head and neck.

Oral cancer includes cancers which originate in any of the parts of the mouth or the oral cavity namely

• Lips
• Tongue
• Gums
• Buccal mucosa/Inner cheeks
• Hard Palate
• Floor of mouth/Undersurface of tongue

Based on the cell of origin, oral cancer can be divided into:

• Carcinoma
• Lymphoma
• Mucosal melanoma
• Sarcomas

Squamous cell carcinoma:

Squamous cell carcinoma is the most common type of mouth cancer accounting for 9 out of 10 cases i.e., more than 90% of the oral cancers. Squamous cells are found in many areas of the body, including the inside of mouth, throat and skin. These cells mutate and divide to grow abnormally to form cancers. Verrucous carcinoma is a type of squamous cell cancer, which is slow-growing and does not spread to other body parts very often. It accounts for 5 % of carcinoma cases.

Lymphoma:

When the cancers develop in the lymph nodes, a part of the body immune system, they are called lymphomas.

Minor Salivary Gland Tumours:

These include the several types of oral cancers, which may affect the minor salivary glands. The salivary glands are located on the lining of both- the mouth and the throat.

A precancerous lesion/Premalignant condition is characterized by significantly increased risk of cancer. Many non-cancerous tumours and growths can develop in the mouth. If not treated on time, they may develop into cancer over a period of time.

The most common precancerous lesions are

• Oral Leukoplakia
• Oral Erythroplakia
• Oral submucous fibrosis[OSMF]
• Oral Lichen planus

Leukoplakia:

Leukoplakia is the most common premalignant disorder.Leukoplakia is a white patch of questionable risk. Leukoplakia is seen 6 times more among tobacco users than non-tobacco users.

Erythroplakia:

Erythroplakia a fiery red. Clinical appearance is characterized by marked by flat or slightly raised erythematous change of the mucosa without a patch lesion. These lesions usually bleed when scraped.

These lesions are most commonly found in the buccal mucosa,floor of the mouth and soft palate.

The factors that can increase your risk of mouth cancer are as follows

• Tobacco use in any form-Smoking Cigarettes/ Beedi, Chewing tobacco, Snuffs, Gutkha, Pan masala.
• Excessive alcohol consumption
• Family history of cancer
• Excessive sun exposure
• HPV or Human papillomavirus infection

• Soreness in lip /mouth which is persistent or won’t heal
• Persistent Swelling/ lump in mouth
• Abnormal bleeding in mouth
• Persistent White/ red patch in tongue, gums, buccal mucosa
• Progressive voice change
• Difficulty in chewing, swallowing, speaking
• Difficulty in moving the jaw or protruding tongue
• Unexplained sudden weight loss
• Persistent Ear pain/ Ringing sensation in the ear
• Numbness/ Pain in mouth or face
• Persistent Swelling/ lump in the neck
• Loose painful teeth

Oral cancer symptoms can appear in many different forms and it may vary from person to person depending upon the site, hence it is best advised to consult our specialists to rule out any possibilities of cancer as a preventive measure if you are experiencing a combination of any of these symptoms.

Oral cancer is often diagnosed during routine dental exams/ oral screening examinations. If the symptoms align with those of oral cancer, our specialist may suggest a few screening tests after taking your entire health history, your symptoms, risk factors, family history of disease and conducting a physical examination.

Physical examination: :

Our specialist doctor will feel for any lumps or abnormal tissue changes, any sore or discoloured tissues in your lips, oral cavity, face, head and neck.

Investigations

• BiopsyBiopsy is the only definitive way to confirm cancer. Small pieces of tissue are taken out from the suspicious area in mouth by using a small scalpel/ surgical blade and checked for cancer cells in laboratory. Your results will be back in about 3 to 5 days.

  After a diagnosis of oral cancer, you will need additional tests for determining the extent of cancer [stage of cancer] and your overall health.

  The following screenings and tests are done to check inside your mouth, throat and neck regions.

• Video directed laryngoscopy:During this, our specialist will pass a small and flexible camera, which is well lighted, into your throat to look for cancerous signs.

Imaging:

Imaging is an essential tool in the management of oral cancer. The most common protocol for patients with a oral cancer will be to image the primary site and to rule out distant spread by either

• Contrast enhanced CT[CECT] or
• Magnetic resonance imaging[MRI] or
• PET/CT and or
• CT Chest
  
  • CT scan of Head & Neck [CECT]: Relatively cheap, quick, non invasive and easy to perform.Computerized tomography scan means taking cross sectional images of your body in various planes. This will give a detailed image appearance of tumours, their extension to the lymph nodes, surrounding tissues and bones.
  • Magnetic Resonance Imaging[MRI]: MRI has some special advantage over CT in terms of less radiation exposure and better soft tissue imaging. Those who have pacemakers, prosthetic cochlear implants or any metal implants cannot undergo MRI.
  • Positron emission Tomography scan[PET/CT]: PET scan is a specialized imaging technique which uses short lived radioactive drugs to produce 3D coloured images. It measures metabolic activity and the function of tissues. It helps to determine the growth of the tumour and as well as the type of tumour. The radioactive drug accumulates in certain tissues and emits positrons. This is detected and analysed by to give the exact disease status
  • The advantages include evaluation of the whole body including the area of interest, Lymph node involvement, distant metastases. Thangam cancer center Namakkal has a dedicated CT/ PET-CT machine which provides an one stop solution for all imaging/ Staging workups.

It is the one of the most important things to know when deciding how to treat the cancer. Staging is done by analyzing the size and the spread of the disease.

The Oral cancer is staged as follows for the purpose of treatment decision

• Stage I
• Stage II
• Stage III
• Stage IV

The treatment choice depends upon the type of oral cancer, test results and the stage of oral cancer. The goal of treatment may be to cure, control or help ease the problem caused by cancer.

Oral cancer can be treated by

• Surgery
• Radiation
• Chemotherapy/ Targeted therapy/ Immunotherapy
• Combined modality approach
• Supportive care

Treatment for oral cancer are either in local form or systemic. Local treatment removes/ destroys or control cancer cells in one area. Systemic treatment is used to destroy/control cancer cells that may have spread to other parts of your body. Surgery and Radiation are local treatment most commonly used in oral cancer. Depending upon the stage of the cancer you may have one treatment approach or combination of treatments.

Surgery:

Surgery is a common treatment for Oral cancer. Surgery is recommended for the treatment at early stages of cancer. When diagnosed during the early stages, the removal of the tumor can be done with clean margins and no other additional treatment is needed.

Radiation therapy:

Radiation treatment involves the use of high-energy beams in the form of Photons/ Electrons/ Protons to destroy the cancer cells. Radiation therapy is given for five days in a week for duration of 5 to 7 weeks depending upon the site, type and stage of cancer. Similar to surgery good tumor control response is achieved by treating with radiation.

Chemotherapy:

Chemotherapy is a form of systemic treatment used to destroy/ control tumour cells which have spread to other parts of the body. Systemic chemotherapy uses drugs or medicines, either given orally or intravenously to kill the cancer cells.

Targeted therapy:

In this treatment, specific drugs that will bind to cancer cell proteins are given to inhibit their growth.

Combined modality treatment:

Treatment in the advanced stages of cancer is done with the combination of chemotherapy, radiation therapy and surgery either combined together or sequentially.

Nutritional Care:

Treatment regimens make it difficult for a patient to swallow or drink food and water and thus nutrition is an important part of the treatment plan. Our nutritionist will plan a food menu for the patient depending on his condition and treatment.

Most of the oral cancers are preventable. Some measures that you can take to prevent these cancers are:

• Avoid tobacco use/ smoking.
• Avoid drinking alcohol.
• Eat a healthy diet.
• Avoid over exposure to sunlight
• Drink plenty of water, fresh juices.
• Do regular self examination of your oral cavity.
• Check up regularly with dentists /oncologist.

Many people feel depressed, worried when dealing with cancer. Getting treatment for cancer can be taxing on mind and body. Keep talking to your family and doctors about any problems or concerns you have.

• Keep yourself active.
• Speak with family/friends.
• Rest as much as needed.
• Ask help from doctors/counsellors.
• Join cancer support groups.