Oral Cancer: Types, Symptoms, Causes, Diagnosis and Treatment

Oral cancer affects approximately 20 in 100,000 people during their lifetime, making it the most common form of head and neck cancer. The treatment of oral cancer has evolved significantly, with about 63% of patients surviving five years after diagnosis when proper medical intervention is received. Early detection & appropriate treatment significantly improve the chances of successful recovery.

What is Oral Cancer?

Cancer that develops in the oral cavity marks the beginning of oral cancer. This condition forms in various parts of the mouth, including the lips, gums, tongue, cheeks, and both the roof and floor of the mouth. The disease primarily starts in the squamous cells, thin, flat cells resembling fish scales that line the mouth and throat.

More than 90% of oral cavity cancers are squamous cell carcinomas. These cancers begin when cells in the mouth undergo mutations, causing them to grow abnormally. These mutated cells accumulate to form tumours that can spread to the nearby tissues and lymph nodes in the neck.

The oral cavity and oropharynx play vital roles in breathing, talking, eating, chewing, and swallowing. Minor salivary glands scattered throughout these regions produce saliva that moistens the mouth and throat while aiding food digestion.

Types of Oral Cancer

Squamous cell carcinoma stands as the predominant form of oral cavity cancer, accounting for more than 90% of all diagnosed cases. Although various types exist, each requires distinct treatment approaches based on their characteristics and location.

• Tongue cancer generally affects the front two-thirds of the tongue and shows a high tendency to spread to lymph nodes within the neck. 
• Gum and jaw cancer can develop in both upper and lower gums, potentially invading the underlying jawbone. 

Several less common oral cancer types include:

• Verrucous carcinoma: A slow-growing variant comprising about 5% of all oral cavity tumours
• Minor salivary gland carcinomas: These develop throughout the mouth and throat lining, presenting multiple subtypes, including adenoid cystic carcinoma and mucoepidermoid carcinoma
• Mucosal melanoma: A rare cancer that forms in the moist membranes lining the mouth rather than the skin
• Lymphoma: Develops in lymph tissue, particularly in areas like the base of the tongue or tonsils.

Oral Cancer Symptoms

Early warning signs of oral cancer often appear subtle, making regular oral examinations crucial for timely detection. White or red patches inside the mouth serve as primary indicators, with specific variations including leukoplakia (white or grey patches), erythroplakia (raised red patches), and erythroleukoplakia (mixed red and white patches).

Physical changes in the mouth might manifest as:

• Persistent sores or ulcers that fail to heal within two weeks
• Thickened areas or lumps in the mouth tissues
• Changes in teeth alignment or bite pattern
• Unexplained bleeding in the mouth
• Rough or crusty spots on lips, gums, or inner mouth surfaces

Functional symptoms become more pronounced as the condition advances. Patients might experience difficulty with basic oral functions, including problems whilst chewing, swallowing, or speaking. Movement restrictions of the jaw or tongue often accompany these symptoms.

Risk Factors and Causes of Oral Cancers

Multiple factors contribute to the occurrence of oral cancer, with tobacco use and alcohol consumption standing at the forefront. The combination of smoking & drinking multiplies the risk substantially. The following are some common oral cancer causes:

• Toacco, Pan Masala, Areca Nut, Bidi 
• People who both smoke heavily and consume excessive alcohol face a risk 30 times higher than those who neither smoke nor drink. 
• Genetic predisposition plays a crucial role through specific inherited conditions. Fanconi anaemia and dyskeratosis congenita carriers face heightened risks of developing mouth and throat cancers. 
• Individuals with siblings previously diagnosed with head and neck cancer show increased susceptibility.
• Human papillomavirus (HPV) infection, specifically type 16, emerges as a significant factor.  
• Other notable risk factors include:
  • Poor nutrition and excess body weight
  • Prolonged UV light exposure, mainly affecting lip cancers
  • Weakened immune system, particularly in HIV/AIDS patients
  • Pre-existing mouth conditions like erythroplakia and leukoplakia
  • Previous diagnoses of certain cancers, specifically cervical, oesophageal, or lung cancer

Complications of Oral Cancer

Most head and neck cancer patients experience oral complications, occasionally becoming severe enough to halt treatment entirely. The primary complications encompass mucositis (inflammation of the mouth's mucous membranes), infections, pain, and bleeding.

Oral Cancer Diagnosis

A thorough physical examination marks the initial step, where doctors inspect the lips and mouth for lumps, white patches (leukoplakia), and areas of irritation.

Imaging Tests:

• Biopsy: Biopsy stands as the definitive method for diagnosing oral cancer. 
• CT scans: Create detailed cross-sectional images using X-rays and computers
• MRI scans: Utilise magnetic fields to examine soft tissues
• PET scans: Track radioactive sugar to identify cancer spread

Treatment for Oral Cancer

Treatment strategies for oral cancer depend on multiple factors, whilst Medical teams consider cancer location, stage, and patient's overall health status. Surgery often serves as the first-line treatment, primarily for small, early-stage cancers that have not spread.

• Surgical options encompass:
  • Primary tumour resection with adequate margin removal
  • Glossectomy for tongue cancers (partial or total)
  • Mandibulectomy for jaw-involved cases
  • Neck dissection for lymph node removal (done in all cases when primary restoration is done)
• Radiation 
  • Adjuvant Radiotherapy
  • Concurrent Chemoradiotherapy 
  • Palliative Radiotherapy 
• Chemotherapy plays various roles in treatment:
  • Post-surgery elimination of remaining cancer cells
  • Pre-surgery tumour shrinkage
  • Advanced cancer management
  • Combined therapy with radiation

Targeted therapy and immunotherapy represent newer treatment approaches. Cetuximab, a targeted drug, blocks epidermal growth factor receptors (EGFR) on cancer cells. Immunotherapy medicines help the immune system identify and destroy cancer cells.

When to See a Doctor

Certain symptoms require urgent medical evaluation, including:

• Persistent sores or irritation in mouth or throat, lossening of teeth, Jaw
• White or red patches inside the mouth
• A sensation of something caught in the throat
• Changes in voice or persistent hoarseness
• Continuous coughing spells
• Problems with chewing, swallowing, or speaking
• Restricted jaw or tongue movement
• Mouth numbness
• Swelling in the jaw or neck region
• Recurring nosebleeds
• Ear pain without hearing changes
• Unexplained weight loss

Prevention

Preventing oral cancer involves making conscious lifestyle choices and maintaining regular health checks. Here are some common guidelines:

• Stopping tobacco use, Pan masala, supari, Hukka
• Alcohol consumption stopping
• Regular dental check-ups 
• HPV vaccination 
• Maintaining a diet enriched in fruits and vegetables, which reduces oral cancer risk by 40-50%
• Using lip balm with SPF 30 or higher to protect against UV radiation
• Practicing safe sex to prevent HPV transmission
• Avoiding betel quid and areca nut consumption, which are classified as type 1 carcinogens

FAQs

1. Is oral cancer curable?

Oral cancer shows promising cure rates when detected early. Studies indicate that approximately 68% of people survive for five years after diagnosis. The survival rate increases substantially for cancers discovered in early stages, reaching 86% for stage 1 cases.

2. What are the primary causes of oral cancer cancer?

About 90% of oral cancer cases stem from specific risk factors. Primary causes include:

• Tobacco, Pan Masala, Areca Nut use in any form
• Regular excessive alcohol consumption
• Human papillomavirus (HPV) infection
• Prolonged sun exposure- affecting lips
• Family history of oral cancer

3. At what age does oral cancer start?

Whilst oral cancer primarily affects older adults, with an average diagnosis age of 63, approximately 20% of cases occur in patients under 55. The median age at death stands at 68 years. The incidence is steadily increasing in young population with respect to increase in tobacco and alcohol.

4. What is the blood test for oral cancer?

Currently, no specific blood test exists to diagnose oral cancer. However, doctors use blood tests to:

• Assess overall health before treatment
• Monitor treatment effectiveness
• Check blood cell counts
• Evaluate liver and kidney function

5. How common is oral cancer?

Statistics show that approximately 20 adults per 100,000 develop oral cancer. Men face twice the risk compared to women.

6. Is oral cancer painful?

Indeed, pain ranks amongst the most significant symptoms. Pain typically worsens with disease progression and affects essential functions like eating, speaking, and swallowing.

7. How to check for oral cancer at home?

Monthly self-examinations prove crucial for early detection. Key steps include:

• Examining lips and inner mouth surfaces using a bright light
• Checking tongue surfaces and sides
• Feeling for lumps or texture changes
• Looking for white or red patches
• Monitoring for persistent sores or bleeding
• Inspecting the roof and floor of the mouth