What is an Oral Cancer?

Oral cancer, also known as mouth cancer, is a type of cancer that affects the tissues inside the mouth. Oral tumours can manifest on different parts of the mouth, such as the surface of the tongue, the inside of the cheeks, the roof of the mouth (palate), the lips, or the gums. In addition to these areas, tumours can also develop in comparatively rare sites like the glands responsible for producing saliva, the tonsils at the rear of the mouth, and the pharynx, the passage connecting the mouth to the windpipe. Symptoms of oral cancer may resemble common issues such as white patches or bleeding sores in the mouth or on the lips. However, the key difference is that these changes do not disappear with time.

What are the risk factors for developing Oral Cancer?

Approximately 75% of individuals diagnosed with oral cancer exhibit specific habits as listed below:

  • Smoking cigarettes, cigars, or pipes
  • Chewing betel nut, paan, gutka, or other tobacco-containing products
  • Excessive alcohol consumption
  • Individuals who spend a lot of time in the sun without adequately protecting their lips with sunblock 

Other risk factors include

  • Having human papillomavirus (HPV) infection
  • A weakened immune system
  • A family history of oral cancer or other types of cancer
  • Males are more affected than females

It is important to note that approximately 25% of individuals who develop oral cancer do not engage in smoking and can have other risk factors.

What are the symptoms experienced when one is suffering from Oral Cancer?

Oral cancer symptoms can manifest in the following ways:

  • A persistent sore or ulcer in the mouth that does not heal
  • A growth or lump anywhere inside the mouth
  • Areas in the mouth that bleed
  • Difficulty or pain while swallowing
  • Trouble wearing dentures
  • A lump in the neck
  • Persistent ear pain
  • Significant weight loss
  • Numbness in the chin, neck, face, or lower lip
  • Red, white, or red and white patches inside the mouth or on the lips
  • Sore throat
  • Stiffness or pain in the jaw
  • Loose teeth

What diagnostic test should one undergo to diagnose Oral Cancer?

Your dentist may identify potential oral cancer symptoms during your regular dental checkups. If necessary, they may perform some initial tests or refer you to a specialist such as an oral and maxillofacial surgeon, head and neck surgeon, or an ear, nose, and throat (ENT) specialist. To detect oral cancer, several tests are available:

  • Physical examination: Your healthcare provider will conduct a thorough examination of your entire mouth, feel around the mouth, and inspect the head, neck, and face to look for any signs of pre-cancer or cancer.
  • Brush biopsy or exfoliative cytology: Involves using a small brush or spatula to gently scrape the affected area to collect cells that will be analyzed for cancer.
  • Incisional biopsy: Involves removing small pieces of tissue from the affected area to obtain cells that will be examined for cancer.
  • Indirect laryngoscopy and pharyngoscopy: In this procedure, a small mirror on a long, thin handle is used to examine the throat, the base of the tongue, and part of the larynx (voice box).
  • Direct (flexible) pharyngoscopy and laryngoscopy: This procedure involves using an endoscope, a thin, flexible tube with an attached light and viewing lens, to examine areas of the throat and mouth that are not visible with a mirror.

Furthermore, your healthcare provider may conduct one or more of the following evaluations:

  • X-rays: to determine if cancer cells have spread to the jaw, chest, or lungs
  • Computed Tomography (CT) scan: to detect any tumours in your mouth, throat, neck, lungs, or other parts of your body
  • Positron Emission Tomography (PET) scan: to identify whether cancer has spread to lymph nodes or other organs
  • Magnetic Resonance Imaging (MRI) scan: to provide a more accurate image of the head and neck and assess the extent or stage of the cancer
  • Endoscopy: to examine the nasal passages, sinuses, inner throat, windpipe, and trachea.

What are the stages of Oral Cancer?

The four stages of oral cancer are:

Stage 1: The tumour is less than or equal to 2 centimeters (cm) in size, and there is no evidence of cancer in the lymph nodes.

Stage 2: The tumour is between 2 and 4 cm, and there is no evidence of cancer in the lymph nodes.

Stage 3: The tumor is larger than 4 cm and has not spread to the lymph nodes or is any size and has spread to only one lymph node but not to other parts of the body.

Stage 4: Tumors can be any size and the cancer cells have spread to nearby tissues, the lymph nodes, or other parts of the body.

What is the treatment for Oral Cancer?

Three primary treatment options are available for oral (mouth) cancer: Surgery, Radiation therapy, and Chemotherapy. It would be best if you discuss the purpose, side effects, and ways to manage side effects for all options with your healthcare provider.

  • Surgery typically removes the tumour and any cancerous lymph nodes in the early stages. Other tissue in the mouth and neck may also need to be removed.
  • Radiation therapy uses strong beams of energy to kill cancer cells or keep them from growing. Advanced-stage treatments may require a combination of chemotherapy and radiation therapy.
  • Targeted therapy uses drugs or other substances to identify and attack certain cancer cells without harming normal cells. It binds to specific proteins on cancer cells and interferes with their growth.
  • Chemotherapy involves using anti-cancer drugs to kill cancer cells, including treatments that affect most parts of your body. It kills cancer cells, either orally or intravenously.
  • Immunotherapy engages your immune system to fight cancer and is sometimes called biological therapy.

How can I prevent Oral Cancer?

Oral cancer can be avoided, and you can take an active role in its prevention. The following tips can assist in the prevention of oral cancer:

  • Avoid all forms of tobacco including smoking cigarettes, cigars, and pipes, as well as using smokeless tobacco products like chewing tobacco or paan, gutka.  Avoid chewing betel nut
  • Limit alcohol consumption
  • Remember to apply sunscreen. Protect your lips from prolonged and unprotected sun exposure by applying lip balm or sunscreen with a high sun protection factor (SPF) when outdoors
  • Get vaccinated for human papillomavirus
  • Consume a healthy, balanced diet
  • Have regular dental checkups. People aged 20 to 40 should have oral cancer screening every three years, and after 40, they should have annual exams

What is the role of reconstructive surgery and rehabilitation in Oral Cancer treatment?

After undergoing oral cancer treatment, individuals with advanced cases may require reconstructive surgery and rehabilitation to aid in their recovery and ability to eat and speak. Reconstructive procedures may involve dental implants or grafts to replace missing bones and tissues in the mouth and face. Artificial palates may also be utilized to replace any missing teeth or tissue. For those with advanced cases of oral cancer, rehabilitation is crucial. Speech therapy can be provided immediately following surgery and continued until the individual reaches their maximum level of improvement.

To summarize, oral cancer is a disease that can be treated successfully if detected early. That is why visiting your dentist twice a year and regularly checking your mouth is essential. You can reduce the risk of oral cancer by avoiding tobacco products. The treatment options are determined by various factors such as your overall health, the location of the cancer within your mouth or throat, the size and type of the tumor, and whether the cancer has spread. Considering these factors, your healthcare team will develop a personalized treatment plan tailored to your needs.

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