ORAL CANCER

What are Oral and Oropharyngeal Cancers?

Cancer is an unwanted purposeless and unchecked growth of any body tissue with a capability of spreading to other areas. Oral cancer starts in the mouth. The oral cavity includes the lips, the buccal mucosa (inside lining of the lips and cheeks), the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth below the tongue, the hard palate and the area behind the wisdom teeth.

Oropharyngeal cancer develops in the part of the throat just behind the mouth. The oropharynx begins where the oral cavity stops. It includes the base of tongue, the soft palate, the area around the tonsils and the back wall of the throat.

The oral cavity and oropharynx assist with breathing, talking, eating, chewing and swallowing. The saliva keeps the mouth moist and helps digest food.

More than 90% of cancers of the oral cavity and oropharynx are squamous cell carcinoma, also called squamous cell cancer. Squamous cells are flat, scale-like cells that normally form the lining of the oral cavity and oropharynx.

Who is at risk?

Some of the more common risk factors are as follows:

• Tobacco: 90 % of patients with oral cavity and oropharyngeal cancer use tobacco and the risk of developing these cancers increases with the amount smoked or chewed and duration of the habit. Tobacco smoke from cigarettes, cigars or pipes can cause cancers anywhere in the oral cavity or oropharynx, as well as causing cancers of the larynx, lungs, esophagus, kidneys, bladder and several other organs. Patients who persist in smoking after apparent cure of their cancer can develop second cancers of oral cavity, oropharynx or larynx. Chewing tobacco is associated with cancers of the cheek, gums and inner surface of the lips.
• Alcohol: Alcohol consumption strongly increases the risk of oral cavity and oropharyngeal cancer.
• Irritation: Chronic (long-term) irritation to the lining of the mouth caused by poorly fitting dentures or irritation by a broken or jagged tooth is a risk factor for oral cancer.
• Vitamin Deficiency: Vitamin A deficiency is associated with an increased risk of developing cancer of the oral cavity and oropharynx.

What are symptoms of oral cancer?

• Sore in the mouth that does not heal (most common symptom)
• Non healing ulcer or growth anywhere in the mouth, which bleeds on touch and is relatively painless
• White or reddish-white patches (leukoplakia or erythroplakia) in the oral cavity.
• Pain in swallowing
• Difficulty in moving the jaw or tongue
• A lump or thickening in the cheek

What are the symptoms of Throat Cancer?

• Change in Voice
• Difficulty in swallowing food
• Recurrent unexplained " sore throat"
• Difficulty in breathing
• Unexplained one sided ear-ache
• Lump in the neck

What is Leukoplakia, Erythroplakia?

Leukoplakia is a white area on the mucosa. Erythroplakia is a slightly raised red area that bleeds easily, if scraped. The most frequent causes of these conditions are smoking or chewing tobacco. Poorly fitting dentures rubbing against the mucosa and irritating it can also cause leuko

plakia or erythroplakia.

Some of the symptoms mentioned above are quite common in everyday illnesses and do not necessarily indicate cancer. Nevertheless, it is wise to pay heed to these symptoms and seek advice from your doctor. Early detection gives the best chance of cure.

How can Oral Cancer be diagnosed?

When we visit a doctor with a problem, the doctor first listens to our complaints in detail and then examines us. To help find the cause of symptoms, the doctor evaluates a person's medical history followed by complete head and neck exam including may be, nasopharyngoscopy, pharyngoscopy, or laryngoscopy.

The only way to make the diagnosis of cancer is to examine cells or tissues from the suspected lesion under a microscope-a procedure referred to as biopsy.

Staging the disease

If the diagnosis is cancer, the doctor wants to know about the stage (or extent) or the disease. Staging is done to find out whether the cancer has spread and if so, to which part of the body. Knowing the stage of the disease helps the doctor plan treatment. Some tests used to determine whether the cancer has spread include:

• CAT (or CT Scan) computed tomography - A computer linked to an X-ray machine creates a series of detailed pictures of areas inside the body.
• MRI (magnetic resonance imaging)- A powerful magnet linked to a computer makes detailed pictures of areas inside the body.
• Radio nuclide scanning - Scanning can show whether cancer has spread to other organs, such as the liver. The patient swallows or receives an injection of a mildly radioactive substance. A machine (scanner) measures and records the level of radioactivity in certain organs to reveal abnormal areas.

What are the treatments options for Oral Cancer?

The three common modes of cancer treatment are surgery, radiation therapy and chemotherapy. Surgery is one of the most commonly used modes of cancer treatment, wherein the surgeon removes a localized tumor in the mouth. If there is evidence that the cancer has spread, the surgeon may also remove lymph nodes in the neck. If the disease has spread to muscles and other tissues in the neck, the operation may be more extensive.

Chemotherapy is treatment of cancer by drugs. Cancer chemotherapy employs cytotoxic drugs capable of arresting fast cellular growth. Chemotherapy also affects other fast growing and dividing normal cells in the body. The treatment is given in cyclic form once in 3 to 4 weeks, to allow for adequate recovery of normal tissues and to ensure that cancer cells are killed at the same time.

Radiation therapy involves subjecting the subjecting the cancer-bearing region to radiation. Ionizing radiation damages of destroys the cancer cells and prevents them from growing and multiplying. Normally the treatment is divided over a period of one month, during which fixed doses of radiation are delivered each day. Radiation affects both normal as well as abnormal tissues. The schedule for radiation is planned in a way that it helps recovery of the normal tissues, while ensuring sustained tumor destruction. Usually most of the radiation treatment is given as an outpatient procedure. Radiotherapy treatment in itself is painless (just like an x-ray), and may take anything form a few seconds to several minutes.

Chemotherapy and Radiation therapy may cause side effects. But most side effects of radiotherapy and chemotherapy are reversible after treatment is over. Most oral cavity and oropharyngeal cancers can be prevented by avoiding risk factors whenever possible.

After treatment

Speech Therapy: After surgery or other treatment for oral cavity or oropharyngeal tumor, the patient may develop problems speaking or swallowing. When this occurs, a speech therapist may be consulted.

The importance of follow-up care

Follow up care after treatment for oral cancer is very important. Patients with cancer of the oral cavity and oropharynx are at risk for developing recurrences of new cancers in the head and neck area. Regular checkups ensure that changes in health are quickly noticed and if the cancer returns or a new cancer develops, it can be treated as soon as possible. Between scheduled appointments, people who have had oral cancer should report any health problem to their doctor as soon as it appears.

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