Mouth Cancer: Early Detection and Management

Mouth cancer, a significant health concern in India, accounts for over 30% of all cancer cases in the country, making it one of the most prevalent forms of cancer in the region. According to the National Cancer Registry Programme, there are approximately 77,000 new cases and 52,000 deaths annually due to mouth cancer in India. Given the growing concern of mouth cancer, it is important to know about its early signs and symptoms, as an early diagnosis is crucial for improving outcomes and quality of life for patients. Shedding more light on the subject, in this article, we outline its early signs and symptoms, along with key management strategies.

What is Mouth Cancer?

Mouth cancer, also known as oral cancer, is a type of cancer that develops in any part of the oral cavity. Characterised by abnormal cell growth, mouth cancer can affect any part of the mouth including the lips, gums, tongue, the inner lining of cheeks, and the roof and floor of the mouth.

What are the Causes of Mouth Cancer?

While the exact cause of mouth cancer is often difficult to determine, there are several factors that can increase the chances of a person developing this disorder. Here are some of the primary causes and risk factors associated with mouth cancer:

• Smoking or chewing tobacco.
• Heavy and chronic alcohol use.
• Human Papillomavirus (HPV), particularly HPV-16.
• Excessive exposure to the sun.
• Poor diet and nutrition, especially low intake of fruits and vegetables.
• Poor oral hygiene and dental issues.
• Weakened immune system, which may be due to medical conditions or medications.
• Genetic predisposition to cancer.
• Occupational exposure to chemicals such as asbestos and sulfuric acid.
• Chronic Gastroesophageal Reflux Disease (GERD).
• More common in individuals over the age of 40.
• More common in men than women. 

Early Signs & Symptoms of Mouth Cancer

Understanding the early signs of mouth cancer can make a significant difference in successful treatment and recovery. By being aware of these symptoms, you can seek medical help sooner and improve your chances of a positive outcome. Here are some common early symptoms to watch for:

• Persistent mouth sores that do not heal within a few weeks or recur.
• Unusual red or white patches in the mouth or on the lips.
• Lumps, swellings, or thickened areas in the mouth, lips, or throat.
• Unexplained bleeding in the mouth without an obvious cause.
• Persistent pain or discomfort in the mouth or throat.
• Problems with chewing or swallowing
• A feeling that something is caught in the throat.
• Numbness in the tongue or other areas of the mouth.
• Teeth becoming loose without apparent dental cause.
• Hoarseness or other changes in the voice.
• Persistent ear pain without hearing loss.
• Unexplained weight loss.

How is Mouth Cancer Diagnosed?

Diagnosing mouth cancer involves a series of steps to accurately identify the presence and extent of cancer. Early diagnosis is key to effective treatment and better outcomes. Here’s how mouth cancer is typically diagnosed:

• Physical examination: A thorough examination of your mouth, throat, and neck to check for any abnormalities, lumps, or lesions.
• Medical history: Discussing your symptoms, medical history, lifestyle, and risk factors with your doctor.
• Biopsy: Removing a small sample of tissue from a suspicious area for laboratory analysis to check for cancer cells.
• Imaging tests:
• X-rays: To check for cancer spread to the jaw or chest.
• CT scan: Provides detailed cross-sectional images of the body to detect tumours and determine their size and location.
• MRI: Uses magnetic fields to create detailed images of soft tissues, helping to identify the extent of the cancer.
• PET scan: Uses a small amount of radioactive material to highlight cancer cells in the body.
• Endoscopy: Using a thin, flexible tube with a light and camera (endoscope) to view the inside of the mouth and throat.
• Blood tests: While not used to diagnose mouth cancer directly, they can help assess overall health and organ function.
• Molecular testing: Analysing cancer cells for specific genes, proteins, and other factors unique to the tumour, which can help guide treatment options.

These diagnostic methods help healthcare providers determine the presence, stage, and spread of mouth cancer, allowing them to develop an appropriate treatment plan. Early detection and prompt diagnosis are critical to improving the prognosis and quality of life for those affected by mouth cancer.

Read more - Mouth Cancer: Symptoms, Causes, and Treatment Options

Staging of Mouth Cancer

The staging of mouth cancer is a critical process that determines the extent of cancer's spread and helps guide treatment decisions. Mouth cancer is typically staged using the TNM system, which assesses three key components: Tumour (T), Nodes (N), and Metastasis (M).

Tumour (T) - Size and extent of the main tumour 

• T describes the size and depth of the tumour (area of cancer). 
• There are 4 main T stages of mouth cancer. These are T1 to T4.
• T1 means the cancer is contained within the tissue of the mouth (oral cavity) and it is: 2cm or smaller, 5mm deep or less
• T2 can mean different things.
• The cancer is 2cm or smaller, and it is deeper than 5mm but no deeper than 10mm. Or the cancer is larger than 2cm, but no larger than 4cm, and it is 10mm deep or less.
• T3 means either the cancer is larger than 2cm, but no larger than 4cm, and it is deeper than 10mm. Or the cancer is larger than 4cm, but not deeper than 10mm.
• T4a means the cancer has grown further than the mouth and into surrounding structures such as bone, skin or the facial air cavities (sinuses).
• T4b means the cancer has spread into nearby areas such as the space behind the jaw, the base of the skull, or the area of the neck surrounding the arteries (carotid arteries).

Nodes (N) - Spread to nearby lymph nodes

• N0: No regional lymph node involvement.
• N1: Cancer has spread to one lymph node on the same side of the neck, 3 cm or smaller.
• N2a: Cancer has spread to one lymph node on the same side of the neck, larger than 3 cm but not larger than 6 cm.
• N2b: Cancer has spread to multiple lymph nodes on the same side of the neck, none larger than 6 cm.
• N2c: Cancer has spread to lymph nodes on both sides of the neck, none larger than 6 cm.
• N3: Cancer has spread to a lymph node larger than 6 cm.

Metastasis (M) - Spread to other parts of the body

• M0: No distant metastasis.
• M1: Cancer has spread to distant parts of the body.

Stages Grouping

• Stage 0: Abnormal cells are present but haven’t spread.
• Stage I: Tumour is 2 cm or smaller, no lymph node involvement, no spread.
• Stage II: Tumour is larger than 2 cm but not larger than 4 cm, no lymph node involvement, no spread.
• Stage III: Tumour larger than 4 cm, or any size with spread to one nearby lymph node (3 cm or smaller), no spread.
• Stage IVA: Tumour has grown into nearby structures, may involve one or more lymph nodes, no distant spread.
• Stage IVB: Tumour has grown into deeper areas, may involve extensive lymph nodes, no distant spread.
• Stage IVC: Any size tumour, any lymph node involvement, with distant spread.

Understanding the stage of mouth cancer helps healthcare providers to plan the most effective treatment strategies and provides insight into the prognosis.

Management for mouth cancer

Managing mouth cancer involves a combination of different treatments and supportive care. Here’s an overview of the main management strategies:

Medical management

• Chemotherapy: Uses powerful drugs to kill cancer cells or stop them from growing. This can be used before surgery to shrink tumours, after surgery to eliminate remaining cancer cells, or alongside radiation therapy.
• Targeted therapy: Involves drugs that specifically target the molecular changes in cancer cells. These therapies can block the growth and spread of cancer while minimising damage to normal cells.
• Immunotherapy: Uses the body's immune system to fight cancer. This may include drugs that help the immune system recognize and attack cancer cells more effectively.

Surgical management

• Tumour resection: Surgical removal of the tumour along with some of the surrounding healthy tissue to ensure all cancerous cells are eliminated.
• Neck dissection: If cancer has spread to the lymph nodes, this procedure involves removing affected lymph nodes in the neck to prevent further spread.
• Reconstructive surgery: After tumour removal, reconstructive surgery may be necessary to restore the appearance and function of the mouth. This can involve grafts or prosthetics to rebuild the affected areas.
• Microvascular free tissue transfer: Advanced reconstructive technique where tissue from another part of the body is transplanted to the mouth, restoring function and appearance.

Radiation therapy

• External beam radiation: This common method involves directing high-energy beams at the cancer from outside the body to destroy cancer cells.
• Brachytherapy: Involves placing radioactive material directly inside or near the tumour, allowing higher doses of radiation to treat a more focused area.
• Combination therapy: Radiation therapy is often used in conjunction with chemotherapy (chemoradiation) to enhance the effectiveness of treatment.

Supportive care

• Pain management: Medications and therapies are used to control pain associated with cancer and its treatment.
• Nutritional support: Dietitians help ensure patients receive adequate nutrition, which might include special diets or feeding tubes if necessary.
• Psychological support: Counselling, support groups, and mental health services help patients cope with the emotional impact of cancer diagnosis and treatment.
• Management of side-effects: Treatments and medications to manage side effects like nausea, dry mouth, and mouth sores.

Rehabilitation

• Speech therapy: Helps patients regain and improve speech and communication skills that might be affected by cancer treatment.
• Physical therapy: Focuses on restoring movement and function, especially important after surgeries that affect the mouth and neck.
• Occupational therapy: Assists patients in adapting to daily activities and maintaining independence, especially if cancer or its treatment has caused physical limitations.
• Swallowing Therapy: Helps patients relearn how to swallow properly, which can be impacted by surgery or radiation therapy.
• Prosthodontic rehabilitation: Custom-made dental and facial prosthetics to restore appearance and function after tumour removal or reconstructive surgery.

Combining these approaches ensures comprehensive care, addressing not only the cancer itself but also the overall well-being and quality of life for the patient.

Wrap up

Early detection and comprehensive management are key to effectively treating mouth cancer and improving patient outcomes. If you or a loved one are experiencing symptoms or have concerns about mouth cancer, it is crucial to seek professional medical advice. At Max Hospitals, our team of experienced specialists offers state-of-the-art diagnostic and treatment options tailored to your individual needs. We are committed to providing compassionate care and support throughout your journey. Consult with a specialist at Max Hospitals and take the first step toward a healthier future.