liver cancer

Facts about oral cavity (mouth) cancer 

Q 1 what is the oral cavity (mouth) cancer?

Oral cancer develops in the oral cavity (mouth). The oral cavity includes the 

  • Lips
  • Inside lining of the lips and cheeks (buccal mucosa)
  • Teeth and gums 
  • Front two-thirds of the tongue
  • The floor of the mouth below the tongue 
  • The bony roof of the mouth (hard palate)
  • The area behind the wisdom teeth (called the retromolar trigone) 

Q 2 what are the causes of oral cavity (mouth) cancer?

  • Tobacco use of any kind, including cigarettes, cigars, pipes, chewing tobacco and snuff
  • Betal nut (Supari) chewing without tobacco 
  • Heavy alcohol use
  • Excessive sun exposure to your lips
  • A sexually transmitted virus called human papillomavirus (HPV)

Q 3 what are the types of oral cavity cancer? 

  • Squamous cell carcinoma is the most common type
  • Adenoid cystic carcinoma
  • Mucoepidermoid carcinoma
  • Adenocarcinoma

There are many other masses or swellings in the oral cavity that are not cancerous (malignant). These are called benign (non-cancerous) swellings. Benign swellings or masses are not life-threatening, but they may cause loss of soft tissue and/ or bone. Examples include Cysts of the Jaw, benign Odontogenic tumors, hamartomas, and fibrous dysplasia. 

Q 4 What are the pre-cancerous conditions of the oral cavity? 

The pre-cancerous condition means conditions or lesions have abnormal cells that are associated with an increased risk of developing into cancer. They are not true cancers. 

Three most common pre-cancerous lesions/conditions are:  

  • Leukoplakia – white or gray patch

  • Erythroplakia – flat or slightly raised, red area

  • Oral submucosal fibrosis – whitish mucosa lacking elasticity

Q 5 what are the symptoms of oral cavity cancer?

  • A lip or mouth ulcer that doesn’t heal even after 15 days of medical treatment.
  • A white or reddish patch on the inside of your mouth
  • Loose teeth
  • A growth or lump inside your mouth
  • Mouth pain
  • Ear pain
  • Difficult or painful swallowing
  • Neck swelling 

A word of caution

All of these symptoms can also be caused by conditions that are not cancer. Kindly consult your doctor first. 

Q 6 How is oral cavity cancer diagnosed? 

  • The initial assessment includes a thorough history and physical examination including careful assessment of the nasal cavity and oral cavity with a visual examination and/or palpation. 
  • Biopsy: If there is any suspicious area or mass visible then the doctor may remove a small tissue sample (biopsy) so it can be checked for cancerous cells. 

A word of caution

There is a common myth that taking biopsy leads to the spread of cancer cells in the body. This is not true. Taking biopsy does not lead to the spread of cancer cells in the body.

Biopsy confirms that it is cancer and not infection and also helps in knowing the type of cancer so that further treatment can be planned accordingly.  

  • Sometimes an examination under anesthesia is performed to characterize the extent of the tumor, to look for synchronous second primary tumors, and to take biopsies for tissue diagnosis. 

If the results of the biopsy confirm oral cancer, then the doctor may advise having additional tests to assess how widespread the cancer is. These tests may include:

  • Blood tests – To assess the state of liver, kidneys and bone marrow
  • CT/MRI scan – To find out the local spread of disease 
  • Chest X-ray – To check if cancer has spread to the lungs or not 
  • Bone scan – To check if cancer has spread to bone or not
  • Sometimes a PET scan – To know the distant spread of disease 

Q 7 What is oral cavity cancer staging? 

Staging is a measurement of how far cancer has spread.

After all the tests have been completed and the results are known, it should be possible to predict what stage the cancer is. The higher the stage, further cancer has spread.

  • Stage 1 oral cancer: Cancer is 2 cm in size or smaller, and no cancer cells are present in nearby structures, such as lymph nodes
  • Stage 2 oral cancer: The tumor is larger than 2 cm but no more than 4 cm.
  • Stage 3 oral cancer: The tumor is larger than 4 cm or cancer has spread to one lymph node in the neck on the same side as the tumor and the lymph node is 3 cm or smaller
  • Stage 4 oral cancer: There are three categories in this stage:

Stage 4A  

Cancer of any size and has grown into any of the following:

  • Bone-in the palate or lower jaw
  • The nerve in the lower jaw called the inferior alveolar nerve
  • The floor of the mouth
  • The skin of the face

Cancer may also have spread to 1 or more lymph nodes in the neck, and they are 6 cm or smaller.

Stage 4B

The tumor has grown into the soft tissues of the cheek such as muscles, nerves, or blood vessels, or into the base of the skull, or the tumor is wrapped around the internal carotid artery of the neck.

OR

Cancer has spread to lymph nodes in the neck and one is larger than 6 cm or cancer in a lymph node has grown into the surrounding tissue.

Stage 4C

Cancer has spread to other parts of the body (called distant metastasis), such as to the lungs, liver or bone. This is also called metastatic oral cancer.

A word of caution 

The above staging is a simplified version for your basic understanding. The reader is advised to follow the TNM staging system developed by the American Joint Committee on Cancer (AJCC) in which 

  • T stands for the size and location of the primary tumor
  • N stands for nodes. It tells whether cancer has spread to the nearby lymph nodes
  • M stands for metastasis. It tells whether cancer has spread to distant parts of the body

Q 8 How oral cavity cancer is treated?  

Oral cavity cancer is curable if diagnosed at an early stage. Surgery and sometimes radiation therapy are the only curative options. 

When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide the individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, radiation therapy or chemotherapy
  • How a treatment will affect appearance and function (such as your speech and ability to swallow and chew)
  • Your personal preferences

Following are the general guidelines but treatment may vary from patient to patient:  

  • Early stage disease Stage 1, 2 & 3 

Surgery followed by radiation therapy and/or chemotherapy. The decision regarding radiation and chemotherapy depends on the final pathology report after the operation and the general condition of the patient. 

  • Locally advanced disease Stage 4A & stage 4B 

Two options exist. 

  • Surgery followed by radiation therapy +/- chemotherapy
  • 2 or 3 cycles of chemotherapy followed by surgery and radiotherapy

The decision for the above options depends upon the local extension of cancer and the general condition of the patient. 

  • Advanced disease Stage 4C 
  • Chemotherapy – Given to slow cancer progression and relieve symptoms. 
  • Radiotherapy – to relieve symptoms and improve the quality of life.
  • Targeted drug therapy

Surgery: 

Surgery includes remove cancer with surrounding healthy tissue and also to remove cancer that has spread to the neck (neck dissection)

The extent of surgery may vary from wide local excision to Hemi or total glossectomy (removal of the tongue), mandibulectomy (removal of the lower jaw bone), maxillectomy (removal of the upper jaw bone), removal of teeth, etc. 

Reconstruction: 

After surgery, defects made are either closed primarily or with the help of plastic surgery.  

Many oral cancer surgery patients are often concerned about disfigurement; but recent advances in reconstructive surgery help patients restore their appearance, sometimes with little or no sign of change. 

Rehabilitation 

Following the treatment of cancer in the oral cavity, several important functions of the oral cavity may be severely affected. These include the lubrication of the mouth and throat, swallowing difficulties, speech, and movement in areas where surgery has been done. 

You may need help from specialists in the rehabilitation of the functions such as speech therapists, swallow therapists, physical therapists, and occupational therapists.