What is Oral/Mouth Cancer?
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What is Oral/Mouth Cancer?

What is Oral/Mouth Cancer?

This information is provided by Dr. Navneet Sharda as an educational source pertaining to oral/mouth cancer. It is not intended as a substitute for a consultation with a qualified healthcare provider.

Navneet Sharda M.D.—Oral cancer is part of a cancer group called head and neck cancers, and is defined as an uncontrollable growth of cancerous cells that invades the mouth (called oral cavity) and the part of the throat behind the mouth (called oropharynx).

Oral cancer starts within the mouth or pharynx cells. Normally, these cells grow and divide to form new cells, and when they get old, they die, allowing new cells to take their place. When this process is impaired, the cells start to divide and grow abnormally, the old cells do not die when they should, and the result is an abnormal tissue mass or tumor.

There are two types of tumors: benign (term that refers to a non-cancerous mass or growth which is not life threatening, because it does not spread and damage adjacent tissues, structures, and organs) and malignant (term that refers to a cancerous mass or growth which can invade and destroy adjacent tissues and organs inside the body causing death).

Oral cancer can spread quickly if left untreated or diagnosed too late. It can affect the lungs, neck, or lymph nodes from the neck area.

 

Signs and Symptoms

Unfortunately, most oral cancers are asymptomatic in the early stages and the symptoms occur when the tumor has reached an advanced stage of development.

Some of the symptoms include:

  • A mouth sore or ulcer that does not heal or bleeds easily.
  • A white or red patch in the mouth.
  • An irritation, lump, or thick patch in the mouth, lip, or throat.
  • A discomforting sensation such as something got caught in the throat.
  • Chewing or swallowing difficulties.
  • Difficulties moving the jaw or tongue.
  • Speaking difficulties.
  • Hoarseness, chronic sore throat, or changes in the voice.
  • Unexplained bleeding in the mouth.
  • Unexplained numbness, loss of feeling, pain or tenderness in the face area, mouth, or throat.
  • Jaw swelling which causes the denture to not fit anymore.
  • Ear pain.
  • Unexplained weight loss.

These symptoms vary from patient to patient, depending on the tumor type and location. Only a doctor can establish if the symptoms you display are signs of oral cancer or other medical conditions.

 

Types

Oral cancer is classified according to two criteria:

1. The cancer location.

According to this criterion, there are two types of oral cancer:

(1) Oral cavity cancer – the cancer that starts in the mouth, which includes the tongue, lining of the cheeks, gums and teeth, upper or lower jaw, the hard palate (the mouth’s roof), the mouth’s floor (the area beneath the tongue), and salivary glands.

(2) Oropharyngeal cancer – the cancer that starts in the oropharynx, which includes the soft palates (the back of the mouth), the base of the tongue, uvula, and tonsils (one of two small masses of lymphoid tissue located on either side of the throat). Around two-thirds of the oral cancers are found in the mouth, while one-third are found in the pharynx.

2. The cells where the cancer starts.

There are two types of oral cancer:

1. Squamous cell carcinoma: This is a type of cancer that starts in the flat cells (called squamous cells) that cover the surface of the oral cavity and orophadynx. Squamous cells carcinoma represents more then 90 percent of all oral cancers. In its early stages, this cancer is confined to the lining layer of the cells and is called carcinoma in situ, but when it extends beyond the lining, it is called invasive squamous cell carcinoma.

A variant of squamous cell carcinoma is verrucous carcinoma. This is a low-grade cancer that rarely metastasis, and has a good prognosis. This type of oral cancer is common among patients that chew tobacco or use snuff (a fine -ground tobacco which is sniffed or snorted). It represents less than 5 percent of all diagnosed oral cancers.

2. Minor salivary gland cancer: This is a type of cancer which starts within the salivary glands located in the oral cavity and orophadynx lining tissue. This is a rare type of oral cancer.

 

Medical Tests & Diagnosis

Oral cancer symptoms can be similar with other medical conditions and only a doctor can establish a correct diagnosis. The diagnosis procedure involves a certain number of steps which include:

Anamnesis (detailed medical review of past health state): One of the first steps in establishing an oral cancer diagnosis is a detailed and complex medical review of a patient’s past health problems and general health state, family medical history, oral cancer risk factors (especially smoking habits, tobacco and alcohol use), and symptoms.

Physical examination During a physical examination, the doctor examines the oral cavity and pharynx, the face, neck, and lips looking for signs of oral cancer. The doctors looks for any possible lump, abnormal or discolored tissue, or sores.

Imaging techniques

  • Computed Tomography: This imaging test is similar with an x-ray test, and creates a detailed, cross-sectional image of the body. This test can identify abnormal mass tissues.
  • Magnetic resonance imaging (MRI): An MRI is an advanced technique that uses radio waves and strong magnets to reveal a complete image of a targeted area of the body.
  • Ultrasonography: Ultrasound imaging is a medical technique that uses high-frequency sound waves to create an interior image of the body on a special computer screen. This image is formed from the echoes of the sound waves on the surface of the organs. Abnormal tissue masses and organs reflect sound waves differently.
  • Endoscopy: This is a minimally invasive, painless diagnostic procedure used to visualize interior surfaces of certain organs and cavities. During this procedure, a flexible tube, called an endoscope, is inserted into the body in order to provide a clear image of the targeted area. This procedure is used to investigate tissues within the pharynx area which cannot be visualize during a normal examination.
  • Biopsy: This is a painless medical procedure that removes a certain amount of tissue for a microscopic examination. This procedure allows the pathologist to establish the nature of the cells and determine whether they are cancerous or not, and the stage of the cancer. In some cases, the doctor might perform a scalpel biopsy. A scalpel is a thin, straight surgical knife used in dissection and surgery. This type of procedure is performed under anesthesia to reduce patient discomfort.

 

Oral Cancer Treatment

The treatment plan varies from patient to patient and is established according to five main factors: (1) the patient’s age, general health and past medical history, (2) the cancer type, size, and location, (3) the treatment tolerance, (4) the risk for hidden disease, and (5) the need to save certain functions.

A better treatment outcome is achieved in patients diagnosed with oral cancer in early stages.

The main treatment approach in patients with oral cancer are: surgery and radiotherapy. Chemotherapy is also used to treat oral cancer, but it is usually used in patients with metastasis and it does not represent a primary treatment approach for oral cancer.

Surgery

Surgery is a medical procedure aimed to completely remove the tumor tissue together with surrounding healthy tissue in order to prevent a future cancer relapse.

There are six surgery techniques performed in patients with oral cancer. These are:

  • Primary tumor resection: This is a type of surgery where the entire tumor together with surrounding tissue is removed.
  • Mandible resection: This is a type of surgery where the tumor is removed together with part or the entire jaw bone.
  • Maxillectomy: This is a type of surgery where the tumor is removed together with part or the entire hard palate (the mouth’s roof). This surgery is usually performed when the cancer has spread to the mouth roof bone.
  • Mohs’ micrographic surgery: This is an advanced surgically procedure that relies on the microscope accuracy to trace and assure a complete removal of the cancer down to its roots, leaving healthy tissue unharmed. Moh‘s micrographic surgery removes the tumor in thin layers. Each layer of tumor removed is checked under a microscope for cancer cells and the procedure will continue until there are no more cancer cells in the removed layer. This type of surgery can be performed when the tumor is on the lip.
  • Laryngectomy: This type of surgery is performed in patients with large tumors on the tongue or oropharynx. In some cases, the surgeon has to remove the larynx (the voice box).
  • Neck dissection: This type of procedure is performed when the cancer has spread to the lymph nodes within the neck. During this procedure, the tumor is removed together with the lymph nodes affected by cancer.

 

When performed in early stages, the surgery is small with less post-surgery scars or disfiguration. When performed in advanced stages, the surgery is complex, it removes a substantial amount of tissue, and in most cases requires future reconstruction work.

Radiation therapy or radiotherapy

This is a local type therapy that uses high-energy rays or particles to destroy cancerous cells. The purpose of this treatment is to destroy cancerous tissues preserving the healthy tissue. There are two type of radiation therapy performed in patients with oral cancer:

  • External beam radiation: This form of radiation therapy uses a device called a linear accelerator that generates an external beam that is concentrated on the tumor area and breaks it up into smaller pieces. Sessions last a few minutes and are administered every day for several weeks.
  • Internal radiation: The radiation is administrated from radioactive materials (such as seeds, needles, thin tubes) inserted into the tumor.

 

Chemotherapy

This is a systemic type of treatment (affects cells throughout the entire body) that uses drugs either to stop the abnormal growth and dividing process of the cancerous cells, or to kill them. This treatment also has the ability to interfere with the cancerous cells’ replication. Chemotherapy can be administrated in combination with surgery and radiation therapy for a better treatment outcome. The chemotherapy drugs can be given intravenous or as pills.

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