Oral cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 22, 2016
StartDiseasesOral cancer

Oral cancer is one of the leading causes of death worldwide. When diagnosed in early stages, this form of cancer has an 80 to 90 percent survival rate. Unfortunately, most tumors are found at late stages of development when treatment options are limited.

Contents

Definition & Facts

More common than brain cancer, thyroid cancer, and leukemia, oral cancer kills over six million people annually. It is estimated that about 30,000 Americans will be diagnosed with this condition in 2016. More than 8,000 will die because of it. Oral cancer refers to cancers of the mouth and pharynx.

It usually affects the throat, lips, tongue, larynx, and part of the nose. According to the Centers for Disease Control and Prevention (CDC), approximately 75 percent of all cases are associated with tobacco smoking. These findings were recently confirmed by the International Agency for Research on Cancer.

Most patients are diagnosed with mouth cancer during regular dental checkups. An oral examination can detect early signs of cancer and prevent complications. Smokers and heavy drinkers should have their pharynx checked regularly for tumors.

Symptoms & Complaints

About 90 percent of all oral cancers are squamous-cell carcinomas, which affect the oral mucosal lining. Other forms of the disease include lymphoma, adenocarcinoma, Kaposi's sarcoma, and teratoma. Some patients develop tumors on the roof of the mouth (palate), gums, cheek lining, and tongue. The most common symptoms of oral cancer include:

People suffering from mouth cancer may notice sores that don’t heal, tongue pain, lumps in the neck, hoarseness, and loss of feeling in any area of the face of mouth. They also develop lumps or ulcers behind the ear, on the tongue, or on the lips. Some feel that something is caught in their throat.

These symptoms are usually painless and last over 14 days. Even though these are not necessarily signs of cancer, it's recommended to see a specialist. If left untreated, the cancer can metastasize, that is, spread to other parts of the body and cause further damage.

Causes

Mouth cancer has more than one cause. People who smoke or drink are the most likely to develop this condition. The use of tobacco and alcohol together poses a higher risk than using either substance alone. Other possible causes include sun exposure, sexually transmitted diseases like human papillomavirus (HPV), poor nutrition, graft-versus-host disease (GVHD), lichen planus, and long term irritation from dentures.

Certain genetic disorders, such as Fanconi anemia and dyskeratosis congenita, can increase the risk of developing oral cancer. Individuals who have a weakened immune system as well as those who chew areca nuts are more likely to develop cancers of the mouth and pharynx.

About seven out of 10 patients diagnosed with this disease are heavy drinkers. Chewing tobacco and snuffing for a log time can lead to oral cancer too. These habits also cause tooth loss and gum disease. The same goes for pipe smoking.

Statistics indicate that mouth cancer is twice as common in men as in women. The tumors take years to develop, so they are rarely found in young people. Most patients diagnosed with oral cancer are over 55 years old. Those suffering from HPV-linked cancers tend to be younger. Studies have also found that a diet low in fruit and vegetables can increase the risk of mouth cancer.

Diagnosis & Tests

The diagnosis of oral cancer remains a challenge to the medical profession. Most forms of cancer are detected in late stages, which is why the survival rate has remained unchanged over the past 30 years. Five-year survival rates in the U.S. are 63 percent. In its early stages, this disorder can be treated in over 90 percent of cases.

Patients are advised to regularly check their mouth, face, and neck for signs of cancer. An oral cancer examination takes only a few minutes and doesn't cause any pain. Dentists and physicians can recognize and detect early changes of the oral mucosa and recommend proper treatment. Any mucosal abnormality that looks suspicious must be sampled and submitted to an oral pathologist for further examination.

A brush biopsy may be needed to obtain additional information concerning a possible carcinoma. The doctor may also use a new technology called chemiluminescent light to examine affected or abnormal mucosa.

Treatment & Therapy

When diagnosed in early stages, oral cancer can be treated with surgery, chemotherapy, and radiation therapy. In late stages, surgery with adjuvant radiation therapy may be recommended.

Treatment options depend on the patient's age, type of cancer, and severity of the disease. Most times, the surgeon will remove the tumor along with cancerous lymph nodes. Large tumors usually require the removal of some of the tongue or jawbone. Common types of surgery include glossectomy, radical neck dissection, and maxillectomy. These procedures are often used in combination. Patients who undergo extensive surgery may need mouth reconstruction and dental implants afterwards.

About 40 percent of all cases require some kind of radiation therapy. This form of treatment uses X-rays to destroy malignant cells. The doctor may also prescribe drugs that prevent tumor growth and kill cancer cells, such as cetuximab.

Prevention & Prophylaxis

The best way to prevent oral cancer is to eliminate the risk factors associated with this disease. Simple lifestyle changes, such as quitting smoking and alcohol, eating more fruits and vegetables, and limiting exposure to ultraviolet light, can lower the risk of cancer.

It's recommended to wear properly fitted dentures and eat a healthy diet that emphasizes plant-based foods. HPV vaccination can help prevent mouth cancer too. Health-conscious individuals should floss their teeth every day and have regular dental check-ups.