Oral Cancer: Symptoms, causes, diagnosis & management

• By RK News
• Comments 0
• 08 Mar 2023

Dr. GOUNSIA AMIN

Cancer that happens inside the mouth is sometimes referred to as oral cancer or oral cavity cancer. Oral cancer, a type of the mouth cancer, where the cancerous tissue grows in the buccal cavity. Oral or mouth cancer most commonly involves the tongue. Carcinoma of the mouth can also occur on:

•  
• Gingiva (Gums).
• Inner lining of the cheeks.
• Palate (Roof of the mouth).
• Floor of the mouth (under the tongue). 

Oral cancer is one of several types of cancer grouped into a class called head and neck cancer. Oral cancer and other cancers of the head and neck are often treated the same. Squamous cell carcinoma is the most commonly occurring type of oral cancer. Squamous cells are found in many parts of the body, including the inside of the mouth and beneath the skin.

Less common types of mouth cancer include:

• Oral malignant melanoma - where the cancer starts in cells called melanocytes, which help give skin its colour.
• Adenocarcinomas - cancers that develop inside the salivary glands.

Symptoms

Signs and symptoms of mouth cancer may include:

• Red or red and white, patches on the lining of mouth or tongue.
• One or more mouth ulcers that do not heal after three weeks.
• Swelling in mouth that lasts for more than three weeks.
• Pain when swallowing (dysphagia).
• A persistent pain in the neck.
• A hoarse voice.
• Unexplained weight loss.
• Unusual changes in sense of taste.
• Pain in ear (Otalgia).
• The lymph nodes (glands) in neck become swollen.
• Loose teeth.

Causes

Oral cancers are formed when cells on the lips or in the mouth develop alterations (mutations) in their DNA. The DNA in a cell contains instructions that tell a cell what it should do. The mutation changes tell the cells to continue growing and dividing when healthy cells would die. Abnormal accumulation of cancer cells in the mouth may cause tumors. Over time, they can spread through the mouth and other areas of the head and neck or other parts of the body.

Risk factors

Smoking and alcohol: The two leading causes of mouth cancer are smoking cigarettes (or other tobacco products, such as pipes or cigars) and drinking too much alcohol. Both of these substances are carcinogenic, which means they contain chemicals that can damage the DNA in cells and lead to cancer. The risk of mouth cancer increases significantly in somebody who is both a heavy smoker and heavy drinker.

Betel nuts: Betel nuts are mildly addictive seeds taken from the betel palm tree, and are widely used in many southeast Asian communities, such as people of Indian and Sri Lankan origin. They have a stimulant effect similar to coffee. Betel nuts also have a carcinogenic effect, which can increase the risk of mouth cancer. This risk is made worse as many people enjoy chewing betel nuts along with tobacco.

Smokeless tobacco: Smokeless tobacco is a general term used to refer to a range of products, such as

Chewing tobacco:

• Snuff – powdered tobacco designed to be snorted.
• Snus – a type of smokeless tobacco popular in Sweden, which is placed under your upper lip, where it is gradually absorbed into your blood.

Cannabis: Smoking cannabis has also been linked to an increased risk of mouth cancer. Regular cannabis smokers may have a higher risk than tobacco smokers because cannabis smoke contains higher levels of tar than tobacco smoke, and tar is carcinogenic.

Human papilloma virus (HPV)            : The human papilloma virus (HPV) is the name of a family of viruses that affect the skin and moist membranes that line your body, such as those in your cervix, anus, mouth and throat.

Poor oral hygiene: There is evidence that poor oral hygiene, such as having tooth decay, gum disease, not brushing your teeth regularly and having ill-fitted dentures (false teeth) can increase your risk of mouth cancer.

Diagnosis

• Biopsy: It may be necessary to remove a small sample of affected tissue to check for the presence of cancerous cells. This procedure is known as a biopsy.
• Punch biopsy: A punch biopsy may be used if the suspected affected area of tissue is in an easily accessible place, such as your tongue or the inside of your mouth. The procedure is not painful, but can feel a little uncomfortable.
• Fine needle aspiration (FNA): A fine needle aspiration (FNA) is a type of biopsy used if it is suspected a swelling in neck is the result of mouth cancer.
• Pan endoscopy: A pan endoscopy is a procedure used to obtain a biopsy when the suspected tissue is at the back of throat or inside nasal cavities.

The tests that may be used include:

• An X-ray.
• A magnetic resonance imaging (MRI) scan.
• A computerised tomography (CT) scan.
• A positron emission tomography (PET) scan.
• A PET scan involves injecting a part of your body with a radioactive ‘tracer’ chemical that can be seen on a special camera.

Management

• Surgery: For mouth cancer, the aim of surgical treatment is to remove any affected tissue while minimizing damage to the rest of the mouth.
• Photodynamic therapy (PDT): If the cancer is in its early stages, it may be possible to remove any tumors using a type of laser surgery known as photodynamic therapy (PDT). PDT involves taking a medicine that makes your tissue sensitive to the effects of light. A laser is then used to remove the tumor.
• Radiotherapy: It uses doses of radiation to kill cancerous cells. It may be possible to remove the cancer using radiotherapy alone, but it is usually used after surgery to prevent the cancer from reoccurring.
• Chemotherapy: It is often used in combination with radiotherapy when the cancer is widespread, or if it is thought there is a significant risk of the cancer returning.

(Author is III year post graduate student, oral medicine and radiology, Shree Bankey Bihari Dental College. Email:  gousiaamin786@gmail.com)