Oral cancer is a type of head and neck cancer that develops when abnormal cells in the lining of the cheeks, gums, roof of the mouth, tongue, or lips grow out of control. Often times this term also refers to oropharyngeal cancer, which affects the soft palate, the side and back walls of the throat, the back third of the tongue, and the tonsils .
Tobacco and alcohol use are the main risk factors for the disease, but there are other factors, including infection with the human papillomavirus (HPV). The most common symptoms of oral cancer are sores that do not heal or persistent mouth pain . A biopsy is needed to confirm the diagnosis. Treatment varies depending on the location and spread of the cancer, but generally includes surgery, radiation therapy, and / or chemotherapy.
The vast majority of oral cancers are squamous cell carcinomas.
Flat cells are thin, flat cells that line the mouth and throat. Much less often, non-squamous cell cancers of the mouth, such as tumors of the salivary glands or lymphoma, can develop.
Symptoms of oral cancer
According to the American Cancer Society , the most common symptoms of oral cancer include pain in the mouth that does not heal or pain in the mouth or throat that does not go away.
Other potential symptoms of oral cancer include :
- White spot (leukoplakia) or red spot (erythroplasia) inside the mouth.
- Non-healing scab on lip or mouth ulcer
- Bleeding from the mouth not related to trauma
- Pain and / or difficulty chewing.
- Swollen glands (lymph nodes) or a lump in the neck.
- Jaw pain or swelling
- Difficulty swallowing, chewing, speaking, or moving the tongue or jaw
- Numbness of the tongue or mouth area
- Loose teeth or dentures
- Persistent bad breath
While the exact cause of oral cancer is unclear, it has been consistently found that there are factors that increase a person's risk of developing it.
Perhaps the most important risk factor for oral cancer is tobacco use. Smoking cigarettes, cigars, and pipes increases the risk of cancer anywhere in the mouth or throat. What's more, oral or smokeless tobacco products, often referred to as "dipping" or "chewing," increase the risk of developing cancers of the cheeks, gums, and inner lips.
Other risk factors associated with the development of oral cancer include :
- Excessive alcohol consumption: The risk increases dramatically when a person smokes and drinks heavily.
- The human papillomavirus (HPV) , especially HPV type 16, is transmitted sexually. Keep in mind that this is rarely associated with oral cancer. Oropharyngeal cancer (occurs in the tonsils, at the base of the tongue, etc.) is a type of cancer commonly associated with HPV infection .
- Eating a diet deficient in fruits and vegetables.
- Excessive exposure to sunlight (increases risk of lip cancer)
- Weakened immune system
- Having certain underlying health problems, such as graft-versus-host disease or a genetic syndrome such as Fanconi anemia.
- Chewing betel nut , a stimulant that is ingested like chewing tobacco and is often mixed with tobacco.
Oral cancer is more common in men, possibly because men are more likely to use tobacco and alcohol than women.
Oral cancer is also more common in adults over the age of 55, although this is changing as the number of cancers associated with HPV infection increases .
Diagnosis of oral cancer is a gradual approach that often begins when a primary care physician or dentist detects an abnormality in the mouth or throat after a physical exam. If this happens, or if you experience one or more symptoms suspected of having oral cancer, your healthcare provider will refer you to a throat and mouth specialist called an otolaryngologist.
The otolaryngologist will perform a complete examination of the head and neck, looking for abnormal areas and / or enlarged lymph nodes. To get the best performance from this exam, the ENT doctor may use an endoscope (a flexible tube with a camera and light on the end).
Discussion guide with an oral oncologist
Get our printable guide to your next doctor's appointment to help you ask the right questions.
If suspicious areas are seen during the exam, a tissue sample is removed (called a biopsy). If cancer cells are found on the biopsy, the stage of the disease (how far the cancer has spread) is determined. In general, staging is used both to determine the correct treatment and to predict a patient's prognosis or outlook.
Some of the tests involved in staging include :
- Examine a biopsy sample for HPV
- Magnetic resonance imaging (MRI)
- Neck and chest computed tomography (CT)
- Positron emission tomography (PET)
- Dental x-rays
- Barium swallow (series of gastrointestinal x-rays of the esophagus and stomach)
The early stages of oral cancer, such as in the gums ( gums ), manifest as a white spot or a red sore. Stage 2 tumors are larger, exceeding 2 centimeters. Stage 3 tumors affect nearby lymph nodes, causing them to become swollen, while stage 4 tumors affect several lymph nodes and other tissues .
The treatment regimen that you, your otolaryngologist, and your oncologist will choose will depend on the stage and location of the cancer, as well as the goals of your treatment. It is advisable to discuss all the options that apply to you.
Surgery (performed by your ENT doctor) to remove cancerous tissue is usually the first treatment for oral cancer and is most often used for early-stage oral cancer. Lymph nodes in the neck can also be removed during cancer removal surgery, as oral cancer usually spreads there .
For some people, surgery is the only necessary treatment; for others, chemotherapy and / or radiation may also be used.
Radiation therapy uses certain types of high-energy radiation beams to shrink tumors or kill cancer cells. Radiation therapy works by damaging the DNA of a cancer cell, rendering it unable to reproduce .
Chemotherapy may be given instead of surgery (usually in combination with radiation therapy) to treat certain types of oral cancers (called chemoradiotherapy). It can also be given before surgery to shrink the cancer (called neoadjuvant chemotherapy) or after surgery in combination with radiation (called adjuvant chemoradiotherapy) to kill the remaining cancer cells. In advanced cancer, chemotherapy can be used to slow tumor growth and relieve symptoms .
A targeted therapy used to treat oral cancer is called Erbitux (cetuximab) and it works by reducing to zero a protein located on cancer cells called epidermal growth factor (EGFR). This protein helps cancer cells grow and multiply, so blocking it can stop cancer growth. Depending on the stage of the cancer, cetuximab can be combined with radiation or chemotherapy, or even used as a single agent .
Supportive therapy for oral cancer focuses on symptom relief, such as pain relief and nutritional optimization .
For many people, the diagnosis and treatment of oral cancer cause psychological stress to one degree or another. This is not only due to the physical problems associated with living with oral cancer (such as fatigue, receiving treatment, or difficulty eating or drinking), but also practical day-to-day problems associated with living with cancer (such as employment or health problems). safe. or navigate relationships with family and friends).
The good news is that with the right coping strategies – those that are tailored to your unique needs – you and your loved ones can move forward.
Get the word of drug information
The key to curing oral cancer is early detection, which sadly does not occur in nearly half of newly diagnosed cases. However, the good news is that despite the lack of an official screening test or recommendation, there is growing awareness of oral cancer.
This has inspired many doctors and dentists to perform more detailed oral exams during routine visits. Patients are also encouraged to participate in regular self-exams and to be proactive in making an emergency visit when a symptom appears, such as a new lump or pain in the mouth or throat.