What is oral cancer

Oral cancer or mouth cancer include cancer of lip, tongue, area between tongue and lower jaw bone (floor of mouth), cheek, upper and lower jawbones and bony palate.

How common is oral cancer

It is the most common cancer amongst Indian males. It is also the most common cause of deaths due to cancer in our country. This is the fourth common cause of cancers in women but in some part of our country, it is one of the commonest cancer in women.

Every year approximately 1 lakh new cases of oral cancers are detected in India. Unfortunately half of them die within one year of detection. The main reason behind it that 60-70 percent of these cases are detected in advanced stages.

What are the causes of oral cancer

Tobacco consumption is the most common cause of oral cancer. It is consumed in various forms. It may be chewed or it may be smoked. Chewing tobacco is used in various forms such as mawa, khaini, pan, pan masala etc. It may be smoked in the form of bidi, Hukkah, cigarette etc. Gutka and areca nut or supari also cause mouth cancer and rampantly used in some part of our country. All these forms are harmful and cause cancer.

Alcohol is another cause of oral cancer especially floor of mouth cancers. The risk of cancer is increased many folds when both tobacco and alcohol are consumed together.

Sharp tooth and ill-fitting dentures causing repeated trauma can also cause oral cancer.

Poor or dental hygiene, HPV virus infection, dietary deficiencies are other causes of mouth cancer.

Can it be cured

Oral cancer can be cured if detected early. Hence early diagnosis and treatment are crucial for a successful outcome. It is important to be aware of symptoms and warning signs of cancer so that treatment can be started on time.

Symptoms & Warning Signs

Non-healing ulcer i.e. an ulcer that does not heal despite treatment

Any rough area inside the mouth
Any growth that bleeds on touch
White patch or red patch inside mouth
Sudden fall of tooth
Change in size of dentures
Altered speech
Difficulty in eating
Pain at the backside of throat radiating to the ear
Neck swelling
Skin ulcer or swelling over face

Diagnosis

Clinical Examination

The patient is examined clinically by the oncologist and the extent of tumor is determined. Based on clinical examination finding further tests are ordered.

Biopsy

Biopsy is done to confirm the presence and type of cancer. It is often done as an outpatient procedure. In this, a small piece from the growth is taken and sent for pathological examination. Biopsy is essential before starting cancer treatment.

Imaging

Imaging is done to know tumor extent in all dimensions including deeper tissues. CT scan, MRI or PET CT is done based on tumor location, site and size.

Staging

Tumor is staged based on clinical and radiological findings. It is staged as early-stage (stage I/II ) or advanced stage (stage III/IV).

Treatment

Treatment of oral cancer is primarily by surgery. Radiation therapy alone or along with chemotherapy is required in late stages.

Surgery

Surgery includes complete excision of tumor along with a safety margin of normal tissue all around the tumor. The extent of surgery depends on tumor size and involvement of adjoining structures. Surgery includes excision of main tumor and removal of draining lymph nodes of the neck called neck dissection.

Plastic Reconstruction

Primary Closure:

If the tumor is small and the resulting defect is not much then sutures are placed to approximate the remaining tissues and closure is achieved.

Local Flap:

When the defect can not be closed primarily, tissue from the adjacent region is used to repair the defect. This tissue can be taken from the adjacent tongue, buccal mucosa, palate etc.

Regional flap:

In case of larger defects, it is not possible to use adjacent tissues. In such situations, tissue from a distant site is used to cover the defects. Tissue from the chest, arm, neck etc. can be utilized for this purpose.

Microvascular Free Flap Reconstruction:

This is the latest advancement in flap surgeries. In this technique, tissue from some distant site such as forearm, thigh or leg along with its blood supply is taken and sutured to the remaining tissue in mouth to cover the defect.

Radiotherapy

Radiotherapy is used mainly in advanced cases after surgery so that chances of recurrence can be reduced.

Chemotherapy

In oral cancer, chemotherapy is mainly used for the treatment of advanced-stage IV cancers where it is used along with radiotherapy after surgery. Chemotherapy alone is generally used in cases where either the tumor is very advanced and has spread to distant areas such as lung, liver or bone or it has come back again and either surgery or radiotherapy can not be given. The intent of treatment in this situation is palliative that means chemotherapy is not going to completely remove the disease but is given to slow the tumor growth.

Targeted therapy

In this therapy, drugs are used which target specific parts of cancer cells such as proteins or genes involved in tumor growth. These are used along with chemotherapy in advanced cases where surgery and radiation therapy are not an option.

Immunotherapy

Immunotherapy is a type of therapy that acts on the body’s immune system to fight cancer. For oral cancer, it is used in advanced cases where surgery can not be done and radiotherapy is not possible. Immunotherapy is given either alone or along with chemotherapy.

Follow up

It is very important to be in regular follow up after cancer treatment. This is done to detect future recurrences at the earliest. At each follow-up visit, the patient is examined clinically by an oncologist. Imaging may be required based on tumor stage and symptoms. Follow up is done at 2-3 months for the initial 2 years, 3-6 monthly for the next 3 years and annually thereafter.

Health tips: 1

Prevention of oral cancer:

Stay away from tobacco and alcohol
Say no to passive smoking
Regular check-up if you have smoked or had alcohol in past

Health tips: 2

Warning signs of Oral cancer :

Persistent ulcer for more than 3 weeks

Growth / rough area inside the mouth
White patch or red patch
Sudden fall of tooth
Altered speech
Difficulty in eating
Pain at the backside of throat radiating to the ear
Neck swelling