Everything you should know about Oral Cancer
You may have heard of how cancer affects different parts of the body such as the lungs or breasts. Apart from this, you also need to know how cancer can also occur in the mouth, where the disease tends to affect the lips, tongue, cheeks, and throat. Cancer is termed as the uncontrollable growth of cells that invade and cause damage to surrounding tissue.
What is oral cancer?
Oral cancer is one such life-threatening condition that begins as growth or soreness in the mouth, which does not tend to go away. It includes cancers of the tongue, cheeks, lips, mouth, hard and soft palate, sinuses, and throat. It can be life-threatening if not diagnosed and treated early.
To understand these cancers, know the parts of the mouth and throat.
The oral cavity (mouth) and oropharynx (throat)
The oral cavity or the mouth is the first part of digestive tract bounded by the lips, the inside lining of the lips and cheeks (buccal mucosa), the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth below the tongue, and the bony roof of the mouth (hard palate). The area behind the wisdom teeth (called the retromolar trigone) can be included as a part of the oral cavity, but it's often thought of as part of the oropharynx.
The oropharynx is the part of the throat just behind the mouth. It starts where the oral cavity stops. It includes the base of the tongue (the back third of the tongue), the soft palate (the back part of the roof of the mouth), the tonsils, and the side and back walls of the throat.
The oral cavity and oropharynx help you breathe, talk, eat, chew, and swallow. Minor salivary glands throughout the oral cavity and oropharynx make saliva that keeps your mouth and throat moist and helps you digest food.
Tumors and growths in the oral cavity and oropharynx
Many types of tumors (abnormal growths of cells) can develop in the oral cavity and oropharynx. They fit into 3 general categories:
- Benign growths are not cancer. They do not invade other tissues and do not spread to other parts of the body.
- Pre-cancerous conditions are harmless growths that can turn into cancer over time.
- Cancer tumors are growths that can grow into nearby tissues and spread to other parts of the body.
Lets brief each
Benign (not cancer) tumors
Many types of benign tumors and tumor-like changes can start in the mouth or throat, such as these:
- Eosinophilic granuloma
- Fibroma
- Granular cell tumor
- Keratoacanthoma
- Leiomyoma
- Osteochondroma
- Lipoma
- Schwannoma
- Neurofibroma
- Papilloma
- Condyloma acuminatum
- Verruciform xanthoma
- Pyogenic granuloma
- Rhabdomyoma
- Odontogenic tumors (tumors that start in tooth-forming tissues)
These non-cancerous tumors start from different kinds of cells and have a variety of causes. Some of them may cause problems, but they're not likely to be life-threatening. The usual treatment for these types of tumors is surgery to remove them completely since they are unlikely to recur (come back).
Pre-cancerous conditions
( Leukoplakia and Erythroplakia)
Leukoplakia and erythroplakia are terms used to describe certain types of tissue changes that can be seen in the mouth or throat:
Leukoplakia : is a white grey patch that cannot be scrapped off clinically and pathologically as any other disease
Sites of Predilection : Alveolar ridge mucosa
Lateral and ventral tongue
Corner of mouth
Floor of mouth
Less frequently Soft palate and Lips
Sites of Predilection : Tongue
Soft palate
Buccal Mucosa
Floor of mouth
Your dentist or dental hygienist may be the first person to find these white or red patches. They may be cancer, they may be a pre-cancerous condition called dysplasia, or they could be a relatively harmless change.
Dysplasia is graded as mild, moderate, or severe, based on how abnormal the tissue looks under the microscope. Knowing the degree of dysplasia helps predict how likely it is to progress to cancer or go away on its own or after treatment. For example, severe dysplasia is more likely to become a cancer, while mild dysplasia is more likely to go away completely.
The most common causes of leukoplakia and erythroplakia are smoking and chewing tobacco. Poorly fitting dentures that rub against the tongue or the inside of the cheeks can also cause these changes. But sometimes, there's no clear cause. Dysplasia will often go away if the cause is removed.
A biopsy is the only way to know for certain if an area of leukoplakia or erythroplakia contains dysplastic (pre-cancerous) cells or cancer cells.
Most cases of leukoplakia do not turn into cancer. But some leukoplakias are either cancer when first found or have pre-cancerous changes that can progress to cancer if not properly treated.
Erythroplakia and erythroleukoplakia are less common, but are usually more serious. Most of these red lesions turn out to be cancer when they are biopsied or will develop into cancer later.
Still, it's important to note that most oral cancers do not develop from pre-existing lesions (either leukoplakia or erythroplakia).
Oral Cavity and Oropharyngeal Cancers
The different parts of the oral cavity and oropharynx are made up of many types of cells. Different cancers can start in each type of cell. These differences are important, because they can impact a person’s treatment options and prognosis (outlook).
The types of oral cancer are:
- Squamous cell carcinoma, which is the most common
- Verrucous carcinoma
- Salivary gland tumors
Squamous cell carcinomas
Almost all (more than 90%) of the cancers in the oral cavity and oropharynx are squamous cell carcinomas, also called squamous cell cancers. These cancers start in early forms of squamous cells, which are flat, scale-like cells that form the lining of the mouth and throat.
The earliest form of squamous cell cancer is called carcinoma in situ. This means that the cancer cells are only in the layer of cells called the epithelium. This is different from invasive squamous cell carcinoma, where the cancer cells have grown into deeper layers of the oral cavity or oropharynx.
Verrucous Carcinoma
Cells from these areas of squamous cell carcinoma may then spread to other parts of the body.For all of these reasons, verrucous carcinomas should be removed right away, along with a wide margin (edge) of surrounding normal tissue.
Lymphomas: the tonsils and base of the tongue contain immune system (lymphoid) tissue, where cancers called lymphomas can start. For more information about these cancers, seeNon-Hodgkin Lymphoma, Non-Hodgkin Lymphoma in Children, and Hodgkin Disease.
Cancers in other parts of the throat
Cancers can also start in other parts of the throat, but these cancers aren’t covered here:
- Cancers of the nasopharynx (the part of the throat behind the nose and above the oropharynx) are covered in Nasopharyngeal Cancer.
- Cancers that start in the larynx (voice box) or the hypopharynx (the part of the throat below the oropharynx) are covered in Laryngeal & Hypopharyngeal Cancer.
Oral cancer is fairly common and very curable if found and treated at an early stage. A healthcare provider or dentist usually finds oral cancer in its early stages because the mouth can be easily examined.The truth is, as uncomfortable as it may be to even think of the word “cancer,” thinking about it, and thus detecting it early, is key. That’s why, if you haven’t been to the dentist in a while, you should schedule a visit, because while the oral exam that accompanies your cleaning may not be noticeable to you,but it’s often your earliest line of defense in the detection of oral cancer.
Let’s take a quick look at a few of the
|CAUSES |RISK FACTOR| PREVENTION| SYMPTOMS|
|DIAGNOSIS|
|TREATMENT|
Causes of Oral Cavity and Oropharyngeal Cancers
Doctors and scientists can’t say for sure what causes each case of oral cavity or oropharyngeal cancer. But they do know many of the risk factors and how some of them may lead to cells becoming cancerous.
Scientists believe that some risk factors, such as tobacco or heavy alcohol use, may cause these cancers by damaging the DNA of cells that line the inside of the mouth and throat.
Now this very important to understand what causes cancer and how
DNA is the chemical in each of our cells that makes up our genes — the instructions for how our cells function. We usually look like our parents because they are the source of our DNA. However, DNA affects more than how we look. Some genes called proto-oncogenes can help control when cells grow and divide. DNA changes can change these into genes that promote cell division that are called oncogenes. Some genes that slow down cell division or make cells die at the right time and are called tumor suppressor genes ( a gene that protects a cell from one step on the path to cancer.) DNA changes can turn off tumor suppressor genes, and lead to cells growing out of control. Cancers can be caused by DNA changes that create oncogenes or turn off tumor suppressor genes.
When tobacco and alcohol damage the cells lining the mouth and throat, the cells in this layer must grow more rapidly to repair this damage. The more often cells need to divide, the more chances there are for them to make mistakes when copying their DNA, which may increase their chances of becoming cancer.
Many of the chemicals found in tobacco can damage DNA directly. Scientists are not sure whether alcohol directly damages DNA, but they have shown that alcohol helps many DNA-damaging chemicals get into cells more easily. This may be why the combination of tobacco and alcohol damages DNA far more than tobacco alone.
This damage can cause certain genes (for example, those in charge of starting or stopping cell growth) to malfunction. Abnormal cells can begin to build up, forming a tumor. With additional damage, the cells may begin to spread into nearby tissue and to distant organs.
How Oral Cancers linked to HPV infection
What is HPV?
HPV is short for human papilloma (pap-uh-LO-muh) virus. HPVs are a large group of related viruses. Each virus in the group is given a number, which is called an HPV type.
Mucous membranes are the moist surface layers that line organs and parts of the body that open to the outside, such as the mouth, and throat.
HPV is divided into 2 main groups:low risk viruses which are rare
and high risks because they can cause cancer in both men and women. Doctors worry more about the cell changes and pre-cancers linked to these types, because they’re more likely to grow into cancers over time. Common high-risk HPV types include HPV 16 and 18.
How do people get HPV?
HPV can be passed from one person to another by skin-to-skin contact, such as occurs with sexual activity. The main way HPV is spread is through sexual activity, including vaginal, anal, and oral sex. HPV can be spread even when an infected person has no visible signs or symptoms.
HPV infection is very common. Most men and women who have ever had sex get at least one type of genital HPV at some time in their lives. Anyone who has had sex can get HPV, even if it was only with only one person, but infections are more likely in people who have had many sex partners. Even if a person delays sexual activity until marriage, or only has one partner, they are still at risk of HPV infection if their partner has been exposed.
You cannot get HPV from:
Toilet seatsHugging or holding hands
Swimming pools or hot tubs
Sharing food or utensils
Being unclean
You can have HPV:
- Even if it has been years since you were sexually active
- Even if you do not have any signs or symptoms
HPV is found in some mouth and throat cancers in men and women. Most cancers found in the back of the throat, including the base of the tongue and tonsils, are HPV-related. These are the most common HPV-related cancers in men.
There’s no standard screening test to find these cancers early. Still, many can be found early during routine exams by a dentist, doctor, dental hygienist, or by self-exam.
Few pictures to illustrate :
Sites
PREVENTION ,DIAGNOSIS AND TREATMENT
- Those who tend to smoke excessively are primarily at a higher likelihood of developing oral cancer.
- Those who do not smoke yet consume tobacco tend to develop oral cancer. Such people tend to dip, snuff, or chew tobacco products that can lead to cancers of the cheek, gums, and lining of the lips.
- Sometimes, the excessive consumption of alcohol leads to the development of oral cancers.
- There are also a few HPV strains that are etiologic risk factors for Oropharyngeal Squamous Cell Carcinoma (OSCC).
- Cancer dentistry is a must for those who suffer from oral medical problems.
Some risk factors may not be in your control. But others may be things you can change.
Oral cancer is twice as common in men as it is in women. You’re also more at risk for it if you have:
- Lack of fruits and vegetables in your diet
- Chronic mouth irritation, such as from poorly-fitted dentures
- Betel nut ,Gutka
- Certain inherited conditions, such as
Fanconi anemia >People with this syndrome often have blood problems at an early age, which may lead to leukemia or aplastic anemia. They also have a very high risk of cancer of the mouth and throat.
Dyskeratosis congenita >genetic syndrome that can cause aplastic anemia, skin rashes, and abnormal fingernails and toenails. People with this syndrome also have a very high risk of developing cancer of the mouth and throat at a young age
5.Weakened immune system can be caused by certain diseases present at birth, the acquired immunodeficiency syndrome (AIDS), and certain medicines (such as those given after organ transplants).
6.Graft-versus-host disease (GVHD) is a condition that sometimes occurs after a stem cell transplant. During this medical procedure, blood stem cells from a donor are used to replace bone marrow that has been destroyed by disease, chemotherapy, or radiation. GVHD occurs when the donor stem cells recognize the patient’s cells as foreign and launch an attack against them. GVHD can affect many tissues of the body, including those in the mouth. This increases the risk of oral cancer, which can occur as early as 2 years after GVHD.
7.Passing certain AGE thresholds and engaging in certain lifestyle habits can place you at increased risk for oral cancer
- Patients age 40 and older (95% of all oral cancer cases)
- Patients age 18-39 who use tobacco, are heavy drinkers, or may have a previously diagnosed oral HPV infection.
PROTECT YOURSELF AGAINST ORAL CANCER
There is no sure way to prevent all oral and throat cancers. But you can control some risk factors to help reduce your risk:
- Quit using all types of tobacco
- Stay away from other people’s tobacco smoke (secondhand smoke)
- Limit or don’t drink alcohol
- Protect yourself from ultraviolet light exposure
- Prevent HPV infection get vaccinated
- Eat lots of fruits and vegetables
- Have dentures fitted properly
- Consume more fruits and vegetables (good for everything, of course)
- Avoid excessive sun exposure that can result in cancer of the lip (using lip balm with an SPF of at least 30 can be helpful)
- Avoid exposure to environmental hazards (wood dust, formaldehyde, printing chemicals)
- Consider coffee. While the jury is still out, some research suggests coffee may help protect the mouth from oral cancer.
SYMPTOMS OF ORAL CANCER
Oral cancer is often found because a person notices unusual changes in their mouth. The symptoms of oral cancer include:
OTHERS
- A sore on your lip or in your mouth that won’t heal
- A lump on your lip, in your mouth, or in your throat
- A feeling of something caught in your throat
- Pain when you chew or swallow
- Swelling around your jaw
- Loose or painful teeth
- A lump, swelling, or mass in your neck that doesn’t go away
- A change in your voice
>Warning Signs If you experience any of the below symptoms lasting more than 7-10 days, please seek the advice of your doctor. Also, keep in mind that aside from an obviously sore throat, the below symptoms can present themselves in the absence of pain. Look out for changes that can be detected on the lips, inside the cheeks, palate, and gum tissue surrounding your teeth and tongue.
>Conduct a self-exam monthly so you can catch any of the symptoms listed above. Use a small hand-held mirror so you can see the back of your mouth and tongue Ask any of the Dental Hygienists how to perform an oral cancer screening. It only takes a minute and anyone can do it at home.
>Oral cancer is serious business. Yet, it can be managed when caught early. So, do the right thing and visit your dentist regularly, and get that screening.
ORAL CANCER DIAGNOSIS
Oral cancer is often found during routine dental or medical exams. Your healthcare provider may check for signs of oral cancer during your regular exams. And you should tell your healthcare provider if you have any symptoms.
If your healthcare provider thinks you may have oral cancer, you will need exams and tests to be sure.
- Your healthcare provider will ask you about your health history, your symptoms, risk factors, and family history of disease.
- He or she will also give you an oral exam. This involves looking at your head and neck and checking inside your mouth.
- He or she may also look at the back of your mouth and throat with small mirrors or with a thin, flexible, lighted tube. This tube is called a laryngoscope or a pharyngoscope.
Based on the results, your healthcare provider may decide you need a biopsy to check for cancer.
A biopsy is the only way to confirm cancer. Small pieces of tissue are taken out and checked for cancer cells. Your results will come back in about 1 week.
After a diagnosis of oral cancer, you’ll likely have other tests. These help your healthcare providers learn more about your cancer. They can help determine the stage of the cancer. The stage is how much and how far the cancer has spread (metastasized) in your body. It is one of the most important things to know when deciding how to treat the cancer.
Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.
STAGES
ORAL CANCER TREATMENT
The goal of treatment may be to cure you, or control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be. Other things to think about are if the cancer can be removed with surgery and your overall health.
Types of treatment for cancer are either local or systemic. Local treatments >remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Surgery is a common treatment for oral cancer.
Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment.
You may have just one treatment or a combination of treatments
What are treatment side effects?
Cancer treatment such as chemotherapy and radiation can damage normal cells.
This can cause side effects such as hair loss, mouth sore, and vomiting.
Talk with your healthcare provider about side effects you might have and ways to manage them. There may be things you can do and medicines you can take to help prevent or control side effects.
After surgery for oral cancer, you may need extra care to adjust to new ways of eating, drinking, speaking, and breathing. The types of changes you have depend on the type of surgery that was done.
Coping with oral cancer
Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.
Here are tips:
- Talk with your family or friends.
- Ask your healthcare team or social worker for help.
- Speak with a counselor.
- Ask your healthcare team about medicines for depression or anxiety.
- Keep socially active.
- Join a cancer support group.
Cancer treatment is also hard on the body. To help yourself stay healthier, try to:
- Eat a healthy diet, with as many protein foods as possible.
- Drink plenty of water, fruit juices, and other liquids.
- Keep physically active.
- Rest as much as needed.
- Talk with your healthcare team about ways to manage treatment side effects.
- Take your medicines as directed by your team.
When should you call consult healthcare provider?
Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:
- New symptoms or symptoms that get worse
- Signs of an infection, such as a fever
- Side effects of treatment that affect your daily function or don't get better with treatment
Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.
Key points about oral cancer
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
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