Oral Cancer: All You Need to Know

Oral Cancer mostly affects people above the age of 40 years but Dr. Sowrabh Kumar Arora, Principal Consultant, Surgical Oncology, Max Super Speciality Hospital, Vaishali, says, we have now come across several patients of younger age group also. Given the increasing instances of oral cancer, it becomes important for everyone to be aware about its early signs, and the way forward, in case any of its symptoms are observed. That’s why in this article, we have covered all you need to know about oral cancer, including its types, causes, symptoms, treatment options and recovery. Let’s begin.

What is Oral Cancer?

Oral cancer refers to cancer that develops in any part of the mouth, including the lips, tongue, gums, inner lining of the cheeks, roof or floor of the mouth, and the throat. It typically begins as

a painless white or red patch, lump, or ulcer that doesn't heal, and can spread to other areas of the head and neck if not detected and treated early. In such cases, it could be fatal.

What are the Types of Oral Cancers?

Oral cancer encompasses several types, each originating from different tissues within the mouth and throat. The main types of oral cancers include:

• Squamous cell carcinoma: This is the most common type of oral cancer, typically originating in the squamous cells lining the lips, tongue, gums, inner cheeks, roof or floor of the mouth, and throat.
• Verrucous carcinoma: A less common subtype of squamous cell carcinoma, verrucous carcinoma tends to grow slowly and may present as a wart-like lesion in the mouth.
• Adenocarcinoma: Adenocarcinoma is a type of oral cancer originating in the salivary glands or glandular tissues within the mouth and throat.
• Mucoepidermoid carcinoma: Another type of salivary gland cancer, mucoepidermoid carcinoma can develop in the minor salivary glands located throughout the mouth and throat.
• Sarcomas: Sarcomas are rare cancers that develop in the muscles, bones, or connective tissues of the mouth and throat.
• Lymphomas: Lymphomas are cancers that originate in the lymphatic system and can occasionally involve the tissues of the mouth and throat.
• Melanomas: Melanomas are cancers that develop from melanocytes, the pigment-producing cells, and can occur in the oral mucosa or on the lips.

What are the Risk Factors and Causes of Oral Cancer?

Oral cancer can be caused by a variety of factors, including:

• Tobacco use: Smoking cigarettes, cigars, pipes, or using smokeless tobacco products increases the risk of developing oral cancer.
• Alcohol abuse: Heavy and prolonged alcohol consumption can damage cells in the mouth and throat, increasing the likelihood of cancer development.
• Human papillomavirus (HPV) infection: Certain strains of HPV, particularly HPV-16 and HPV-18, are associated with an increased risk of oral cancer.
• Poor oral hygiene: Neglecting oral hygiene practices such as regular brushing, flossing, and dental check-ups can contribute to the development of oral cancer.
• Diet: A diet low in fruits and vegetables and high in processed foods and red meat may increase the risk of oral cancer.
• Sun exposure: Prolonged exposure to sunlight without adequate protection can lead to lip cancer.
• Genetics: A family history of oral cancer or other types of cancer may increase an individual's susceptibility to developing the disease.
• Weakened immune system: Certain medical conditions or medications that suppress the immune system can increase the risk of oral cancer.
• Age: The risk of oral cancer increases with age, with most cases diagnosed in individuals over the age of 45.

It's important to note that while these factors can increase the risk of oral cancer, not everyone exposed to these risk factors will develop the disease. Additionally, some cases of oral cancer may occur in individuals without any known risk factors, highlighting the importance of regular screenings and early detection.

What are the symptoms of oral cancer?

Symptoms of oral cancer are much like other health complications and may confuse the patient. It is important to consult a cancer specialist rather than self-diagnosing the condition and relying on OTC medications for a longer duration. Common oral cancer symptoms include:

• Persistent ulcer for more than 3 weeks in oral cavity
• A red or white patch in the oral cavity

• A lump in the mouth

• A feeling that something is stuck in the throat

• Difficulty in chewing and swallowing

• Change in voice

• Unexplained bleeding in the mouth

• Swelling in the neck, not resolved with conservative treatment

How does Oral Cancer Affect the Body?

Oral cancer can have various effects on the body, depending on factors such as the stage of the cancer, its location, and the effectiveness of treatment. Some potential effects of oral cancer on the body include:

• Localised effects: Oral cancer can cause pain, discomfort, or difficulty chewing, swallowing, speaking, or moving the jaw or tongue, depending on its location within the mouth or throat.
• Spread to surrounding tissues: As oral cancer progresses, it can invade nearby tissues, such as the gums, tongue, throat, or jawbone, leading to further damage and impairment of function.
• Spread to lymph nodes: Oral cancer can spread to nearby lymph nodes, causing swelling, tenderness, or lumps in the neck.
• Metastasis to distant organs: In advanced stages, oral cancer can spread (metastasize) to other parts of the body, such as the lungs, liver, or bones, leading to symptoms such as shortness of breath, jaundice, bone pain, or neurological symptoms.
• Nutritional deficiencies: Difficulty chewing, swallowing, or appetite loss due to oral cancer can lead to nutritional deficiencies, weight loss, and weakness.

How is Oral Cancer Diagnosed?

Oral cancer is typically diagnosed through a combination of clinical examinations and diagnostic tests. The diagnostic process may include:

• Physical examination: A healthcare professional, such as a dentist or dental surgeon, will conduct a thorough examination of the mouth, lips, tongue, gums, and throat to look for any abnormalities, such as lumps, sores, or discoloured patches.
• Biopsy: If suspicious areas are found during the physical examination, a biopsy may be performed to obtain a small sample of tissue for further analysis. The tissue sample is examined under a microscope by a pathologist to determine if cancer cells are present.
• Imaging tests: Imaging tests such as X-rays, CT scans, MRI scans, or PET scans may be used to assess the extent of the cancer, determine if it has spread to nearby tissues or lymph nodes, and identify any metastases to distant organs.
• Endoscopy: In some cases, an endoscope—a thin, flexible tube with a camera on the end—may be used to visualise the inside of the throat and oesophagus, allowing for a more detailed examination of the affected area.
• Blood tests: Blood tests may be performed to assess overall health and to look for markers that may indicate the presence of cancer or its effects on the body.

Note: Once a diagnosis of oral cancer is confirmed, further tests may be performed to determine the stage of the cancer and guide treatment decisions.

What are the Stages of Oral Cancer?

Oral cancer is staged based on the size and extent of the tumour, as well as whether it has spread to nearby tissues, lymph nodes, or distant organs. The stages of oral cancer are typically classified using the TNM system, which stands for Tumour, Node, and Metastasis. The stages range from 0 to IV, with higher stages indicating more advanced disease. Here is an overview of the stages of oral cancer:

Stage 0: Carcinoma in situ. Cancer cells are present only in the outer layer of cells lining the oral cavity and have not invaded deeper tissues.

• Stage I: The tumour is small (less than 2 centimetres) and limited to the oral cavity. It has not spread to nearby lymph nodes or distant sites.
• Stage II: The tumour is larger (2-4 centimetres) or has spread to nearby tissues, but has not spread to lymph nodes or distant sites.
• Stage III: The tumour is larger (more than 4 centimetres) and may have spread to nearby tissues or lymph nodes.
• Stage IVA: The tumour has spread to nearby tissues, lymph nodes, or both, but has not spread to distant sites.
• Stage IVB: The tumour has spread to nearby tissues, lymph nodes, or both, and may have spread to distant sites.
• Stage IVC: The tumour has spread to distant organs or distant lymph nodes.

The specific treatment and prognosis for oral cancer depend on the stage of the disease, as well as other factors such as the individual's overall health and treatment preferences.

How is Oral Cancer Treated?

Like any other cancer, oral cancer when diagnosed at an early stage is highly treatable. However, the treatment type depends on the stage and location in which it is diagnosed. The patient’s general health is also kept in mind before devising the treatment chart. In many cases, for maximum result, a combination of treatments is required. The treatment options for oral cancer may include:

Surgery

Surgery involves the surgical removal of tumours and a small margin of healthy tissue around it. Small tumours can be easily removed through a minor surgery; however, big tumours require a major surgery that may even involve removing some part of the jaw bone or the tongue. Newer technologies like LASER and Robotic surgery are also helpful to deal with these tumours.

Note: The ablative surgery may be combined with reconstructive surgery to improve speech and swallowing.

Radiation therapy

This treatment typically involves the use of high-energy radiation particles and X-rays that are targeted directly on the affected area from outside the body. Oral cancers can be treated with brachytherapy –radioactive seeds are placed inside the body to fight cancer cells.

Chemotherapy

One of the most widely known treatment options for cancer, chemotherapy involves either a single or a combination of powerful medicines that help in killing cancer cells throughout the body. In oral cavity cancer treatment, chemotherapy is usually combined with surgery or radiotherapy.

Targeted drug therapy 

This therapy targets cancer cells with the use of monoclonal antibodies. These antibodies, on a molecular level, interfere with the cell growth. Targeted drug therapy may be combined with other treatment options as a part of the treatment plan devised for the patient.

How to Prevent Oral Cancer?

There are many ways in which one can reduce the risk of developing it. These prevention techniques include:

• Quitting smoking

• Stop chewing tobacco

• Limiting alcohol intake or completely staying away from it

• Choosing a diet rich in vitamins and antioxidants

• Avoiding prolonged sun exposure to the lips
• Periodically visiting the dentist or ENT

Reconstruction and Rehabilitation after Oral Cancer Treatment

Reconstruction and rehabilitation after oral cancer treatment are often multidisciplinary efforts, involving collaboration between surgeons, dentists, speech therapists, physical therapists, and other healthcare professionals. The goal is to optimise outcomes and help individuals regain function, confidence, and quality of life after treatment.

Depending on the extent of treatment and the specific needs of the individual, reconstruction and rehabilitation may involve various approaches, including:

• Surgical reconstruction: Surgical procedures may be performed to repair or rebuild damaged tissues in the mouth, jaw, or face. This may include reconstructive surgery to restore missing or damaged structures, such as the tongue, palate, or jawbone.
• Dental rehabilitation: Dental specialists may work to restore or replace missing teeth, repair damaged dental structures, or improve oral function and aesthetics. This may involve procedures such as dental implants, dentures, bridges, or orthodontic treatment.
• Speech therapy: Speech therapists can help individuals regain or improve speech and swallowing function after oral cancer treatment. This may involve exercises to strengthen muscles, improve articulation, or learn alternative methods of communication.
• Swallowing therapy: Individuals who experience difficulty swallowing (dysphagia) after oral cancer treatment may benefit from swallowing therapy. This may include exercises to improve swallow function, dietary modifications, or the use of assistive devices.
• Prosthetic rehabilitation: Prosthetic devices, such as dental prostheses, speech aids, or facial prosthetics, may be used to restore function and appearance after oral cancer treatment. These devices are custom-designed to fit the individual's unique needs and may be used in conjunction with other forms of rehabilitation.
• Psychological support: Coping with the physical and emotional effects of oral cancer treatment can be challenging, and individuals may benefit from psychological support and counselling. Support groups, individual therapy, or holistic approaches such as mindfulness or relaxation techniques may help individuals adjust to changes and improve overall well-being.

If you or someone you know is undergoing oral cancer treatment, it's essential to discuss reconstruction and rehabilitation options with a healthcare team experienced in managing oral cancer and its effects.

Last words

We at Max Healthcare advise everyone to make an appointment with the doctor if they feel any abnormality and see any signs and symptoms that last for more than two to three weeks. The doctor will perform the required tests to understand and evaluate the root cause of the symptoms. Remember, the timely diagnosis has saved lives of many across the world; thus, planning a visit to the doctor should never be delayed.