This article has been reviewed and approved by Dr Niti Raizada for authenticity and medical correctness on 21 Jun 2020

All about Oral Cancer

Oral cancer or mouth cancer affects the structures in your mouth or oral cavity. It may affect your lips, cheeks, gums, tongue, the floor of your mouth, the palate or roof of the mouth, etc. 

Mouth cancers are two times more common in men than women. A majority of those who have it are above sixty years of age. It is rare in children and young adults. 

Habits like smoking, tobacco chewing, heavy alcohol use, etc. may increase your risk of mouth cancers. 

Mouth cancers have very few symptoms in its early stages. It makes early detection of cancer difficult. These cancers usually show up early as small growths, patches, or ulcers that do not heal.

Due to the presence of a large number of lymph nodes close to the mouth, oral cancers spread very quickly to other parts of the body.

A biopsy is the best way to confirm oral cancers. Early detection will help to treat this very effectively. Surgery is the most common treatment for oral cancers.

What causes oral cancer?

Cancers occur when certain changes or mutations occur in the genetic materials that control cell division. Mutations also affect the cell factors that control how long a cell should live. Mouth cancers also happen due to these reasons.

But your chance of getting mouth cancers may increase due to certain factors. These may or may not be under your control 

What are the risk factors of oral cancers?

Some of the common risk factors for oral cancers are

  • Smoking and Alcohol- If you smoke cigarettes or cigars, use pipes, etc. you are at higher risk. Similarly, habits like tobacco chewing, placing tobacco pouches under the tongue, etc. will also increase your risk. Overuse of alcohol is another possible reason
  • Viral infections- If you have human papillomavirus(HPV) infections in your lips or other parts of the mouth, your risk of mouth cancer is more. It usually occurs due to unprotected oral sex. Herpes simplex virus (HSV) infections are another risk. 
  • Having sharp tooth edges that cause wounds
  • Having poor oral hygiene
  • Poor diet without enough nutrients
  • A weak immune system
  • Chronic fungal infections of the mouth

 

Mouth cancers may also occur without any of these risk factors.

What are the symptoms of mouth cancers?

Mouth cancers have few early signs symptoms. In most, it will start as a small harmless growth, patch, or an ulcer that does not heal. Gradually these will start increasing in size. If you have any of these, you will need to consult your dentist or doctor immediately.

 

Other symptoms include

  • Pain in some areas of the mouth
  • A thickening of some areas without a reason
  • A feeling of a lump in the throat
  • Difficulty in swallowing food
  • Pain in the jaws
  • Persistent foul breath
  • Loosening of the teeth without a reason
  • Swellings in some areas of the jaws or mouth
  • Large ulcers in the mouth    

Diagnosis of oral cancer

If you have any of these symptoms and your doctor suspects that something is wrong, you will have a few tests.

Biopsy- In this procedure, the surgeon will remove a small part of the tissue from the suspicious area to examine it under a microscope. If the tissue sample has cancer cells, the surgeon will start treatment at the earliest.

If the area is small, the surgeon may remove it entirely during a biopsy. Further treatment is necessary only if the sample is positive for cancer.

Treatment for oral cancer

There are different treatment options for oral cancers.

Surgery for mouth cancers

Surgery is by far the best option to treat oral cancers that have not spread to other areas. There are different surgeries for treating oral cancers. 

The type of surgery you will have will depend on the location and extent of your cancer. Your cancer surgeon will remove the part of your mouth having cancer. The surgeon will also remove the lymph nodes close to the area to prevent the spread of cancer.

You will have surgery under general anesthesia. The surgeon will remove the part of the mouth with cancer along with a margin of healthy tissue. It is to make sure that no cancer cells are left behind after surgery.

Removing large cancer that involves a major part of your mouth will disfigure your face. Hence, you will have reconstructive surgery, later on, to bring your face to a normal shape. 

Some of the common surgeries for oral cancers are;  

  • Mohs micrographic surgery- You will have this surgery if you have lip cancer. Your surgeon will remove the area of the lip with cancer as thin slices. Soon after removing it, the surgeon will have a pathologist to examine the slice for cancer cells. If the specimen show cancer cells, the surgeon will remove another thin slice for examination. It will go on until the surgeon has a slice without any cancer cells. The main benefit is that it allows the surgeon to conserve as much healthy tissue as possible.
  • Glossectomy- You will have this for if you have tongue cancer. Your surgeon will remove the part of your tongue having cancer(partial glossectomy). If cancer involves a larger portion of the tongue, your surgeon may remove it altogether.
  • Mandibulectomy- This surgery is for cancers of the lower jaw or mandible. Buring the operation, the surgeon may remove the part or whole of the lower jaw with cancer. The surgeon may also remove the lymph nodes close to cancer as well during the surgery.
  • Maxillectomy- You will have the surgery if the cancer is in the palate, maxillary sinus, or any other part of the upper jaw or maxilla. During surgery, your surgeon will remove the areas with cancer. Hence, it is possible to have gaps in the maxilla after surgery. To restore the shape of your face, you will have prostheses as well as surgery.

 

Commando operation- If you have cancer of the tongue, it is easy for it to spread to the lower jaw. If your surgeon has a suspicion regarding this, you may have a ‘commando operation’. Here, the surgeon will remove the part of your tongue with cancer, the part of the lower jaw close to it, and the lymph nodes as well.

Radiation therapy for mouth cancer

You will have this only for very advanced mouth cancer where surgery to remove it is not possible. It helps to reduce the symptoms and to prevent it from spreading fast. Your doctor will take all precautions to avoid any exposure of the brain to radiation.

Your surgeon will treat cancers of the tongue with internal radiation therapy. In this treatment, the doctor will place a metered radiation source in the form of pellets or ribbons close to cancer. This source will emit radiation to kill cancer cells.

Chemotherapy for mouth cancer

Given as a radio-sensitizer or given when the disease is advanced, to control the spread of disease.

Targeted therapy for mouth cancer

Targeted therapy uses medicines to destroy the tissue mechanism in the cancer cells that allow them to survive and multiply. You will have the treatment as pills or as injections through the veins. The medicines target the genetic materials, proteins, or other factors responsible for cancer cell growth and division.

Immunotherapy for mouth cancer

It aims to treat cancer by raising the immunity of your body and training it to fight cancers. Cancer cells have certain factors that allow them to disguise as normal cells. It thus escapes the natural immune system of the body. Immunotherapy medicines help to identify the cancer cells and make the immune system destroy it. 

Oral cancers are treatable if it is in the early stages. Cancers that have spread to other parts of the body will need extensive treatments

Oral cancer treatment in India
Oral cancer treatment in India

References / Additional Reading
This article has been reviewed by Dr Niti Raizada for authenticity and medical correctness on 21 Jun 2020
Dr Niti Raizada
Dr Niti Raizada
MBBS, MD, DM-Medical Oncology, MRCP
Dr. Niti Raizada is a senior Medical Oncologist with over fifteen years of experience in the field. Dr Niti has special interests in the areas of Thoracic, Gastrointestinal, Breast, Gynaecological Oncology, and Bone Marrow Transplants. She did her MBBS at Gandhi Medical College, Bhopal; MD-General Medicine at G R Medical College, Gwalior, DNB-General Medicine from National Board Of Examination,DM from Adyar Cancer Institute Chennai and Fellowship in Hematology from Hammersmith Hospital and Imperial College,London. She is a member of American Society of Clinical Oncology,USA; Royal College of Physicians,Edinburgh,UK; Member of Pharmacy Committee,Member of DNB teaching program in Medical Oncology and European Society of Medical Oncology (ESMO).
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