Oral Cancer: types, causes, symptoms, diagnosis, and its treatment.

Oral cancers can develop in any part of the oral cavity and back of the mouth (throat). Oral cancers commonly appear as a lump or sore that does not heal for more than 3 weeks. Most oral cancers usually occur after the age of 40. People with a family history of oral cancer are at higher risk of oral cancer. Especially, men are twice at risk of developing oral cancers than women. Oral cancer is curable only if it is detected in the early stages. Advanced-stage oral cancer is hard to manage and compromises the quality of life.

• Lips
• Lateral border of the tongue
• Floor of mouth under the tongue
• Gum
• Mucosal lining of cheeks
• Roof of mouth

Types of Oral Cancer

Smokers and Alcoholics are at higher risk of developing oral cancers. The types of oral cancers include:

• Squamous cell carcinoma (most common)
• Minor salivary gland carcinomas
• Lymphoma
• Mucosal melanoma
• Sarcoma
• Verrucous carcinoma (least common)

Following are the pre-cancerous conditions that tend to develop into cancerous conditions if left untreated. These conditions are removed surgically in their benign state.

• Luekoplakia or erythroplakia
• Eosinophilic granuloma
• Fibroma
• Granular cell tumor
• Lichen planus
• Lipoma
• Schwannoma
• Neurofibroma

Causes

• Smoking (cigarettes, e-cigarettes, pipes)
• Smokeless tobacco
• Excessive alcohol drinking
• Family history
• Human papilloma virus (HPV)
• Excessive exposure to sunlight without protection
• Poor nutrition
• Weak immunity

Signs and Symptoms

Signs of oral cancer can vary among patients depending on the severity. Common oral cancer symptoms include:

• White or red patch that persists on scraping/swabbing
• Ulcers on lips or inside the oral cavity for more than 3 weeks
• Rough spots on lips, tongue, or gums
• Bleeding from the mouth without any significant cause
• Numbness or tenderness in mouth or neck
• Difficulty in chewing and swallowing
• Lump inside the oral cavity
• Sore throat
• Jaw stiffness
• Tongue pain
• Significant weight loss

Diagnosis and staging

A biopsy is performed for the diagnosis of oral cancers: either incisional biopsy or excisional biopsy. In an incisional biopsy, part of the tumor tissue is removed and examined under a microscope. In an excisional biopsy, the whole tumor is removed to examine under a microscope.

Before biopsy following radiological tests are performed:

• X-rays to see the spread of cancerous cells
• CT scan to look for soft tissue tumors (head and neck)
• PET scan to see if lymph nodes are involved
• MRI scan to determine the stage of cancer and exact image of head and neck cancers

Oral cancers can be divided into four distinct stages:

• Stage 1: Cancer of 2 cm or smaller and not spread to lymph nodes
• Stage 2: Cancer of 2-4 cm but not spread to lymph nodes
• Stage 3: Cancer of larger than 4 cm but not spread to lymph nodes or cancer of any size spread to lymph nodes but not travel to other parts of the body
• Stage 4: Cancer of any size involving lymph nodes and has traveled to other parts of the body

Treatment Options

Oral cancer treatment depends on the type, location, and stage at the time of diagnosis. Most of the treatment of oral cancer is a combination of surgery with chemotherapy or radiotherapy or in severe cases combination of all.

Surgery

Oral cancer in its early stages is removed surgically as well as the affected lymph nodes. The dentist determines whether to have surgery before or after radiation therapy, depending on the location and extent of the cancer.

Chemotherapy

A treatment used to kill cancerous cells with medications is termed chemotherapy. Chemotherapy is an adjunct treatment to remove all the daughter cells of a tumor. The medications prevent the reproduction of cancerous cells. Chemotherapy is used to destroy cancerous cells but might affect healthy tissues of the body.

Radiation Therapy

Radiation therapy can be sensitive to oral malignancies. High-energy X-rays or radiation beams are used in this treatment. This radiation damages the DNA within tumor cells to stop proliferation of cancerous cells.

Prevention Methods

Oral cancers occur after damaging the DNA of mouth cells. For this reason, there is no definite way to prevent oral cancer from occurrence. However, the following tips can be used to lower the risk of oral cancer:

• Quit tobacco
• Smoking cessation
• Limit alcohol intake
• Avoid direct sun exposure
• Eat a healthy and balanced diet

Impact of Oral Cancer on Quality of Life

Many cancer patients experience reduced quality of life during or after treatment. Oral cancer and its treatment can cause a range of effects on life. Pain, nausea, fatigue, or breathlessness are the short-term consequences while cognitive impairment, psychological and physiological dysfunction are the long-term side effects.