ORAL CANCER
Oral
cancer
Oral
cancer or
mouth
cancer,
a
type of head
and neck cancer ,
is any cancerous
tissue
growth located in the oral cancer.
It
may arise as a primary lesion
originating
in any of the tissue
in
the mouth, by metasis
from
a distant site of origin, or by extension from a neighboring anatomic
structure, such as the nasal
cavity.
Alternatively, the oral cancers may originate in any of the tissues
of the mouth, and may be of varied histologic
types:
teratoma,
adenocarcinoma
derived
from a major or minor salivary
gland,
lymphoma from tonsillar
or
other lymphoid
tissue,
or melanoma
from
the pigment-producing cells of the oral mucosa. There are several
types of oral cancers, but around 90% are squamous
cell carcinomas,
originating
in the tissues that line the mouth and lips. Oral or mouth cancer
most commonly involves thetongue.
It may also occur on the floor
of the mouth,
cheek lining, gingiva
(gums),
lips, or palate (roof of the mouth). Most oral cancers look very
similar under the microscope and are called squamous
cell carcinoma,
but less commonly other types of oral cancer occur, such as Kaposi's
sarcoma.
In
2013 oral cancer resulted in 135,000 deaths up from 84,000 deaths in
1990.
Five year survival in
the United States are 63%
Skin
lesion, lump, or ulcer
that
do not resolve in 14 days located:
- On the tongue, lip, or other mouth areas
- Usually small
- Most often pale colored, may be dark or discolored
- Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth
- Usually painless initially
- May develop a burning sensation or pain when the tumor is advanced
- Behind the wisdom tooth
- Even behind the ear
Additional
symptoms that may be associated with this disease:
- Tongue problems (moving it)
- Swallowing difficulty
- Pain and paraesthesia are late symptoms.
- A change in the way your teeth or dentures fit together
- Dramatic weight loss.
CAUSES:
According
to the American cancer
Society,
men face twice the risk of developing oral cancer as women, and men
who are over age 50 face the greatest risk. It's estimated that over
40,000 people in the U.S. received a diagnosis of oral cancer
in
2014.
Risk
factors for the development of oral cancer include:
- Smokeless tobacco users. Users of dip, snuff, or chewing tobacco products are 50 times more likely to develop cancers of the cheek, gums, and lining of the lips.
- Excessive consumption of alcohol. Oral cancers are about six times more common in drinkers than in nondrinkers.
- Family history of cancer.
- Excessive sun exposure, especially at a young age.
- Human papillomavirus (HPV). Certain HPV strains are etiologic risk factors for Oropharyngeal squamous cell carcinoma(OSCC)
It
is important to note that over 25% of all oral cancers occur in
people who do not smoke and who only drink alcohol occasionally.
Oral
Cancer Diagnosis:
As
part of your routine dental exam, your dentist will conduct an oral
cancer screening exam. More specifically, your dentist will feel for
any lumps or irregular tissue changes in your neck, head, face, and
oral cavity. When examining your mouth, your dentist will look for
any sores or discolored tissue as well as check for any signs and
symptoms mentioned above.
Your
dentist may perform an oral brush biopsy
if
he or she sees tissue in your mouth that looks suspicious. This test
is painless and involves taking a small sample of the tissue and
analyzing it for abnormal cells. Alternatively, if the tissue looks
more suspicious, your dentist may recommend a scalpel biopsy. This
procedure usually requires local anesthesia and may be performed by
your dentist or a specialist. These tests are necessary to detect
oral cancer early, before it has had a chance to progress and spread.
TREATMENT:
Surgical
excision (removal) of the tumor is usually recommended if the tumor
is small enough, and if surgery is likely to result in a functionally
satisfactory result. Radiation therapy
with
or without chemotherapy
is
often used in conjunction with surgery, or as the definitive radical
treatment, especially if the tumour is inoperable. Surgeries for oral
cancers include
- Mandibulectomy (removal of the mandible or lower jaw or part of it)
- Glossectomy (tongue removal, can be total, hemi or partial)
- Radical neck dissection
- Combinational e.g. glossectomy and laryngectomy done together.
- Feeding tube to sustain nutrition.
Owing
to the vital nature of the structures in the head and neck area,
surgery for larger cancers is technically demanding. Reconstructive
surgery may be required to give an acceptable cosmetic and functional
result. Bone grafts
and
surgical flaps
such
as the radial
forearm flap are
used to help rebuild the structures removed during excision of the
cancer. An oral prosthesis
may
also be required. Most oral cancer patients depend on a feeding tube
for their hydration and nutrition. Some will also get a port for the
chemo to be delivered. Many oral cancer patients are disfigured and
suffer from many long term after effects. The after effects often
include fatigue, speech problems, trouble maintaining weight, thyroid
issues, swallowing difficulties, inability to swallow, memory loss,
weakness, dizziness, high frequency hearing loss and sinus damage.
Survival
rates for oral cancer depend on the precise site, and the stage of
the cancer at diagnosis. Overall, 2011 data from the SEER database
shows that survival is around 57% at five years when all stages of
initial diagnosis, all genders, all ethnicities, all age groups, and
all treatment modalities are considered. Survival rates for stage 1
cancers are approximately 90%, hence the emphasis on early detection
to increase survival outcome for patients. Similar survival rates are
reported from other countries such as Germany.
Following
treatment, rehabilitation
may
be necessary to improve movement, chewing, swallowing, and speech.
Speech and language pathologist
may
be involved at this stage.
chemotherapy
is
useful in oral cancers when used in combination with other treatment
modalities such as radiation therapy. It is not used alone as a
monotherapy. When cure is unlikely it can also be used to extend life
and can be considered palliative but not curative
care.
Biological agents, such as cetuximb
have
recently been shown to be effective in the treatment of squamous cell
head and neck cancers, and are likely to have an increasing role in
the future management of this condition when used in conjunction with
other established treatment modalities.
Treatment
of oral cancer will usually be by a multidisciplinary team, with
treatment professionals from the realms of radiation, surgery,
chemotherapy, nutrition, dental professionals, and even psychology
all possibly involved with diagnosis, treatment, rehabilitation, and
patient care.
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