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Health Corners
ORAL CANCER

Indians, especially men, make themselves prime targets for oral cancer. Their weakness for chewing tobacco, betel nut, zardha, smoking beedis (with the lit end in the mouth) and using snuff puts them at risk. India records a very high incidence of oral cancer.

Oral cancer includes cancers found in the lips, the lining inside the lips and cheeks (buccal mucosa), the teeth, the tongue, the floor of the mouth under the tongue, the bony top of the mouth (hard palate), the gums, the small area behind the wisdom teeth as well as the soft palate, the tonsils and the back of the throat.

  • Causes

  • Symptoms

  • Diagnosis

  • Staging

  • Treatment Options

  • Prevention

  • What causes oral cancer?

    The following have been identified as possible causative factors of Oral cancer:

    • Tobacco in any form: smoking, chewing or snuff.
    • Chronic irritation due to ill fitting dentures, jagged teeth and poor oral hygiene.
    • Consumption of alcohol.
    • Smoking of bidis with the lit end inside the mouth. (Leads to palatal cancer.)
    • Pipe smoking. (Increases risk of lip cancer.)
    • Excessive exposure to the sun. (Increases risk of lip cancer.)

    Tobacco has been identified as a major risk factor. This in combination with other factors can multiply the risk.

    Symptoms

    One or more of the following symptoms may be present:

    • A sore on the lip or in the mouth that does not heal.
    • A lump on the lip or in the mouth or throat.
    • A white or red patch on the gums, tongue, or lining of mouth.
    • Unusual bleeding, pain, or numbness in the mouth.
    • A sore throat that persists.
    • Change in voice.
    • Pain or difficulty in swallowing or chewing
    • Swelling of the jaw.
    • Pain in the ear.

    Screening

    Those in the high risk group should perform oral self examination periodically.

    Here is how you perform the self examination:

    Remove any dental appliances. Using a bright torch, look and feel the inside of your lips and the front gums. Tilt your head back to look at the roof of your mouth. Pull your cheek out to see the inside and also the back gums. Put out your tongue and look at all surfaces, particularly the sides and underneath. Feel for lumps or enlarged lymph nodes on both sides of the neck and under the lower jaw. When you are performing your oral cancer self-examination, please look specifically for reddish patches, whitish patches, a sore that fails to heal (within about two weeks) and bleeds easily, a lump or thickening of the tissues, a chronic sore throat etc.,

    If any area of abnormality is detected by a self examination, it needs to be evaluated further.

    • The doctor will need to know your personal and family medical history. He will also want to know if there has been exposure to carcinogens.
    • The doctor will examine the mouth, tongue and throat area thoroughly, using a torch, mirror and may be a piece of gauze to hold out the tongue with for examination.
    • Blood tests to observe the blood counts and liver functions may be required.
    • A CT or MRI of the head and neck may be necessary to identify a tumour not easily visible to the eye and also to note the extent of spread. Dental X rays and Bone Scans may also be needed.
    • A biopsy is also performed. This is done by removing a small portion of tissue from the suspicious area and subjected to microscopic examination.

    Staging

    If cancer is detected in the oral cavity, the cancer is staged to assess the extent of spread. This is done by dental X rays, X rays of the head and chest, CT scan etc.,

    The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.

    TNM ( Tumor size, Size of Lymph Nodes, Distant Metastasis ) definitions

    Primary tumor (T)

    TX: Primary tumor cannot be assessed
    T0: No evidence of primary tumor
    Tis: Carcinoma in situ
    T1: Tumor 2 cm or less in greatest dimension
    T2: Tumor more than 2 cm but not more than 4 cm in greatest dimension
    T3: Tumor more than 4 cm in greatest dimension
    T4: (lip) Tumor invades adjacent structures (e.g., through cortical bone, inferior alveolar nerve, floor of mouth, skin of face)

    (oral cavity) Tumor invades adjacent structures (e.g., through cortical bone, into deep [extrinsic] muscles of tongue, maxillary sinus, skin. Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify as T4)

    Regional lymph nodes (N)

    NX: Regional lymph nodes cannot be assessed.
    N0: No regional lymph node metastasis.
    N1: Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension.
    N2: Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.
    N3: Metastasis is more than 6cm in the lymph nodes in the greater dimension.

    Regional lymph nodes (N)

    MX: Distant metastasis cannot be assessed.
    M0: No distant metastasis
    M1: Distant metastasis.

    Based on these definitions oral cancer has been grouped into four stages.

    Treatment

    Specific treatment for oral cancer can be decided based on:

    • The overall health and medical history of the patient
    • Spread of the disease
    • Tolerance of the patient for specific medications, procedures, or therapy

    The treatment modalities include surgery, radiation therapy, and sometimes, chemotherapy.

    Prevention

    Some simple precautions help reduce risk of oral cancer:

    • Avoid tobacco in any form.
    • Avoid alcohol.
    • Keep your mouth clean.
    • Discard ill-fitting dentures.
    • Attend to unhealthy and bad teeth.
    • If anaemic, get treated.

    Cancer of the lip can be avoided by the use of a lotion or lip balm containing a sunscreen. Wearing a hat with a brim can also block the sun's harmful rays.

    It is important to detect oral cancer as early as possible because treatment works best before the disease has spread.

    Early detection is aided by:

    • A routine monthly self examination.
    • Regular dental check ups that include an examination of the entire mouth.

    Cure rate in Oral Cancer

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