Oral cancer is one of the most common cancers in India. A large percentage of oral cancer cases are attributed to tobacco and alcohol consumption. Oral cancer has a better prognosis when it is diagnosed and treated in the early stages.
The oral cavity comprises different parts, namely the lips, gums, tongue, teeth, inside cheeks, roof of the mouth, and floor. These parts of the oral cavity have different types of cells that divide based on the information present in their DNA. Due to certain factors, such as radiation or excessive tobacco exposure, the information in the DNA changes (the process is called mutation), resulting in uncontrolled cell division. This excessive cell division leads to the formation of tumors in the oral cavity, and the condition is known as oral cancer or mouth cancer. Men are at greater risk of developing oral cancer than women.
Oral cancer is one of the top ten cancers globally. India has the largest number of mouth cancer cases, accounting for about one-third of the global burden of the disease. Approximately 70% of the oral cancer cases in India are diagnosed in advanced stages; thus, the five-year survival rate in India is only 20%.
Mouth cancer may start in any location of the oral cavity:
Oral cancer may occur on the lips in the form of lesions or tumors. Squamous cell carcinoma is the most common lip cancer. Patients with mouth cancer may often experience thickening of the lips with or without bleeding.
Gum cancer occurs when the cells of the gums (upper or lower) grow and divide uncontrollably, resulting in the formation of a lesion or tumor. It is usually seen in the form of a white or red mass that may also bleed.
Tongue cancer is characterized by the uncontrolled growth and division of tongue cells. It is usually presented in the form of red or white patches. Based on the site of cancer on the tongue, tongue cancer can be classified into oral tongue cancer and basal tongue cancer.
The cancer of the inner lining of the cheeks is known as buccal mucosal cancer. The patients have painful ulcers or sores and may be presented with raised red or white patches. Early-stage cheek mouth cancer can be treated with surgery.
The hard palate and soft palate make up the roof of the mouth. Cancer of the hard palate is considered a type of oral cancer, while soft palate cancer is classified as throat cancer.
Floor of the mouth cancer starts when the cells beneath the tongue divide and grow uncontrollably. Patients experience pain during swallowing, loose teeth, and ear pain.
As teeth do not have living cells, they do not have cancerous growth. However, various other cancers, such as gum cancer, palate cancer, or cancer of the floor of the buccal cavity, significantly affect tooth health.
Some of the common types of mouth cancer are
It is the most common type of oral cancer, constituting about 80-90% of all oral malignancies. Squamous cells are flat and thin, resembling fish scales.
It is considered a low-grade type of squamous cell carcinoma. It has slow growth due to slow mitotic activity. It has almost no potential to metastasize. However, it can significantly affect the adjacent tissues in the oral cavity.
Minor salivary glands are present in the oral cavity, especially in the palate and aerodigestive tract. Minor salivary gland carcinoma is rare, and mucoepidermoid carcinoma is the most common type of minor salivary gland carcinoma.
Lymphoma of the oral cavity ranks third among the oral cavity cancers, after squamous cell carcinoma and minor salivary gland cancers. Patients with AIDS have a higher risk of developing lymphoma in the oral cavity. Patients with oral cavity lymphoma experience dental pain, swelling, ulcers, and loosening of teeth.
Oral mucosal melanoma is a rare but aggressive cancer that rapidly progresses and metastasizes. It is usually presented as black or brown patches, nodular lesions, or macules.
The stages of Oral Cancer are:
The cancerous cells in this early-stage mouth cancer develop only on the outermost layer of the oral cavity.
In stage 1 mouth cancer, the lesion is not larger than 2 cm and does not spread to nearby structures or lymph nodes.
In stage 2 oral cancer, the lesion is larger than 2 cm but not more than 4 cm and does not spread to nearby structures or lymph nodes.
Stage 3 oral cancer refers to a tumor larger than 4 cm that has spread to the nearby lymph nodes.
Stage 4 oral cancer is metastatic cancer, which spreads to nearby lymph nodes and distant organs like the lungs or liver.
There are several differences between oral cancer and mouth ulcers. Mouth cancer is usually not painful, whereas mouth ulcers are almost always painful. Mouth ulcers heal within 2 to 3 weeks, while oral cancer does not heal and begins to spread gradually.
It is easy to catch oral cancer in its early stages, as the symptoms are easy to notice. One may examine their oral cavity for different signs and symptoms of oral cancer and see a doctor if something is not normal.
Anyone can get oral cancer. However, it most commonly occurs in people over the age of 40. Further, men are at greater risk of getting oral cancer than women. Certain factors increase the risk of oral cancer. These include excessive tobacco use, high alcohol consumption, and frequent exposure to sun radiation. Human papillomavirus (HPV) is also an important risk factor for oral cancer.
Most signs and symptoms of oral cancer overlap with those of other common oral disorders. It is thus important to consult with the doctor if the symptoms persist or worsen. Some of the symptoms of oral cancer are:
Patients with lip cancer develop sores on the lips that do not heal and progressively worsen. Although lip sores may occur anywhere on the upper and lower lips, there is a greater likelihood of developing sores on the lower lip.
Benign oral ulcers generally heal within two weeks. However, oral ulcers due to oral cancer do not heal within two weeks and easily bleed. Further, in most cases, the ulcers due to cancer are not painful at the initial stage. However, the pain develops as the condition progresses.
Patients with oral ulcers also experience white or red patches inside the oral cavity, including the area under the tongue. Cancer of the oral cavity can be caught early if one pays attention to this symptom.
Concerns for red patches are higher than those for white patches; however, both should be evaluated if they do not heal within a few weeks.
Bleeding, especially unexplained bleeding, may also occur in patients with oral cancer. It may be due to tumor invasion, angiogenesis, or damage to the gums.
Loose teeth without any obvious cause may also be one of the symptoms of oral cancer. It may be due to the invasion of the tumor into the base of the teeth. Patients should consult their doctor to rule out oral cancer.
When the cancerous cells divide uncontrollably, they form a tumor or lump. This lump can be felt during a comprehensive oral examination. This is one of the roof of mouth cancer symptoms.
Swelling and tenderness are the signs and symptoms of various oral diseases, including oral cancer.
Patients with oral cancer have trouble chewing for various reasons. These include pain due to sores and the loosening of teeth.
Patients with tongue cancer experience difficulty swallowing food.
Patients with oral cancer also lose weight due to malnutrition and insufficient calorie intake. These patients have difficulty chewing and swallowing food.
Ear pain may also be a symptom of oral cancer. The patients experience fullness in their ears and symptoms resembling trigeminal neuralgia.
Oral malodor also occurs in patients with oral cancer due to nasal obstruction, tissue necrosis, and poor oral hygiene.
Some other symptoms of oral cancer are:
It is a condition characterized by the presence of white patches inside the cheeks, on the tongue, and on the gums. These are also the symptoms of squamous cell carcinoma of the oral cavity. Patients with leukoplakia do not experience pain. However, the condition persists and may develop into oral cancer.
Erythroplakia refers to a precancerous condition of the oral cavity. The presence of lesions on the mucosa of the oral cavity characterizes Erythroplakia. It easily bleeds when scraped.
In some patients with oral cancer, both leukoplakia and erythroplakia exist, and this condition is known as erythroleukoplakia.
Oral cancer risk increases due to various factors. The following are possible mouth cancer reasons:
People often ask, “Can smoking cause mouth cancer?”
Smoking causes mouth cancer and is the most common cause of oral cancer. People who smoke have an increased risk of oral cancer compared to people who do not smoke. Carcinogenic substances present in tobacco cause DNA mutations, resulting in the development of oral cancer.
The tobacco juice from hookah irritates the oral mucosa and may become a possible cause of mouth cancer. Studies have reported that the repair index of the oral mucosa in patients using hookah is significantly lower.
Excessive alcohol consumption is one of the possible reasons for oral cancer.
Exposure to solar radiation may cause lip cancer. Continuous solar radiation on the lips results in disruptive and non-disruptive mutations, causing lip cancer.
People with one or more family members diagnosed with oral cancer may also have a higher risk of developing oral cancer.
Often, it is observed that oral cancer is caused by an HPV infection. HPV alters the normal cellular characteristics of the oral epithelium, which may be one of the reasons for oral cancer.
The following are the oral cancer diagnosis tests:
Patients suspected of having oral cancer undergo a comprehensive examination to find the cause of their symptoms. The medical history, social history, and presence of risk factors are evaluated. The doctors may ask about the development, progression, and severity of symptoms. The doctor may examine the internal mucosa of the oral cavity by touching it with gloved hands to detect the presence of bumps. If the doctor finds anything suspicious about the symptoms, the patients are referred to specialists, such as head and neck cancer specialists. There is no blood test for oral cancer diagnosis.
Scrape biopsy is also known as exfoliative cytology. In this procedure, the doctor scrapes the abnormal area of the oral cavity and collects the cells on a glass slide. The cells are stained for a clear view and examined. If abnormal cells exist, the doctor may advise the patient to undergo a biopsy. The exfoliative cytology test is simple and causes relatively little discomfort. It is one of the important tests recommended for oral cancer diagnosis.
Incisional biopsy involves obtaining a sample of the abnormal tissues through an incision. It is one of the most common methods of performing a biopsy of the oral cavity. The type of procedure (inpatient or outpatient) depends on several factors, such as the location of the tumor and the ease of access to the abnormal cells. The inpatient biopsy (in the operating room) is done under general anesthesia, while the outpatient biopsy can be performed under local anesthesia.
During this examination, the doctor uses a mirror with a thin, long handle to view the base of the tongue, throat, and larynx. The doctor may also shine a light on the mirror to view the throat and a part of the larynx.
Flexible pharyngoscopy and laryngoscopy are performed to view the areas that cannot be assessed with indirect laryngoscopy and pharyngoscopy. The procedure is performed with a pharyngoscope. It is a long tube with a camera at the end to view the deeper areas of the throat. Flexible pharyngoscopy and laryngoscopy also provide a clear view of the areas examined with indirect laryngoscopy and pharyngoscopy.
Endoscopy is the procedure used to examine the throat for the presence of abnormal tissues. The procedure is done through an endoscope, a thin tube with a camera at the end.
Imaging tests are an important part of oral cancer diagnosis. The following oral cancer tests are recommended as part of imaging and cancer staging:
A computed tomography scan determines the size and location of the oral tumor. It involves using X-rays to create clear and detailed images of the oral cavity. CT scans also provide information about the spread of cancer to the lymph nodes or distant organs, such as the lungs.
An MRI provides detailed information about the tumors in the oral cavity. The technique uses radio waves and powerful magnetic fields to develop detailed images. The information related to the tumor provided by MRI includes the extent of tumor spread, lymphadenopathy, and depth of invasion.
PET scan is an advanced imaging technique for staging oral cancers. The technique involves the use of radioactive tracers which comprises a sugar molecular tagged with a radioactive substance. When these tracers are injected, they are rapidly taken up by the cancer cells. Further, this radioactive substances are traced with a specialized device to determine the spread of cancer to other body parts.
Genomic analysis of the tumor cells provides detailed information about the tumor biology and the response of cancer cells to various drugs. Genomic testing of oral cancer cells improves staging and optimizes the choice of therapy for patients with oral cancer.
Some risk factors, such as chewing tobacco and smoking, overlap with oral, esophageal, and lung cancers. In some cases, there is a chance that more than one cancer is present in a patient. To rule out the presence of abnormal tissues in patients suspected of having oral cancer, the doctor may advise a panendoscopy. During this procedure, the doctor may use a laryngoscope, esophagoscope, or bronchoscope to look into the larynx, esophagus, windpipe, and bronchi. Panendoscopy is done to determine the location and size of the tumor and its invasion of nearby tissues.
There are several oral cancer treatment options:
It uses high-energy radiation to kill the cancerous cells. Radiation therapy can be delivered through the following techniques:
EBR is used for oral cancer early-stage treatment when patients are not able to undergo surgical interventions. The technique is also advised when patients have cosmetic concerns because of surgery, especially lip cancer. EBR is recommended along with chemotherapy in patients with advanced disease when surgery is not feasible due to poor health status or comorbidities.
This form of oral cancer treatment is used in patients with early stages of the disease and well-defined tumors. It is also used along with EBR to increase the dose of radiotherapy in areas with high risk. It is a useful option in cases where re-radiation therapy is required.
Oral cancer chemotherapy is a method of treating oral cancer that involves delivering oral cancer medications to kill cancer cells. The delivery of the oral cancer medicines may be done orally or by injection. It is combined with radiation therapy in patients with advanced and unresectable diseases. Chemotherapy may also be combined with surgery and delivered before (neoadjuvant therapy) and after the surgery (adjuvant therapy).
Although combinatorial strategies involving surgery, chemotherapy, and radiation therapy effectively manage oral cancer, treatment-related toxicity due to non-specific cell death causes major problems. Molecularly targeted therapies are an effective way to manage advanced-stage oral cancers with relatively fewer side effects. This form of oral cancer treatment targets specific molecules and cellular pathways that are responsible for the growth of cancer cells. Several receptors are related to oral squamous cell carcinoma through targeted therapy. These include the urokinase-type plasminogen activator receptor, the folate receptor, and Integrin αvβ6.
Immunotherapy is the therapy administered to treat various types of cancer, including oral cancer. Certain mechanisms within the cancer cells allow them to hide from the immune system. Immunotherapy inhibits those processes and allows the immune cells to identify, target, and kill cancer cells. Immunotherapy also strengthens the functioning of the immune system. A study reported that administering immunotherapy before surgery improves long-term outcomes in patients with oral cancer.
Oral cancer surgery is often the first line of oral cancer treatment. Following are the types of oral cancer surgery:
A glossectomy is performed to manage tongue cancer. It involves the partial or complete removal of the tongue. A glossectomy may also be done to remove the premalignant lesions on the tongue.
This procedure is also known as mandibular resection. The procedure removes the tumor or diseased part of the lower jawbone. Mandibulectomy is usually performed in patients with advanced stages of oral cancer.
Maxillectomy removes all or part of the maxillary bone (upper jawbone). It is done to remove both malignant and benign tumors. The process may also involve the removal of the roof of the oral cavity and some teeth.
Neck dissection is a procedure that removes the lymph nodes affected by cancer. The different types of neck dissection surgeries include selective or partial neck dissection, modified radical neck dissection, and radical neck dissection.
Reconstruction surgery is when the surgeon restores the structure, function, and overall appearance of the sites affected during oral cancer surgery. Reconstructive surgery often plays a pivotal role in improving the quality of life for oral cancer patients.
Surgical resection is the primary line of oral cancer treatment. However, mouth cancer treatment without surgery is possible through radiation therapy and chemotherapy in the early stages of cancer for patients who are concerned about their appearance or in the advanced stages when cancer surgery is not possible. These treatments help in the effective management of oral cancer.
HCG is an advanced center for the diagnosis and treatment of oral cancer. The center has all the diagnostic facilities, including CT, PET, and MRI scans. The oral cancer treatment facilities available at HCG are specifically designed with the comfort and well-being of cancer patients in mind. With the advanced technology and clinical expertise available at HCG, we aim to deliver superior-quality diagnostic and treatment support to our patients.
The following are the oropharyngeal cancer risk factors:
Many studies have reported that tobacco causes mouth cancer. A study reported that individuals have a ten-fold enhanced risk of oral cancer from smoking as compared to those who do not smoke. Various mechanisms through which smoking causes oral cancer include oxidative stress, a weakened immune system, and disruptive DNA mutations.
Smokeless tobacco consumption is one of the biggest oral cancer risk factors. Smokeless tobacco contains around 28 cancer-causing substances. Although snuffing and chewing tobacco may not involve inhaling smoke, the oral cavity still encounters harmful and carcinogenic substances, including nicotine. Betel quid-induced oral cancer often begins as white patches in the throat and oral cavity.
The risk of oral cancer with alcohol consumption depends on the amount of alcohol consumed. People with moderate alcohol consumption have a 1.4-fold increased risk of oral cancer, and people with excessive alcohol consumption have a 5-fold increased risk of oral cancer compared to those who do not drink. People who simultaneously smoke and drink have a 30-fold increased risk of oral cancer.
People with a family history of oral cancer have a higher possibility of developing oral cancer at an early age. This increased risk is irrespective of one’s smoking and drinking habits. Certain genetic conditions, such as Fanconi anemia and dyskeratosis congenital, also increase the risk of oral cancer.
Excessive sun exposure increases the risk of oral cancer. The most commonly affected area is the lips. People with outdoor jobs and prolonged sun exposure are at increased risk of lip cancer.
HPV infection increases the risk of oral cancer. The most common type of HPV linked to oral cancer is the HPV type 16 infection of the base of the tongue and tonsils.
Increasing age is one of the most important oral cancer risk factors. Oral cancers usually take several years to develop. Thus, they are not common among people of younger ages. In most cases, oral cancer is diagnosed in people over the age of 55. However, patients with HPV infection may also develop oral cancer below the age of 55. The age-related risk of mouth cancer should not be ignored.
Men are twice as likely to develop oral cancer as women. This is because several risk factors are more prevalent in males than females. These include alcohol consumption, HPV infection, smoking, and chewing tobacco.
In people with poor hygiene, the bacteria grow and accumulate in the oral cavity, altering cellular characteristics. It increases the risk of oral cancer.
Studies have reported that reduced fruit and vegetable consumption is linked to an increased risk of oral cancer. Thus, people living in geographic areas with malnutrition have a higher risk of oral cancer.
The immune system targets abnormal cells in the body and prevents cancer development. Those with a compromised immune system are at increased risk of developing oral cancer.
The following are the most important oral cancer prevention measures:
One of the important strategies for primary prevention of oral cancer is quitting chewing or smoking tobacco, especially in people with simultaneous alcohol consumption. Even if the patient has been consuming tobacco for years, quitting lowers the risk of oral cancer.
Limiting the consumption of alcohol helps increase the chances of oral cancer prevention. Studies have reported that people who have not drunk for ten years but were previously consuming alcohol have a similar risk of oral cancer to people who have never consumed alcohol.
Limiting exposure to solar radiation increases the chances of oral cancer prevention, especially lip cancer. Use sunscreen and lip balm with an appropriate sun protection factor (SPF) of 30 or above to avoid the harmful effects of radiation.
Erythroplakia and leukoplakia are pre-malignant conditions and should be regularly monitored. Further, maintaining good oral hygiene lowers the risk of oral cancer. Regular dental checkups can help catch oral cancer in its early stages, when it is best treated.
HPV is one of the most common causes of oral cancer. It is important to prevent the occurrence of HPV infection by receiving the HPV vaccine.
Self-examining the oral cavity is important to detect cancer early or prevent oral cancer. People should consult the doctor if they see black or white patches, ulcers that do not heal, or a lump in the oral cavity.
There are several causes of oral cancer, such as smoking and chewing tobacco, family history, alcohol consumption, HPV infection, and poor oral hygiene. The vaccine for HPV helps reduce the risk of HPV-associated oral cancers. Thus, the HPV vaccine, which is also sometimes called the oral cancer vaccine, may reduce the risk of oral cancer.
The risk factors for squamous cell carcinoma and other oral cancers include smoking, chewing tobacco, alcohol consumption, family history, poor oral hygiene, a poor diet, a compromised immune system, and family history. The measures to prevent oral cancers are quitting smoking, limiting alcohol consumption, self-examination, dental checkups, and reducing solar exposure.
