Oral Cancer

What is Oral Cancer?

Oral cancer is also called as mouth cancer or oral cavity cancer. Cancerous growth occurring within the structures of the oral cavity is known as ‘Oral Cancer’ The oral cavity includes the mouth and all the structures within it, such as the tongue, teeth, gums and the jaw. It can occur anywhere in the mouth, surfaces of the tongue, lips, cheeks, floor of the mouth, soft palate, pharynx, tonsils and in salivary glands. It is a type of neck and head cancer.

There are several types of oral cancers, but around 90% are squamous cell carcinomas, less common type of oral cancer is Kaposi's sarcoma.

Cancer is an abnormal disorganized growth of cells in the tissue or organ of a person. Cancer cells keep dividing and multiplying and this abnormal growth destroys the normal structure and the function of the affected tissue. Majority of the oral cancers affect the outer layer of mucous membrane covering the oral cavity.

Facts & Incidence on Oral Cancer

• Oral cancer is one of the most common causes of death
• In male, oral cancer represents 4% of total body cancer and in female; it is 2% of all cancers
• Mouth cancer mostly occurs after the age of 40 years
• Men are more prone to oral cancer than women
• 86% of cases are diagnosed in those over 50
• In India, more than 1 million cases are affected by oral cancer due to chewing of tobacco and more recently a mixture of tobacco, betel nut and other ingredients called ‘gutka’
• More than 90% of oral cancers in men and 85% in women are associated with lifestyle and environmental factors
• In UK, Oral cancer ranked 16^th most common cancer

What are the Stages, Types and Grading of Oral Cancer?

The stage, type and grade of your oral cancer is one of the most important factors in choosing the right treatment course for the patient.

TNM staging system for Oral Cancer

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TNM stands for Tumor, Node and Metastasis (TNM). TNM staging system used to describe the extent of the cancer. TNM can be further sub-divided to indicate the correct stage.

T - Indicates Primary Tumor mass

N - Indicates extent of cancer spread to lymph nodes

M - Indicates the spread of cancer to other parts of the body

Tumor (T) Stage:

T describes the tumor size. There are 4 T stages of oral cancer T1 to T4

T1 - Tumor present within the tissues of the mouth. Its less than 2cm

T2 - Tumor is larger than 2 cm

T3 - Tumor is larger than 4 cm

T4 - It further divided into T4a & T4b

T4a - It is an advanced (moderately) local disease. Tumor has spread to the surrounding tissues such as tongue, skin, face, jawbone, and floor of the mouth.

T4b - It is in a very advanced stage. Tumor has invaded into nearby areas such as the space behind the jaw, pterygoid plates, base of the skull and surrounding carotid arteries.

Node (N) Stage:

NX: Nearby lymph nodes cannot be determined

N0: Cancer has not spread to any nearby lymph nodes.

N1: It has spread to one lymph node on the same side of the head or neck. This lymph node is smaller than 3 cm.

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N2 is divided into three subgroups:

• N2a: It has spread to one lymph node on the same side as the primary tumor, and the lymph node measures 3–6 cm.
• N2b: It has spread to 2 or more lymph nodes on the same side as the primary tumor. Lymph nodes are not larger than 6 cm.
• N2c: It has spread to one or more lymph nodes on both sides of the neck. Lymph nodes are not larger than 6 cm across.

N3: It has spread to a lymph node that measures more than 6 cm across.

Metastasis

M0 No Metastasis

M1 - Tumor has spread to distant locations

What are the Causes and Risk factors for Oral Cancer?

Cancer in the mouth does not occur overnight. It occurs as a series changes within the tissue, which eventually promotes the development of cancer.

Tobacco Use: Smoking tobacco and cigarettes are the major risk factors for developing oral cancer. Smokeless tobacco use can increase the risk of mouth cancer by 15 times. Pipe smoking can cause cancer in the part of the lips that touch the pipe stem. About 97% of oral cancer victims are known to be associated with tobacco either in the form of smoking or chewing.

Among the various habits associated with tobacco, tobacco chewing is known to cause oral cancer more rapidly than any of the other habits. This is because of the direct and repeated contact of the tobacco with the mucous membrane of the oral cavity.

Alcohol: Excessive alcohol consumption can put you at higher risk. Heavy drinkers who are also smokers are 100 times more likely to be diagnosed with oral cancer than those who don’t drink or smoke.

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Gender: Men are at higher risk than women

Sun Exposure: Prolonged exposure to UV rays from the sun has been linked to cancer of the lip but it can be prevented by wearing lip balm with sun protection cream like SPF protection

Oral cancer is 2.5 times higher in people with periodontal and gum diseases

Family history may contribute to higher risk

HPV virus causing infection increasing the risk of developing oropharyngeal cancer

People with poor oral hygiene and oral care may have an increased risk for oral cavity cancer.

What are the Symptoms of Oral Cancer?

Oral cancer may initially present without any symptoms. Patients are most often identified only after a significant progression of the disease. Discomfort is the most common symptom that compels a patient to seek medical care.

Patient may present with any of the following symptoms:

• Persistent mouth sore
• A non-healing ulcer in the oral cavity
• Excessive bleeding which is not seen that commonly
• Swollen gums interfering with the seating of the dentures in the mouth
• Awareness of a mass present or growing within the Oral Cavity
• A lump in the neck and cheek
• Persistent bad breath
• Difficulty in swallowing

• Toothache
• Weight loss
• Pain in the ear
• Limited mouth opening
• Voice changes
• Loosening of the teeth

A majority of oral cancers involve the tongue, the posterior region of the oral cavity and the floor of the mouth. The lips, gums, the under surface of the tongue and the palate (bones separating the mouth from the floor of the nose) are less frequently involved.

What are the Warning Signs of Oral Cancer?

Certain pre-cancerous lesions occurring in the oral cavity may indicate the person's susceptibility to cancer.

Warning Signs of Oral Cancer can be in the form of -

• Non-healing mouth sore for than 2 to 3 weeks
• White patches in the mucous membrane covering the oral cavity and along the lateral border of the tongue, which cannot be removed by rubbing the affected area for more than 2 weeks.
• Red patches seen on the mucous membrane lining the mouth and the tongue for more than 2 weeks.
• Increase in fibrous content of the mucous membrane lining the cheek, which presents itself as thick fibrous bands running along the inner aspect of the cheek. Commonly seen in betel nut chewers this condition results in inability to open the mouth. All the above lesions will cause a burning sensation when consuming spicy food.

How do you Diagnose Oral Cancer?

• Thorough Examination of the oral cavity and the neck region conducted without neglecting any area that may show hard lumps of tissues, which may indicate cancer. The patient is assessed for any suspicious tissue changes, which may include a white, red or a mixed white or red lesion.
• Complete head and neck examination can be done to look for any abnormal masses
• Biopsy: If your specialist finds any tumors or lesions, they will perform biopsy

What are the Techniques for Biopsy?

• Brush Biopsy: It collects tumor cells by brushing them onto a slide. It is a painless procedure.
• Tissue Biopsy: it removes a piece of the tissue and it can be examined under a microscope.

Microscopic Examination of a tissue specimen from the suspected lesion is the best method to confirm or rule out oral cancer. It gives the exact type and nature of cancer.

Imaging Techniques:

Variety of imaging techniques performed to determine whether the cancer has spread to other parts of the body beyond the mouth

• X-rays to check whether the cancer cells have spread to the other areas
• CT scan helps to diagnose any tumors in your mouth, throat, neck, lungs, or elsewhere in your body
• PET scan diagnose if the cancer has spread to lymph nodes or other organs
• MRI scan can show a more accurate image of the head and neck, and determine the extent of the cancer
• Endoscopy diagnose the inner throat, nasal passages, sinuses, windpipe, and trachea

How can Oral Cancer be Treated?

The choice of treatment depends upon factors such as -

• Type of cancer
• Stage and changes in the cell
• Size of the cancer and
• Location of the cancerous growth.

Treatment options include surgery, radiation and chemotherapy.

Surgery or Radiation is used with curative intent in treatment of cancer.

Chemotherapy (Medicines) is used as an additional form of treatment for locally or distantly advanced form of cancer.

In lesion that is superficial either surgery or radiation as a form of treatment would suffice. But in an advanced condition, a combination of both surgery and radiation is required.

There is rarely a second chance available for cure. Hence the initial approach of treatment is critical. The survival rates after early detection and treatment of cancer have been noted to be over 70%.

Targeted drug therapy is effective in treating early and advanced stages of cancer.

Targeted drugs will alter specific proteins in cancer cells that increase their growth.

Nutrition plays an important part in oral cancer treatment because most of the treatment makes it difficult and painful to eat and swallow food. Loss of appetite and weight loss are common side effects of oral cancer treatments.

It is important to discuss diet regimen with your doctor and nutritionist. Getting the advice of a nutritionist can help you plan a food menu that will be gentle on your mouth and throat, and will provide your body with the required calories, vitamins, and minerals.

Finally, keeping the mouth healthy during cancer treatments is a crucial part of treatment. Make sure to keep the mouth moist and the teeth and gums clean.

How do you Prevent Oral cancer?

One can lower their risk of developing Oral cancer by avoiding certain risk factors –

• Stop smoking
• Limit alcohol intake
• Get vaccinated for HPV infections
• Limit exposure to UV rays
• Eat a Healthy Diet