Oral Cancer. Part 1

Oral cancer is diagnosed in over 30,000 people each year, and over 7,500 people will die of this disease yearly, according to the American Cancer Society. The following is an overview of risk factors, symptoms, diagnosis, treatment, and other facets of the disease.

Men are 2-4 times more likely to develop oral cancer than women, and African-Americans are more prone to the disease than Caucasians. More than 90 percent of oral cancers occur in people over age 45, with the incidence increasing steadily until age 65, when the rate levels off.

Oral cancer involves the oral cavity and the oropharynx.

The oral cavity consists of:

* the lips, teeth, and gums
* the lining inside the lips and cheeks (buccal mucosa)
* the bottom of the mouth under the tongue
* the front two-thirds of the tongue
* the hard palate (bony top of the mouth)
* the small area behind the wisdom teeth

The oropharynx consists of:

* the back one-third of the tongue
* the soft palate
* the tonsils
* the back of the throat

The main causes of oral cancer include:

* Tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff
* Alcohol use, especially when combined with cigarette smoking
* Leukoplakia – a whitish patch that forms inside the mouth or throat
* Erythroplakia – a red, raised patch that forms inside the mouth
* Too much sun exposure can cause cancer on the lip
* Chewing of betel nuts

Symptoms

The warning signs of oral cancer can include:

* A growing mass that may be painful or painless
* An ulcer that does not heal
* A continuing sore throat
* Difficulty swallowing
* Bleeding or numbness
* Loose teeth or dentures
* Foul mouth odor
* Changes in hearing, smell, or taste
* Difficulty speaking or changes in voice
* Facial weakness or pain
* Decreased saliva
* Painful, enlarged lymph node in the neck

Cancer or some other, less serious problem may cause these symptoms. Pain is not usually an early symptom of oral cancer. If any of these symptoms lasts more than 2 weeks, you should see a physician or dentist immediately.

Diagnosis

Regular dental checkups are important to detect cancerous or precancerous conditions early. Looking in the mirror and checking your mouth every month also helps detect any changes early.

If an abnormal area is found, an oral surgeon or ear, nose, and throat surgeon will remove all or part of the mass (biopsy). Almost all oral cancers are squamous cell carcinomas because squamous cells line the oral cavity. If cancer is found, then further tests, such as x-ray, CT (or CAT) scan, ultrasonography, and/or MRI, may also be done to determine the spread of the cancer.

Treatment

The type of treatment used is based on the patient’s overall health and medical history, the stage of disease, the patient’s preference, and how the disease is expected to proceed.

Early cancers (stages I and II) are highly curable by surgery or radiation therapy, while more advanced cancers (stages III and IV) are usually treated with a combination of surgery, radiation therapy, and sometimes other experimental therapy.

Surgery may include one or more of the following techniques:

* Primary tumor resection – the entire tumor and surrounding tissue are removed
* Maxillectomy – The tumor and part or all of the hard palate are removed, if bone is involved
* Mohs’ micrographic surgery – the tumor is removed in “slices” so that very little normal tissue is removed
* Laryngectomy – A large tumor of the tongue or oropharynx is removed, which may also include the larynx (voice box)
* Neck dissection – The lymph nodes are removed along with the main tumor

Radiation therapy may be administered externally using a machine or internally with radioactive materials. Radiation may be given before surgery (to shrink the tumor) or after surgery (to destroy any remaining cancer cells).

According to the National Cancer Institute, patients who smoke while undergoing radiation therapy do not respond as well to treatment and do not live as long as patients who do not smoke.

Some experimental treatments being studied include chemotherapy (drugs used to treat cancer), radiosensitizers (drugs used to make the tumor more sensitive to radiation), and hyperthermia (heat treatment).
to be continued soon…