Oral cancer

Overview

Oral cancer is any cancerous tissue growth located in the mouth. It may arise as a primary lesion originating in any of the oral tissues, by metastasis from a distant site of origin, or by extension from a neighboring anatomic structure, such as the nasal cavity or the maxillary sinus. Oral cancers may originate in any of the tissues of the mouth, and may be of varied histologic types: teratoma, adenocarcinoma derived from a major or minor salivary gland, lymphoma from tonsillar or other lymphoid tissue, or melanoma from the pigment producing cells of the oral mucosa.

Symptoms

Oral cancer can form in any part of the mouth or throat. Most oral cancers begin in the tongue and in the floor of the mouth. Anyone can get oral cancer, but the risk is higher if you are male, over age 40, use tobacco or alcohol or have a history of head or neck cancer. Frequent sun exposure is also a risk for lip cancer. Symptoms of oral cancer include * White or red patches in your mouth * A mouth sore that won't heal * Bleeding in your mouth * Loose teeth * Problems or pain with swallowing * A lump in your neck * An earache

Causes

Eighty percent of these cancers are related to tobacco use, either by smoking or chewing. Persons chewing the betel leaf (paan) are also at increased risk. Alcohol by itself may not cause these cancers, but it aggravates the effects of tobacco in causing cancer. Repeated irritation of the mouth from sharp edges of broken teeth or from poorly fitting dentures may also cause oral cancers. Some diseases such as leukoplakia (white patches in the lining of the mouth) and oral submucous fibrosis predispose to the occurrence of oral cancers.

Diagnosis

Most of these cancers can be diagnosed easily using simple tests. Some tumours are readily accessible and can be felt externally or seen on opening the mouth. A biopsy (taking a piece of the tumour for examination) or fine needle aspiration cytology (FNAC- sucking out tumour cells by a syringe and needle) can be done for diagnosis. Deep-seated tumours such as those of the larynx need special mirrors and light for visualisation. In many patients, tests like CT scan and MRI may be needed to determine the extent of the disease, so that a decision can be made whether the tumour is removable by operation or not.

Prognosis

Postoperative disfigurement of the face, head and neck.

Complications of radiation therapy, including dry mouth and difficulty swallowing.

Other metastasis (spread) of the cancer.

Significant weight loss.

Prognosis depends on stage and overall health. Grading of the invasive front of the tumor is a very important prognostic Parameter.

Treatment

Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough, and if surgery is likely to result in a functionally satisfactory result. Radiation therapy is often used in conjunction with surgery, or as the definitive radical treatment, especially if the tumour is inoperable. Owing to the vital nature of the structures in the head and neck area, surgery for larger cancers is technically demanding. Reconstructive surgery may be required to give an acceptable cosmetic and functional result. Bone grafts and surgical flaps such as the radial forearm flap are used to help rebuild the structures removed during excision of the cancer. Survival rates for oral cancer depend on the precise site, and the stage of the cancer at diagnosis. Overall, survival is around 50% at five years when all stages of initial diagnosis are considered. Survival rates for stage 1 cancers are 90%, hence the emphasis on early detection to increase survival outcome for patients.