Oral cancer – are you aware?

Oral cancer is cancer of the mouth. It most commonly involves the tissue of the lips or the tongue. It may also occur on the:

Cheek lining

Floor of the mouth

Gums (gingiva)

Roof of the mouth (palate)

Historically at least 75% of those diagnosed are tobacco users. Those who both smoke and drink alcohol have a 15 times greater risk of developing oral cancer than others. Tobacco, betel nut and 'paan/betel leaves' chewing, in addition to smoking and alcohol abuse also contribute to oral cancer.

Other factors that may increase the risk for oral cancer include:

Chronic irritation (such as from rough teeth, dentures, or fillings)

Human papilloma virus infection

Poor dental and oral hygiene

Most oral cancers could be prevented if people did not use tobacco or consume alcohol

Initially, chronic irritation produces a white patch (leukoplakia) or a red patch (erythroplakia) in the mouth and these can sometimes become cancer.

Submucous fibrosis, is a unique condition associated with ‘paan/ betel leaves’ chewing. It produces a burning sensation in the mouth in early stages. Later, it produces excessive scarring in the mouth that prevents the patient from opening the mouth. These patients are prone to develop oral cancers at multiple areas.

Symptoms:

You may notice a sore lump or ulcer which may be a deep, hard-edged crack in the mouth. It is most often pale colored, but may be dark or discoloured. It is usually painless at first (may develop a burning sensation or pain when the tumor is advanced)

Other symptoms that may occur include:

Abnormal taste in the mouth

Chewing problems

Mouth sores

Pain with swallowing

Speech difficulties

Swallowing difficulty

Tongue problems

Weight loss

Diagnosis

Once the presence of cancer is confirmed, the stage (extent) of the disease needs to be assessed to plan the best treatment. The stage is based on the size of the tumour, whether the cancer has spread to other parts of the body.

Endoscopy, CT scan and MRI give useful information to stage and plan the treatment better. PET scan can pick up disease from any part of the body with certain limitations.

Cancer in these locations usually affects breathing, swallowing and speech. The aim of the treatment is to cure the patient and also to preserve and restore these vital functions. Cosmetic concerns such as facial symmetry and facial contours are also important to ensure good quality of life after cancer treatment.

Treatment

The choice of treatment depends mainly on general health, the location where the cancer began, the size of the tumour and whether the cancer has spread. Treatment of oral cancers is ideally a multidisciplinary approach involving the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists and rehabilitation and restorative specialists.

The actual curative treatment modalities are usually surgery and radiation, with chemotherapy added to decrease the possibility of metastasis to sensitize the malignant cells to radiation, or for those patients who have confirmed distant metastasis of the disease. Some patients have a combination of treatments.

Surgery is the main form of treatment for head and neck cancers. Numerous surgical approaches have been developed that permit preservation of organ function and facial appearance to a far greater degree than was possible in the past. Patients are usually worried about changes in the facial appearance following cancer surgery.

That was the scenario in the past. Currently, when surgery is extensive, immediate reconstruction of complex defects is done by transfer of appropriate tissue from distant sites (like the forearm, thigh, leg etc.) along with their blood supply which is then reestablished using microvascular technique. With this we can bring the facial appearance as well as the functions of mouth as close to normal as possible.

Prevention

Visit your dentist regularly.

Oral cancer may be discovered when the dentist performs a routine cleaning and examination. Call for an appointment with your health care provider if you have a sore in your mouth or lip or a lump in the neck that does not go away within 1 month. Early diagnosis and treatment of oral cancer greatly increases the chances of survival.

Other preventive steps include:

Avoiding smoking or other tobacco use

Having dental problems corrected

Limiting or avoiding alcohol use

Practicing good oral hygiene.

(Reprint)