Oral Cancer

A brief about Oral Cancer

Cancer, occurring inside the mouth is called Oral cancer or Oral cavity cancer. Oral cancer, also known as mouth cancer, is something similar to 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. 

 

Mouth cancer or 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 tumours 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 the first time growth of oral cancer

What are the types 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 which 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.

 

  • 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. So, 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.

 

 

The chances of getting this kind of oral cancer are increased for those who chew tobacco often or consume too much alcohol. Dentists are often the ones noticing the signs of floor or mouth cancer during routine checkups. Symptoms of the floor of mouth cancer include

    • A regular growing sore in the mouth.
    • White, red, or dark leukoplakic patches inside the mouth.
    • Mouth pain
    • A lump in the neck

 

 

  • Gum Cancer: 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. During the routine dental examination, dentists are often the one spotting the symptoms of such cancer. Symptoms of Gum Cancer include

 

    • Red, white or dark leukoplakic patches on the gums itself.
    • Increased or thick area of the gums.
    • Bleeding or cracking of the gums.

 

 

  • 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 that grows there tends to spread into the nasal cavity when cancer enters the higher stage or when cancer becomes more advanced. People who regularly chew tobacco and drink too much alcohol regularly are the ones with higher risks of getting such kind of oral cancer. Symptoms of Hard Palate Cancer include

 

    • Ulcers on the roof of the mouth which may start to bleed when cancer starts to grow even more.
    • Difficulty while moving the jaw.
    • Cancer tends to change the speech of the patient.
    • Dentures don’t fit in the mouth.
    • Patients tend to feel loose teeth or pain around the teeth.
    • Most patients tend to have bad breath.

 

 

  • 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 which 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 regularly and drink excessive alcohol daily. Symptoms of Inner Cheek Cancer include

 

    • White, dark or red leukoplakic patches are often found in the mouth of the patients.
    • This type of oral cancer can cause severe ear pain.
    • The patients often feel a lump in their mouth.
    • It can also cause mouth pain or numbness in the mouth.
    • The patients can feel loose teeth and/or the pain around the teeth.
    • This oral cancer can also cause jaw pain or swelling of the jaws in patients.
    • The patients may also feel the hoarseness, the change in the voice.

 

 

  • 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 and start 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. Symptoms of Lip Cancer include

 

    • The patients having lip cancer can experience a sore on the lip that does not heal.
    • Patients also feel a lump on the lips.
    • They may also feel the swelling or the thickening of the lips.
    • Cancer also causes the pain, bleeding or numbness in the lips.

 

 

  • Tongue Cancer: Tongue cancer begins when the cells that form the tongue start to grow without control and start 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 the oral part, the part of the tongue a person can stick out, can have oral cancer. Symptoms of Tongue Cancer include

 

    • Patients suffering from this cancer may experience a sore throat that does not go away.
    • They might also experience red, white or dark leukoplakic patches on their tongue.
    • This oral cancer can cause mouth numbness.
    • Patients can experience pain while swallowing.
    • Patients may also have a sore spot or ulcer on the tongue that does not heal.
    • They may also experience bleeding from the tongue.

 

 

  • Verrucous Carcinoma

 

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 the 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 those 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.
    • Patients may feel gradual destruction of the jaw bone.
    • 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.

 

 

  • 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 they grow very slowly.
  • 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

 

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 tumors tend to come back after treatment and sometimes they can come back years later.

 

 

  • Adenocarcinomas

 

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 tend to start in the minor salivary glands. They are most commonly found in the palate.

 

 

  • Benign Oral Cavity Tumors

 

Sometimes, there can be several kinds of non-cancerous tumors, and tumor-like conditions can develop in the oral cavity. These tumors can sometimes convert into cancer and for that reason, they are usually surgically removed. Some of these benign lesions are:

  • Fibroma
  • Eosinophilic Granuloma
  • Granular Cell Tumor
  • Leiomyoma
  • Lipoma
  • Papilloma
  • And many more.

What are the symptoms and signs of Oral cancer?

 

  • The patients with Oral Cancer might feel some loose teeth.
  • Bleeding from the mouth can also be experienced by the patients.
  • Oral cancer can cause a sore on the mouth or on the lip that does not heal.
  • An unusual growth anywhere in the mouth can also be seen in many Oral cancer cases.
  • The patients might also feel lower lip, neck, chin or face numbness.
  • Patients might also feel a lump in their throat.
  • Oral cancer can also cause pain or difficulty while swallowing food.
  • Patients may also feel their ears hurting that won’t go away.
  • A significant weight loss can also be seen in some cases.
  • White, red, red and white or dark patches start to form in or on the mouth and lips of the affected person.
  • Patients may also feel tongue pain.
  • The patients diagnosed with oral cancer may also feel the stiffness or the pain in their jaw.

 

What are the causes of Oral Cancer?

 

Oral cancers can grow or occur when the cells in the lips and mouth somehow 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. Over time these tumorous cells can form cancer and can spread throughout the body.

 

Oral cancers usually begin to grow from the thin, flat cells called squamous cells which 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. But doctors have figured out some risk factors which increase the risks of oral cancers.

 

Risk Factors involved in Oral Cancer

 

Risk factors maximize the risks of getting affected by tumors or cancer cells. Having symptoms of oral cancers doesn’t always result in a positive case. Researchers have identified some risk factors based on the people diagnosed with oral cancer, to give an idea about the risks of being affected by such cancers. Oral cancer is a disease of environmental factors and like any other environmental factors, 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.

 

  • Tobacco: Tobacco is the most commonly used carcinogen. It is the main cause of oral and pharyngeal cancer. Tobacco directly damages the DNA and causes mouth and pharynx cancer. It is responsible for around 40% of total Oral cases.

 

  • Alcohol: Excessive regular intake of alcohol can increase the risk of being affected by oral cancers. Oral cancers occur around six times more in drinkers than non-drinkers. A 2008 study suggests that the breakdown product of alcohols, acetaldehyde, can increase the risks of oral cancers.
The combination of these two takes the risk factor even further than them being taken on their own. According to the National Institutes of Health, nicotine and alcohol together serve around 80% oral cancer cases in males and around 65% in women.
  • Human Papillomavirus: Human papillomavirus (HPV) causes human papillomavirus infection (HPV infection). Most HPV infections cause and/or show any symptoms and can be resolved in two years. However, there are some cases where it can go a little over the top and can cause precancerous lesions which can then convert into cancer tumors. There are over 180 types of known papillomavirus and type 16, in particular, is a known risk and independent causative factor for oral cancer. These infections are usually the most common sexually transmitted infections. Of all the types, about 40 types can spread through direct sexual contact to genital areas, as well as the mouth and throat. Oral HPV infection is transmitted to mouth or throat by oral sex. Oral HPV is most common in older age, it tends to affect around 10% of men and 3.6% of women.

 

  • Betel Nut: Betel nuts are a major cause of oral cancer even when taken without the tobacco. Chewing betel nuts can increase the risk of getting oral cancer by 2.1 times. In India, chewing ‘paan’ or betel is a common practice and due to that, 40% of all the cancer cases in the country are oral cancers.

 

  • Stem Cell Transplantation: People tend to be in an increased risk of oral squamous cell carcinoma after Hematopoietic Stem Cells Transplantation (HSCT). Hematopoietic Stem Cell Transplantation or HSCT is the transplantation of multipotent hematopoietic stem cells that are usually derived from bone marrow, peripheral blood or umbilical cord blood. After the transplantation, the immune system of the patient is destroyed or suppressed which can lead to oral cancers with more aggressive behaviour.

 

  • Premalignant Lesions: The Premalignant or precancerous lesions are lesions that are benign at the beginning and then they start to grow and cause cancer cells.

 

  • Gender: Men, in general, have a higher rate of getting cancer than women. The rate in men is twice the rate in women. Although men also tend to consume more tobacco and alcohol than women.

 

  • Age: Oral cancers are usually slow occurring and they take time to grow. Due to that, these cancers are more likely to occur in people in their 40s. However, the average age of diagnosis is 60 years.

 

  • Ultraviolet Light: Lip cancers are majorly caused in people who spend more time in the sun. Some tanning devices also use UV radiation which can lead to Lip or skin cancer.

 

  • Other risk factors: There are other, less-common risk factors as well, which can potentially cause Oral cancer:
  • A weak or suppressed immune system is home to many diseases and oral cancer is one of the many.
  • Fruits and vegetables are important for the human body and a diet with a low to no fruits and vegetable diet can increase the risks of being affected.
  • Graft-versus-host disease is a condition which can occur after a stem cell transplantation and these conditions can further lead to the cancer formation.

How to prevent Oral cancer?

 

Although there is no proven way to prevent oral cancers, there are ways which can lower the risk of getting affected by one.

 

 

  • Quitting tobacco or not starting at all

 

People consuming tobacco by any means should stop using it and those who have not started should never do so as consuming tobacco (whether it’s chewing or smoking or anything else) can expose the cell to cancerous tumors.

 

 

  • Drinking alcohol occasionally

 

Excessive consumption of alcohol can irritate the cells in the mouth and can make them vulnerable to oral tumors. Limiting alcohol intake can reduce the risks of getting oral cancer.

 

 

  • Avoiding overexposure of the sun

 

Overexposing the lips under the sun is a major cause of lip cancers and it can be avoided by staying in the shades or using lip sunscreens products daily.

 

 

  • Regular dental checkups

 

Routine dental check-ups are important as the dentists are usually one of the first to notice the cancerous cells.

 

Diagnosis for Oral cancer

 

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.

 

  • Biopsy: A tissue biopsy can be performed if the doctor finds abnormal tissue growth and/or any oral tumors.

 

  • X-rays: X-rays can help in determining whether the tumors have spread to the jaw, chest or lungs.

 

  • CT Scan: A CT Scan can reveal any tumor growth in the mouth, throat, lungs, neck or anywhere else in the body.

 

  • PET Scan: It helps determine if cancer has reached the lymph nodes or other organs.

 

  • MRI Scan: It shows a more accurate image of the head and neck and helps figure out the stage of cancer.

 

  • Endoscopy: Endoscopy helps examine the inner throat, nasal passages, sinus, windpipe and trachea.

 

Treatment options for oral cancers. Treating oral cancers can vary depending on the type, location and stage of cancer.

 

 

  • Surgery

 

Early stages 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.

 

Treatment based on different stages

 

Stage 0

 

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, it can spread into the deeper layer of the skin if not treated on time. The 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 the cancer coming back. If it keeps coming back, then it might need a treatment with radiation therapy.

Almost all patients diagnosed with a stage 0 cancer survive for a long time without the need of 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 are surgery and/or radiation therapy. Chemo 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. Both radiation and surgery work when treating the cancer in stage I and II.

 

  • Stage I: In Stage I, 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. Pain in the area where surgery was performed.

 

  • Stage II: In Stage II, 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.

 

  • Stage III: in Stage III, tumor is either larger than 4cm or it can be of any size with the spread to one lymph node 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/or hoarseness. 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.

 

Both the stage I and II have the five-year survival rate of around 70 to 90 percent depending on various factors.

 

Stage IV

 

Cancer in this stage is HPV-negative cancer (independent from HPV-infection) and has already been spread to nearby tissues, lymph nodes and other nearby organs (usually, the lungs). Treatment for this stage cancers include 

 

Life in remission

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
    • A sore throat or mouth
    • Tooth decay
    • Nausea and vomiting
    • Dry mouth and loss of salivary gland function
    • Jaw stiffness and pain
    • Sore or bleeding gums
    • Weight loss
    • Fatigue
    • And many more

 

  • Negative effects of chemotherapy
    • Hair  loss
    • Diarrhoea
    • Vomiting
    • Nausea
    • Mouth and  lip sores
    • Numbness in the hands and feet
    • Poor appetite
    • And a lot more

 

  • Targeted therapies can also have negative effects on the body
    • Fever
    • Headache
    • Diarrhoea
    • Skin rashes
    • Allergic reactions

 

The treatments of oral cancer can have side effects but they are essential to help prevent the further damage caused by the cancer cells.

 

How Can we help?

 

 

  • Nourish Yourself 

 

Cancer is a life-threatening or even a deadly disease which affects majorly on the lifestyle of an individual. However, small safety measures choosing a healthy lifestyle can help heal mentally as well as physically. Having healthy food choices and better nourishments can help the healing process. Thus, making sure to eat healthily is important.

 

 

  • Stay fit yourself 

 

Exercising is an important part of a healthy lifestyle and it also helps boost the body immune system, keeping calm, and enhancing muscle strength. Moderate exercise helps ease the pain after the painful treatment. Basic exercise (excluding heavy lifting) can help cancer patients stay strong mentally and physically.

 

 

  • Stay calm 

 

Oral cancer can be incredibly overwhelming and painful. It can also affect overall health. However, staying calm can help minimize stress. Asking support from loved ones, meditating regularly also helps make the overall situation.

 

 

  • Cancer-proof your home

 

Minor lifestyle changes are really helpful in the long run. Awareness about the surrounding and the effects it has on one’s health is important to avoid the risk of oral cancers. Radon-treating the home and replacing the home-decors that can be hazardous is a great way to prevent cancer chances on primary levels.

 

 

  • Get community support 

 

We have an extensive community offering comprehensive support to people dealing with oral cancers. Our support services are available for the patients and people suffering from these cancers can also open up to any supportive community to stay connected with people. Our official website can help gain more insights on what we do.