Cancer, occurring inside the mouth, is called Oral cancer or Mouth cancer or Oral cavity cancer. It arises when there is an uncontrolled growth or sore patch that does not go away when treated normally. Oral cancer is also referred to as Oral carcinoma, in which the carcinoma stands for cancer. Oral cancer, including the cancer of lips, tongue, upper throat, cheeks, gums, the floor of the mouth, etc., can be life-threatening if not diagnosed and treated early on time.
Oral cancer is one of the many known cancers and is grouped with head and neck cancers. They are often treated similarly as well. Oral cancers are most likely to be diagnosed or discovered after spreading to lymph nodes of the neck. The crucial thing to survive oral cancer is to detect cancer in its earlier stage.
Oral cancer is particularly dangerous because it can grow without causing any pain to the carrier and it also has a high risk of producing primary tumors for consecutive times, which means the patients who have already been diagnosed, treated and survived the first encounter are more likely to have a second encounter. The risk factor can last from 5 to 10 years after the treatment of oral cancer.
Every case of oral cancer is different, depending on the patient itself, and is treated accordingly. These cancers are oral tumors. There are many malignant oral tumors that can lead up to the stage when they become cancerous, and then there are many benign oral tumors too which can be treated more easily.
1.Squamous Cell Carcinoma
More than 90% of the cancers that occur in the oral cavity are squamous cell carcinoma. Squamous cells are fish scale looking thin, flat cells. These cells are found in the tissues that form the skin surface and the lining of hollow body organs, respiratory and digestive tracts. The squamous cell carcinoma begins when some cells are mutated and begin to grow abnormally.
The floor of mouth cancer: The floor of mouth cancer falls under the head and neck cancer category. This type of oral cancer begins when the cells that make the floor of the mouth (under the tongue, horseshoe-shaped area) begin to grow abnormally or uncontrollably and start to form lesions or oral tumors. In most cases, these oral tumors are mistaken as Canker sores.
Often mistaken for gingivitis, this type of cancer begins when the cells in the upper or lower gums start to grow abnormally and start to form lesions or oral tumors. People with the habit of regularly chewing tobacco and drinking excessive alcohol daily have higher risks of getting this type of cancer.
Hard Palate Cancer: Hard palate cancer begins when the cells present in the roof of the mouth (the hard part), mutate or start to grow out of control and form oral tumors. The bony part of the mouth's roof works as a separation between the mouth and the nasal cavity. Cancer tends to spread into the nasal cavity when it becomes more advanced. People who chew tobacco and drink excessive alcohol on a regular basis are the ones with higher risk of getting such kind of oral cancer.
Inner Cheek Cancer (Buccal Mucosa Cancer): Inner cheek cancer, or Buccal Mucosa Cancer, begins when the cells of the inner cheeks start to grow abnormally and form oral tumors. Buccal Mucosa in Buccal Mucosa Cancer stands for the inner linings of the cheeks. This type of oral cancer occurs in squamous cells that form the inner linings of the cheeks and other parts (and other organs of the body) of the mouth. Chances of getting this kind of oral cancer are increased in those who chew tobacco and drink excessive alcohol daily.
Lip Cancer: Lip cancer is a type of oral cancer that forms or occurs when the cells present in the lips start to have uncontrolled growth to form oral tumors. It is the most common type of Oral cancer. Lip cancer occurring on the squamous cells is referred to as the squamous cell carcinoma. A more aggressive type of cancer than the squamous cell carcinoma, Melanoma- a type of skin cancer, can also occur on the lips. The people with a habit of chewing tobacco and drinking too much alcohol regularly, tend to have higher risks of getting this type of oral cancer. People who spend a longer period under the sun also have an increased risk of developing such cancer.
Tongue Cancer: Tongue cancer begins when the cells that form the tongue start to grow without control to form oral tumors. The tongue consists of two parts, the oral tongue and the base of the tongue. Tongue cancer can occur on either part of the tongue. However, cancer occurring on the base of the tongue is classified as throat cancer, and cancer occurring on the part of the tongue which people can stick out is called oral cancer.
Verrucous Carcinoma takes up around 5% of all oral cancers that occur in the oral cavity. This cancer type is made up of squamous cells, and it is a slow-growing cancer. Due to its slow growth, it does not spread to any other nearby organs or body parts, but it most certainly has an impact on the surrounding cells. This type of cancer often occurs in people who chew tobacco or use snuff (smokeless tobacco, made from ground tobacco leaves) orally. It occurs in these people so often that it is usually referred to as “Snuff Dipper's Cancer.” Chewing betel nuts can also add to the risks. Symptoms of Verrucous Carcinoma include
It has a slow-growing lesion covered in red, white, or dark leukoplakic patches on the affected area. In verrucous carcinoma, invasive lesions are formed, which can invade bones quickly. This cancer can cause the enlargement of regional lymph nodes. The lesions in this cancer are painful and have multiple rugae-like folds and deep clefts between them. Patients also experience pain and difficulty when chewing their food.
3.Minor Salivary Gland Carcinomas
Minor salivary gland carcinomas include various kinds of oral cancers, which may develop on the minor salivary glands. There are many kinds of salivary gland cancers as the salivary glands are made up of different kinds of cells, and tumors can start growing in any one of these cells. These salivary gland cancers are named according to the cells they look like the most when looked under the microscope.
Doctors usually assign a grade to these cancers, ranging from 1 to 3, 1 being the lowest and 3 being the highest. These assigned grades give a subtle idea about the rate of the tumor's growth and spread.
Grade 1 cancers are low-grade cancers or well-differentiated cancers, they look very similar to normal salivary glands, and have slow growth.
Grade 2 cancers are intermediate grade cancers or moderately differentiated cancers; they are generally classified as the appearance and outlook are in between grade 1 and grade 3.
Grade 3 cancers are high-grade cancers or poorly differentiated cancers, they look very different from the regular cells, and they can also spread or grow quickly.
Mucoepidermoid carcinoma is the most common type of oral cancer that occurs in the salivary glands. Most of them start in the Parotid glands. They are less likely to occur in the submandibular glands or minor salivary glands inside the mouth. Mucoepidermoid Carcinoma cancer is normally low-grade cancer, but it can also be an intermediate or high-grade cancer.
Adenoid Cystic Carcinoma
Adenoid Cystic Carcinoma appears to be a slow-growing, low-grade oral cancer when looked under the microscope. However, they are hard to get rid of as they tend to spread along the nerves. This kind of cancer tumor tends to come back after treatment, and sometimes they can even come back years later.
Adenocarcinoma is used to describe the cancers which start in gland cells. There are multiple types of Salivary Gland Adenocarcinomas.
Acinic Cell Carcinoma: It is most likely to start from a parotid gland. They are slow-growing tumors, and they tend to occur at a younger age than other salivary gland cancers. They are mostly low-grade cancers, but the outcome solely depends upon how far cancer has grown into nearby tissue.
Polymorphous Low-Grade adenocarcinoma: These tumors mostly grow slower, and they tend to be cured. They start in the minor salivary glands. They are most commonly found in the palate.
4.Benign Oral Cavity Tumors Sometimes, several kinds of non-cancerous tumors called Benign Oral Cavity Tumors can develop in the oral region which may impose tumor-like conditions but are benign in nature. However, to make sure that these tumors do not develop into something cancerous, doctors normally advise to remove them surgically.
Oral cancers can grow or occur when the cells in the lips and mouth get mutated. The mutation occurs in their DNA. The DNA of a cell contains valuable information about the work process of that cell as well as the replication cycle. With the mutation in the picture, the cell continues replicating itself even when not required. It slowly depletes the healthy cells, and those healthy cells are, over time, replaced by the tumorous cells. These tumorous cells later form cancer and can spread throughout the body in the later stages. Oral cancers usually begin to grow from the thin, flat cells called squamous cells that form the lips and inside of the mouth. Most of the oral cancers are squamous cell carcinomas. The actual cause of the mutation occurring in the cell has not been identified yet.
Researchers have identified some risk factors based on the people diagnosed with oral cancer, to give an idea about the risks of getting affected by such cancers. Oral cancer is a disease of environmental factors, and like any other environmental factor, the rate of spread and/or growth of oral cancer depends on the dose, method, frequency of the intake of the carcinogenic compound (a compound that causes cancer). Here are the most common risk factors in the case of Oral Cancers.
The patients will most likely go through a physical examination at first, which means a close examination of the roof and/or floor of the mouth, back of the tongue, cheeks, and the lymph nodes in the neck. ENT specialists can further examine if and when the doctor is unable to figure out the cause of the symptoms.
Treating oral cancers can vary depending on the type, location, and stage of cancer.
Surgery: Early stages of oral cancers can be cured by surgically removing the tumors and lymph nodes. In most cases, removal of the cells and tissues around the affected area is also performed.
Radiation therapy: Radiation therapy also helps to cure cancer. In this, the doctor focuses a beam at the tumor once or twice a day, five times a week for around two to eight weeks. Advanced stages, however, are treated with the combination of radiation therapy and chemotherapy.
Targeted therapy: Targeted therapy is helpful in both early and advanced stages of oral cancer. In this, the drugs will bind to the specific proteins on cancer cells and halt their uncontrolled growth.
Nutrition: Nutrition plays an important role in oral cancer treatment. Most of the treatments make it painful to eat and swallow, resulting in the reduction of the weight. Then the nutrition comes in the picture to maintain the processes going.
Cancer in this stage is only on the epithelium, the outermost layer of the skin. Stage 0 means that it has not started to grow to the tissues; but it can spread into the deeper layer of the skin if not treated on time. Cancer in this stage is usually treated with a small surgery to remove the top layer of the skin along with a small margin of normal tissues. A follow up in this stage is really important to watch for the signs of cancer coming back. If it keeps coming back, then it might need treatment with radiation therapy.
Almost all patients diagnosed with stage 0 cancer survive for a long time without the need for any intense treatment. However, continuous smoking and/or excessive drinking can lead to a new type of cancer formation.
Stage I to III The common and usual treatment for cancer in these stages is surgery and/or radiation therapy. Chemotherapy, along with radiation (chemoradiation), is also an option in some cases. Radiation is usually given after the surgery to get rid of the traces of cancer cells that might be left behind.
Stage I: In Stage I, the tumor is less than 2cm in size and is contained to the place of beginning, which means it has not yet spread to any lymph nodes. Side effects include swelling or bloating of the face and pain in the area where surgery was performed.
Stage II: In Stage II, the tumor is between 2-4 cm in size. Cancer cells have not spread to the lymph nodes yet. Side effects of the treatment include pain, tiredness, swelling of the face, and even bleeding in some cases.Both I and II stages have the five-year survival rate of around 70% to 90% depending on various factors.
Stage III: In Stage III, the tumor is either larger than 4cm, or it can be of any size, spreading to one lymph node and leaving other organs intact. Side effects of treating a Stage III cancer can range from swelling or bloating of the face to bleeding, nausea, tiredness, weakness and hoarseness. The survival rate is around 83% in case the tumor hasn't spread to nearby lymph nodes and around 64% when the nearby lymph nodes are affected too.
Stage IV Cancer in this stage is HPV-negative cancer (independent from HPV-infection) and has already spread to nearby tissues, lymph nodes, and other nearby organs (usually, the lungs). Treatment for this stage cancers include chemotherapy, cetuximab (targeted drugs to cure cancer), or the combination of both for the treatments. Immunotherapy can also be an option, and it can also be given along with chemotherapy to help fasten the process.
The survival rate for this stage cancer is around 38%, and the side effects after the treatment include swelling of the face, change in taste, dryness of mouth, bleeding in some cases, hoarseness, pain and/or redness in and around the mouth. Removal of lymph nodes can also cause shoulder weakness, ear numbness, and swelling in the area if they were removed from the neck. Constipation or diarrhea can also occur in some cases due to heavy medications.
Along with medical help, mental health, lifestyle management, and community support are also required to further improve the overall health gain. A healthy lifestyle with a proper sleep schedule, various exercises, and a healthy diet can help fight against oral cancer. Every positive aspect is necessary while going through the situation
The recovery varies for different treatment methods. Chemotherapies and radiation therapies can be extremely painful and overwhelming. Post surgery symptoms can cause pain and swelling in and around the cured area.
Negative effects of radiation therapy on the body include a sore throat, tooth decay, nausea and vomiting, jaw stiffness and pain, weight loss, and fatigue. Adverse effects of chemotherapy include hair loss, diarrhea, numbness in the hands and feet, nausea and vomiting, and poor appetite.
Targeted therapies can also have negative effects on the body, such as fever, headache, skin rashes, and allergic reactions. The treatments of oral cancer can have side effects, but they are essential to help prevent further damage caused by the cancer cells.