Oral Cancer – Statistics, Risk factors, Signs and Symptoms, Diagnosis and Treatment

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Oral cancer can be defined as an abnormal, malignant growth of tissue in the lip, mouth and oropharynx. Oral tumors can develop anywhere in the oral cavity and can be benign (non-cancerous), precancerous (potential to become cancerous), and malignant (cancerous).

Statistics for Oral Cancer:

Approximately 35,000 Americans are diagnosed each year with oral cancer that causes about 8000 deaths, killing roughly 1 person per hour. There has been no significant improvement in the statistics over the decades. India has one of the highest incidences of oral cancer in the world. However, if we consider the worldwide statistics, the problem is much greater as there are more than 400,000 new cases found every year.

Cancers involving the head and neck region are found mostly in people above the age of 45. The incidence of Oral cancer is highest of all cancers amongst men (12%) as compared to women (8%). See Oral Cancer Incidence (New Cases) by Age, Race and Gender.

Another alarming fact is that the death rate of oral cancer is higher than that of other cancers like Hodgkin’s Lymphoma, cancer of the larynx, endocrine cancers, skin cancer or cancer of the testes. The most probable cause for the high death rate could be the fact that oral cancers are mostly detected in their later stages when the cancer cells have already migrated to other sites through the lymph nodes thereby making it more difficult to treat. However, oral cancer can be detected early if the patient comes to the dentist in time and the dentist is able to diagnose the condition correctly. Oral cancers can be of several different types, but it is found that about 90% of them are squamous cell carcinomas.

Risk factors:

There are several risk factors that can be associated with oral cancers. Understanding these factors can help in preventing its onset.

Ø One of the prominent factors to be considered is the age. (above 40)
Ø Most oral cancers can be related to the excessive use of tobacco and or alcohol. In India, oral cancer has been linked to the use of betel nut chewing, cigarette or bidi smoking and the use of tobacco in products like Gutka etc.
Ø Biological factors include viral and fungal infections: Most commonly the human papilloma virus, particularly HPV16 has been found to be associated with oral cancers that occur in the back of the mouth.
Ø Other than Lifestyle factors there are also physical factors like exposure to ultraviolet radiation and exposure to x-rays.
Ø Nutritional factors like Diet that is deficient in fruits and vegetables could become a risk factor.

Signs And Symptoms Of Oral Cancer:

In majority of cases oral cancers remain unnoticed in their early stages due to the fact that it is painless and the patient may ignore other symptoms like color changes of the mucosa or small lumps. But, if the patient does land up at the dentists office in time then the dentist or even a doctor can detect the minor tissue changes while it is still very small.

Oral cancer may appear as red or white patches of tissue in the mouth or sometimes even as a small indurated ulcer that appears like a canker sore. Most of these signs and symptoms may appear like any other benign tissue changes that occur commonly in the mouth, like a cheek bite, and therefore it is very important to have any such discolorations or ulcers that do not heal within 14 days to be examined by a professional.

There may be other symptoms like small lumps or masses in the oral cavity or neck with pain and difficulty in swallowing, speaking, chewing and or hoarseness which may last for a long time. There may also be numbness in the oral or facial region or a unilateral persistent earache that may serve as adequate warning signs to visit a doctor.

Establishing a Diagnosis:

The dentist or doctor can quickly establish a firm diagnosis of the oral cancer by doing a biopsy of the tissues involved. The procedure is inexpensive, painless, doesn’t take much time and generally can be done under local anesthesia.

There may be many other factors that also need to be established before any treatment can be initiated. The doctor may advise various other investigations like dental x-rays, chest x-rays, CT Scan and MRI to rule out any other underlying conditions.

Apart from the age and the general health of the patient, the extent of treatment for oral cancer will also depend upon the location, size, type, extent of the tumor and the stage of the disease.
Determination of the stage of cancer in the lip or oral cavity is important in order to plan the best course of treatment.

Treatment of Oral Cancer:

Cancer that involves the lip or oral cavity can be treated best if detected in the early stages, like most cancers that involve the other parts of the body.

The treatment of oral cancer may involve surgery, radiation therapy or a combination of both, and or chemotherapy. It is recommended that the patient should get a complete dental examination before any treatment is carried out. Cancer treatment makes the mouth sensitive to infection and so it is advisable to get all the fillings, extractions and prosthesis work done prior to any surgical or radiation therapy. A thorough prophylaxis, or cleaning should be done as well. Taking care of the oral health before any other procedure ensures minimal post-therapeutic complications.

The treatment of oral cancers involves the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists, rehabilitation and restorative specialists.

Surgery:

surgery is the usual treatment undertaken to remove tumors from the mouth in patients with oral cancer. The different surgical techniques that are used to remove specific oral tumors includes- Primary tumor resection, mandible resection, maxillectomy, Moh’s micrographic surgery, laryngectomy and neck dissection in cases of extensive involvement of the lymph nodes in the neck.

Radiation Therapy:

Radiotherapy is a treatment that involves high-energy rays that damages the cancer cells and stops their further growth. The therapy is localized to the area where cancer cells are found just like the surgical therapy. The radiation may be given externally or internally with the help of machines or radioactive materials. Some patients may require a combination of both surgical and radiation therapy.

Chemotherapy:

Chemotherapy involves the use of medications that kill the cancer cells by their ability to interfere with it’s replication. Researchers are still looking for effective drugs or combination of drugs to treat Oral cancers and are also exploring ways to combine chemotherapy with other treatment modalities to destroy the cancer cells and prevent it from spreading. Chemotherapy is also used in combination with surgery and radiation therapy in severe cases.

After Effects of Oral Cancer Treatment:

Side effects of oral cancer treatment will vary depending upon the type and extent of treatment and area being treated, which can be temporary or permanent. There may be swelling, sore mouth, difficulty in chewing or talking or swallowing, changes to appearance, fatigue, lowered immunity and a lack of appetite due to nausea, vomiting and others. Therefore such patients need to be rehabilitated.
Rehabilitation varies from person to person depending upon the extent of oral cancer treatment and it involves – dietary counseling, reconstructive surgery, prosthesis, speech therapy and other adjunctive therapy to assist in chewing of foods and the problems associated with the lack of salivary function.