Oral/Mouth Cancer

Oral/Mouth Cancer


India has one third of oral cancer cases in the world. Oral cancer accounts for around 30% of all cancers in India.



Overview


Risk Factors

The following factors are known to increase the risk of Oral and Mouth cancer.

Risk Factors
Tobacco consumption
Cigarettes, beedi, pipes, cigars, and chewing (smokeless) tobacco, can cause oral cancer
Keeping gutkha/tobacco quid inside mouth may lead to cancer of cheek, gums and inner cavity of mouth
Paan and betel nut are also causal agents and have been linked to oral cancer
Alcohol consumption increases the risk of mouth cancer
Chronic irritation of gums and cheek by ill fitting dentures or sharp teeth is a risk factor
A diet low in vegetables and fruits and low proper nutrition
Human Papillomavirus (HPV): Infection with certain high risk HPV types increases the risk of oral cancer
Weak immune system: people with weakened immunity are more prone to suffer from oral cancers
Exposure to sun’s ultra violet rays: may cause lip cancer

Symptoms

The following are the common symptoms of mouth cancer

Symptoms
A lump or hard mass in the neck
Development of white, red or mixed patches on tongue, gums or inner linings of mouth
Chronic pain in mouth, tongue/jaw pain
Difficulty in chewing or swallowing
Swelling, thickening, lumps or bumps on lips, gums or inner cavity of mouth
Bleeding in mouth
Unexplained weight loss

Diagnosis

Like all types of cancer, Patient history, General physical examination and Oral examination are also considered for diagnosis of cancer

Diagnosis Common tests
Patient History Duration and frequency of tobacco use in any form like cigarette, beedi, chewing pan, gutka, khaini etc and of alcohol consumption is recorded
Examination of mouth General physical examination and Oral examination: examination of entire inner cavity of the mouth , back of the throat, and inside of cheeks and lips is done
The doctor looks for red or white patches or any other abnormal areas over head, neck or face. He/she also examines for any lumps, swelling or any other problem with the nerves of mouth or face.
Brush Cytology The suspected area is scraped by a brush and tested by a pathologist
Fine Needle Aspiration Cytology (FNAC) A thin needle which is attached to a syringe is used to draw few cells from the suspected lump or swelling. FNAC is generally used to diagnose metastatic carcinoma of mouth, head and neck, in the cervical region
Biopsy A small piece of tissue is taken from suspicious area using a punch biopsy instrument. Sometimes it may be done under the guidance of endoscopy, if the lesion is not easily accessible.
Imaging tests X-rays, CT scan, MRI and PET scan can be used to confirm the spread of cancer
Human Papillomavirus (HPV) Testing Test for the HPV virus is done

Treatment Options

Stage Treatment Description
Stage 0 (carcinoma in situ)
  • Surgical stripping or thin resection:The surgery involves removal of the top layers of tissue along with a small margin of normal tissue
  • Nearly all patients at this stage survive a long time without the need for more intensive treatment. But it is important to note that continuing to smoke increases the risk that a new cancer will develop
Stages I and II

Treated with either surgery or radiation therapy. Chemotherapy (chemo) may be given with radiation, especially to treat any cancer left after surgery.

Small cancers are often removed with surgery, with Mohs surgery as an option

Stages III and IVA
  • A combination of Surgery , Chemotherapy and Radiation is given
  • Sometimes a combination of cetuximab (a biologic drug) and chemotherapy is also given
Stage IVB
  • treated with chemo, cetuximab, or both. Other treatments such as radiation may also be used to help relieve symptoms from the cancer or to help prevent problems from occurring

Recurrent (relapsed) cancer

Recurrent (relapsed) disease means that the cancer has come back (recurred) after treatment. Recurrent oral cavity or mouth cancer may return in the mouth or throat (local recurrence), in nearby lymph nodes (regional recurrence) or in another part of the body, such as the lungs (distant recurrence). They are also treated with chemotherapy, radiation and surgery


Research and Further Reading

There are many resources on the net for reading further about cancer

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