Mouth cancer or oral cancer is the cancer in the mouth which can develop in any part like the tongue's surface, inside the cheeks, the roof of the mouth, gums, or lips.
What are the symptoms of oral cancer?
Some common oral cancer signs and symptoms are:
A sore mouth or lip that won’t heal
A mass anywhere in the mouth
Bleeding from mouth
Difficulty in wearing dentures
Pain or difficulty in swallowing
Lump in the neck
Earache that won’t go away
Unintended or dramatic loss in weight
Numbness in lower lip, neck, face, or chin numbness
White and/or red patches in or on your mouth or lips
What causes oral cancer, and who is at risk?
The exact cause of oral cancer is unknown. However, certain risk factors will increase the chances of cancer.
Intake of tobacco in any form like pipes, cigars, cigarettes, chewing tobacco, etc.
Heavy intake of alcohol.
Excessive exposure to the sun over lips.
Sexually transmitted virus called human papillomavirus (HPV)
Weak immune system.
How is oral cancer diagnosed?
When you visit the doctor with symptoms, he will examine you to identify the problem.
Physical examination: The doctor will take your health history, including eating habits, past illness, etc. He will examine your mouth and lips to look for any abnormalities, areas of irritation, such as sores and white patches (leukoplakia).
Endoscopy: A probe with a camera attached at the tip, is inserted via mouth to examine the nasal passages, sinuses, inner throat, trachea, and windpipe.
Biopsy: In case your doctor suspects anything serious, he will perform a brush biopsy or a tissue biopsy. A brush biopsy is a painless procedure that collects cells from the suspected site by brushing them onto a slide and then sending them to the lab for study. In tissue biopsy, a piece of the tissue is removed from the suspected site, sent to pathology to look for cancer cells.
What are the next steps after confirmation of oral cancer?
After confirmation of oral cancer, your doctor may ask you to go for additional tests to determine the tumor spread to the lymph nodes or other areas of your body. These tests also help in determining the grade of cancer. These tests may include:
CT scan: This test uses a special dye medium that helps with a clear image of the body parts from different angles. It can help in seeing detailed images of soft tissue and blood vessels. CT scan is used to measure the tumor size and helps look for the spread of the tumor to your mouth, throat, neck, lungs, or elsewhere in your body.
Magnetic resonance imaging (MRI): An MRI uses magnetic fields to produce detailed body images. It helps in measuring the size of the tumor and also to look for the spread of cancer.
Chest X-ray: X-ray uses a small amount of radiation to create a picture of the structures inside of the body. It helps the doctors to find out if cancer has spread to the lungs.
Positron emission tomography (PET) or PET-CT scan: A PET scan uses a small amount of radioactive sugar substance, which is injected into the patient's body. This sugar substance is then used by cells, and a scanner then detects this substance to make images of the organs inside of the body.
What are the stages of oral cancer?
Stage 1: The size of the tumor is 2 cm or smaller, and there is no spread to the lymph nodes.
Stage 2: The tumor size is between 2-4 cm, and cancer hasn’t spread to the lymph nodes.
Stage 3: The size of the tumor is either larger than 4 cm and hasn’t spread to the lymph nodes, or can be of any size and has spread to 1 lymph node, but not to other body parts.
Stage 4: Tumor is of any size and the cancer has spread to nearby tissues, the lymph nodes, or various other body parts.
How is oral cancer treated?
Treatment of oral cancer depends on many factors like the stage of the disease, the patient's age, and his overall health. A combination of treatments such as surgery, target therapy, radiation therapy, and chemotherapy is planned for patients which are best suited for them.
Surgery: Surgery for cancer depends upon the size and the location of the tumor. In oral cancer, the entire tumor is resected from the mouth. Depending on the location of the tumor, a small incision may be made in the jawbone or neck for easier removal. After surgical removal, it may be necessary to reconstruct part of the mouth. In these cases, patients may have to go for reconstruction surgery.
Radiation therapy: Radiation therapy utilises high-energy x-rays or other types of radiation to kill cancer cells. Radiation therapy can be used in a targeted area or whole body; the doctor carefully directs the energy to the affected area that focuses on killing the cancer cells.
Chemotherapy: Chemotherapy uses drugs that stop the cancer cells from multiplying, either by killing the cancer cells or by inhibiting them from multiplying. These drugs are administered through the vein or can be given in the form of pills.
Targeted therapy: This treatment uses drugs and other substances that identify and attack the cancer cells. As this treatment focuses on cancer cells, it is less harmful in comparison to radiation and chemotherapy.
Nutrition:Nutrition plays a vital role in oral cancer treatment. Many treatments make it painful or difficult for patients to eat and swallow: leading to weight loss. Getting the right advice from the nutritionist can help you plan a diet chart that will be gentle on your mouth and throat, and will provide sufficient nutrition to heal.
What to expect after surgery?
In case a small tumor is removed, the stay in the hospital will be around a day or two. During this time, doctors and nurses will monitor your health and manage any pain or discomfort with medication. In case of extensive surgery and reconstruction, hospital stay may be several days or longer.
Surgery may lead to structural changes in the mouth and temporary swelling of tissue can affect the ability to swallow and may interfere with speech. During the recovery phase, your doctor may recommend various inpatient or outpatient speech and swallowing therapy.
Consult the dietician, and they will give you a proper diet plan. It is essential to remember to drink fluids between meals to stay hydrated.
What is the survival rate of oral cancer?
The survival rate of the patient depends on the factors like type and stage of cancer.
5-year survival rate for patients with localized (cancer is limited to the area where it has started) cancer is 83%.
5-year survival rate for patients with regional (cancer has spread to the nearby lymph nodes) cancer is 64%.
5-year survival rate for patients with distant (cancer has moved farther, such as liver, brain, etc.) cancer is 38%.
How to keep a check on reoccurrence?
Oral cancer can come back even after the treatment. It is advisable to be vigilant with the follow-up protocol, and in case of any problem you experience, inform your doctor immediately. The doctor will do a physical examination and recommend you to go for tests to learn as much as possible about the recurrence. After this testing is done, your doctor may plan the best treatment option available that might include previous treatment as well.
Prevention of oral cancer is not possible. However, by making some lifestyle changes, you can lower the risk.
Quit tobacco use: In caseyou use tobacco, stop and if you don't use it then never start. Use of tobacco in any form (smoked or chewed), exposes the mouth cells to dangerous chemicals which causes cancer.
Drink alcohol only in moderation, if at all: Chronic excessive alcohol use can irritate the cells in your mouth, making them vulnerable to mouth cancer.
Avoid excessive sun exposure to your lips: Avoid excessive exposure of sun to the lips.Cover the exposed areas of your body when going out and use sunscreen as part of your sun protection regimen.
See your dentist regularly: As part of a routine dental exam, request your dentist to inspect your entire mouth for abnormal areas that may indicate mouth cancer or precancerous changes.
Causes for Developing Oral Cancer
Tobacco use is one of the most significant risk factors for oral cancer. This also includes smoking cigars, cigarettes, and pipes, as well as chewing tobacco. Additionally, people who consume alcohol and tobacco regularly are at even more substantial risk.
Other risk factors include:
human papillomavirus (HPV) infection
chronic facial sun exposure
a previous diagnosis of oral cancer
a family history of oral or any different types of cancer
a weakened immune system
Being male- men are known to get it twice as likely as women.
Symptoms of oral cancer
Following are the symptoms:
a mass or growth present anywhere in your mouth
bleeding from your mouth
a sore on your mouth or lip that won’t heal
pain or difficulty swallowing
trouble wearing dentures
a lump in your neck
an earache that won’t go away
Significant weight loss
Numbness in the face, lower lip, neck
white, red and white, or red patches in or on your mouth or lips
a sore throat
jaw pain or stiffness
However, some of these symptoms, such as an earache or sore throat, may indicate other conditions. If you find that one of these symptoms persist, visit, and consult your doctor.
The doctor may advise the following tests and procedures to diagnose mouth cancer:
Physical exam: Your doctor or dentist will examine the roof and floor of your mouth, the back of your throat, tongue, and cheeks, and the lymph nodes in your neck for abnormalities.
Removal of tissue for testing (biopsy): If the doctor finds any suspicious tumours, growths or lesions, then the doctor or dentist may remove a sample of cells for laboratory testing in a procedure called a biopsy. The doctor will remove a sample away from the tissue by a needle, so it can be examined under a microscope for cancerous cells.
Treatment for Oral Cancer
The doctor will determine your treatment for oral cancer on the type, location, and stage of cancer at diagnosis.
Surgery: The surgeon will remove the tumour and cancerous lymph nodes. Other tissue around the mouth and neck may also be removed.
Radiation therapy: This treatment is used for advanced stages in oral cancer. The doctor focuses radiation beams at the tumour once or twice a day, five days a week, for two to eight weeks.
Chemotherapy: Chemotherapy is implemented to kill cancer cells. The medicine is provided to you either orally or through an intravenous (IV) line. Chemotherapy drugs can be used in combination with other cancer treatments.
Targeted therapy: Targeted drug therapy is effective in both early and advanced stages of cancer. It alters specific aspects of cancer cells that stimulate their growth. These drugs will bind to particular proteins on cancer cells and interfere with their growth.
Recovering from oral cancer treatment
Recovery from oral cancer will vary from person to person and the type of treatment. Post-surgery can involve pain and swelling. However, if small tumours are excised, it will have no associated chronic problems.
When large tumours are removed, they can hamper your ability to swallow, chew, or talk as well as you did before the surgery.
Reconstruction and Rehabilitation after Oral Cancer Treatment
For rebuilding the bones and tissues in your face removed during surgery, you might also need reconstructive surgery and some rehabilitation to assist with eating and speaking during recovery. To repair the missing bones and tissues in the mouth or face, dental implants and grafts are utilized. To replace any lost tissue or teeth, artificial palates are used.
You might also need speech therapy until you achieve the maximum level of improvement.
Follow the following lifestyle changes for prevention.