Oral cancer, also known as Mouth cancer, is a life threatening disease. Every hour one person dies because of oral cancer in the USA alone. According to the WHO oral cancer is the 13th most common cancer worldwide. The country with maximum cases of oral cancer is Papua New Guinea followed by Bangladesh. Whereas India is at the 7th position in this list.
Oral cancer is a part of a group of cancer commonly referred to as Head and Neck cancers. Oral cancer excludes brain, auditory, ocular and thyroid cancer as mentioned by National Cancer Institute (NCI). The oral cancer comprises of following parts:
- Lips
- Gums
- Tongue (front 2/3rd of the tongue)
- Cheeks inner lining (buccal mucosa)
- Mouth roof (hard palate)
- Mouth floor (area under the tongue)
- Area behind the wisdom teeth
Oral Cancer Signs
Understanding of signs and symptoms can help in early detection of oral cancer. The following signs and symptoms needs your attention:
- Lumps – unusual lumps or swelling in mouth.
- Patches – Red or white patches in the mouth.
- Ulcers – Any part of the mouth cavity thickened, rough, crusted or eroded can be a problem. Ulcers which do not heal within 3 weeks.
- Difficulty in chewing or swallowing.
- A persistent sore throat or irritation.
- Speech difficulties like hoarseness.
Symptoms Of Mouth Cancer
In the early stages of mouth cancer there are hardly any symptoms or no symptoms at all. But people with smoking habit, tobacco chewing should go for regular checkups to detect any changes as early as possible.
The symptoms vary depending on the area of mouth involved, your dentist may find these symptoms, which can indicate the development of oral cancer. These include:
- Pre Cancer signs – are those signs which can eventually develop in cancer and it includes –
- Leukoplakia – are white patches in the mouth which do not disappear on rubbing.
- Oral Lichen Planus – is white lines with reddish border in the oral cavity that results from ulceration mainly.
- If a person develops cancer then the following symptoms are seen :
- Sore mouth
- Lips are sore or reddish and don’t heal easily
- Bleeding of gums
- Loosening of teeth
- Voice changes
- Swallowing is difficult or painful or both
- Pain in mouth
- Ear pain
- Swelling or pain in the jaws
- Pain during jaw movements like chewing food, speaking, etc
- Weight loss
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Types of Oral/Mouth cancer
There are two classification of Mouth Cancers on the basis of
Oral Cancer By Region:
- Lip cancer —
The Most common type of oral cancer and dominates in males mainly. It can be Squamous cell or Basal cell cancer, the former being more common among the two. Smoking, chewing tobacco, and alcohol consumption are the main risk factors of lip cancer.
- Jaw Cancer —
Jaw cancer usually does not begin in the jaws; it starts as a cyst or growth in the jaw area known as Odontogenic tumors. These odontogenic tumors are mainly benign in nature and few (1%-6%) are malignant. There are different types of malignant odontogenic tumors like Ameloblastic, Clear cell, Sclerosing, Primary intraosseous, Ghost cell, etc. Biopsy and x-rays are used to diagnose jaw cancers.
- Palate, Cheek and other Mouth Cancer —
This category of oral cavity cancer includes buccal cavity and hard palate mainly. The most common type of cancer in this is squamous cell carcinoma.
- Tongue Cancer —
According to the National Cancer Institute Surveillance, Epidemiology , and End Results (SEER) program there will be more than 18,000 cases of tongue cancer in 2023. The main cause of tongue cancer is tobacco chewing.
Mouth Cancer By Cell Types :
- Squamous Cell Carcinoma — most common type of cell carcinoma, almost 90% of the oral cancers are squamous cell carcinomas. It is caused mainly by mutation in genes of squamous cells.
- Verrucous Carcinoma — 5% of the carcinoma belongs to this rare type of carcinoma. It is a slow developing carcinoma made up of squamous cells only.
- Minor Salivary gland carcinomas — in this carcinoma cancerous cell are found on the lining of salivary gland which lines the mouth and throat. It includes adenoid cystic carcinoma, mucoepidermoid carcinoma, and polymorphous low grade adenocarcinoma.
- Lymphoma — these are cancer of lymph tissue in the oral cavity. Lymph tissue is part of the immune system. In the oral cavity lymphoid tissue is present in the base of the tongue and tonsils.
- Mucosal Melanoma — is the cancer of the inner lining or moist membrane that lines the inner part of the organs like oral cavity, digestive tract etc. In general melanomas are cancerous cells that start in pigmented cells called Melanocytes. It has a tendency to move to different parts of the body. Though it is a rare disorder, it can be aggressive in nature.
Oral Cancer Causes
Genetic Mutations – mutations in cells are one of the primary causes of cancers in the human body. Mutations can happen due to various causes, internal factors or external factors; these factors are commonly known as Risk factors. These risk factors increase the participation rate of cancer and its symptoms.
So, the most common risk factors of the mouth cancer includes –
- Smoking – all smokers and non-smokers must have seen that the cigarette pack is highlighted with the warning sign “Smoking causes cancer”. In Fact it is one of the leading causes of oral cancer. Smoke from cigarettes, pipes, cigars, etc is not only a problem for smokers but non smokers too.
- Tobacco Use – using snuff, dip, spit, chew or dissolvable tobacco is very dangerous. Oral tobacco products cause cancer of lips, gums, cheeks, tongue, and oral cavity. About 85% of patients with oral cancers use tobacco. The risk of developing oral cancer depends on the duration and frequency of tobacco use. It is usually associated with cancer of gums, cheeks, inner surface of lips.
- Alcohol (excessive) consumption – around 70% of people diagnosed with oral cancer belong to an excessive alcohol consumption group. If a person smokes and drinks then the risk of development of oral cancer increases by 30 times.
- HPV (Human PapillomaVirus) – HPV is a group of 150 types of viruses. Oral HPV often has no symptoms. This type of HPV can turn into oropharyngeal cancer. Oral HPV can enter the body usually through a cut or tear inside the oral cavity. In some cases oral sex can bring in contact with oral HPV.
- Age – the average age of diagnosis for oral cancer is 63. 2/3rd of the people suffering from oral cancer are over the age of 55. The risk of developing oral cancer increases post 40 especially in smokers and tobacco chewers. But usually it is not diagnosed early as cancer takes years to grow.
- Gender – oral cancer is twice more common in males than females. This is mainly due to consumption of carcinogenic products like tobacco, alcohol, etc is more predominant in them as compared to females.
- Unhealthy diet – poor eating habits always deteriorates your overall health and is one of the risk factors that lead to the development of oral cancer. A diet which lacks fruits, vegetables, etc and is rich in processed food will lead to depletion of antioxidants which fights free radicals that are one of the causes of genetic mutation of cells in our body.
- Exposure to UV rays – is mostly associated with lip cancer of the oral cavity.
How To Prevent Oral Cancer
Some of the risk factors that causes oral cancer needs to be checked to prevent its development like :
- Maintaining good oral hygiene
- Say no to smoking
- No to tobacco chewing
- No to alcohol or drink in moderation.
- Immunization against HPV in sexually active people is important.
- Unprotected oral sex should be avoided to avoid contact with HPV.
- Healthy diet
The prevention of oral cancer needs timely visits to the dentist and regular checkups. This includes :
- Physical examination
- Tests like Biopsy, X-rays, CT Scan , PET Scan (to know if cancer has moved to lymph nodes or other organs), MRI Scan (to know exact state and extent of cancer).
Treatment Of Mouth Cancer :
The treatment of mouth cancer depends on the stage of the mouth cancer. Like :
- Stage 0 – surgery is the main line of treatment in this stage which aims to remove the top layers of tissue with a small margin of normal tissue. If it keeps recurring then radiation therapy is used.
- Stage I & II – needs surgery &/or radiation therapy. Chemoradiation is another option in which chemotherapy with radiation is used for treatment.
- Stage III & IVA – surgery followed by radiation or chemoradiation.
- Stage IVB & IVC – in this stage immunotherapy with or without chemotherapy is the option.
Oral cancer is a very common form of cancer which is closely associated with our lifestyle choices like smoking, drinking, poor diet, unsafe oral sex, etc. it is also difficult to detect the cancer in early stages also. It is almost two times more common in males than in females. So, regular checkups and maintaining good oral hygiene are some basic tasks which one should do to find out its early presence. So, visit your dentist regularly.