What are the early stages of mouth cancer look like

Introduction

Mouth cancer is predominantly known as a disease of poor people. It is the 11th most common cancer in the world. This cancer includes cancers of the lip, tongue, gum, floor of the mouth, and palate. These cancers are known as squamous cell carcinoma (OSCC) because 90% of cancers originate in the squamous cells

Statistics

This cancer is 2 to 3 times more common in men than women. India alone accounts for 1/5th of all mouth cancer cases and 1/4th of all mouth cancer deaths

Pathophysiology

This cancer begins with the uncontrolled growth of normal cells. This increased growth of cells causing cell death was mainly because of the exposure to cancer-causing substances (alcohol, smoking, etc)

Etiology

Tobacco usage and excessive alcohol use are the major risk factors for this cancer. These factors cause more than 90% of mouth cancers. Smokeless and smoking forms of tobacco equally predispose to cancer occurrence.

1. Smokeless tobacco

Betel quid, oral snuff, gutkha, nass, naswar, khaini, mawa, mishri, and gudakhu

2. Smoking tobacco

Cigarettes, bidis, hookah, chutta, chillum

3. Areca Nut Chewing

Areca nut or betel nut wrapped in betel leaf is cancerous. It is chewed raw, dried, or roasted, or as part of betel quid, by millions of people in Asia. Cheap areca nut products, such as pan masala are increasing eaten by the teenagers.

4. Alcohol Use

Drinking alcoholic beverages increases the risk of this cancer by 2 to 6 fold. When alcohol and tobacco both are consumed by the individual it further increases this risk.

5. Poor Nutrition

Frequent dietary intake of fruits and vegetables is associated with a 40-50% reduction in the risk of this cancer

6. Viruses

Human papillomavirus infection (HPV) infection is another risk factor for this cancer.

7. Chronic Trauma

Chronic trauma, from sharp teeth, restorations, or dentures also increases the risk

Clinical features

The cheek mucosa is the most common site for this cancer followed by the tongue. Some of the frequently observed signs and symptoms include

  • Pain (persistent mouth pain)

  • Lump or thickening in the cheek region

  • Soreness of the mouth and throat

  • Whitish or red patch on the gums, tongue, tonsil, lining of the mouth

  • Difficulty chewing

  • Numbness of the mouth

  • Loosening teeth

  • Persistent bad breath

Oral Cancer diagnosis

Diagnosis of this condition involves evaluating the spread of disease by physical examination, biopsy, and imaging techniques like

1. X-rays of the lower jaw bone, maxillary sinuses, and chest

2. Computerized tomography (CT) scans

3. Magnetic resonance imaging (MRI)

4. Positron emission tomography (PET)

Highly developed techniques such as CT, PET, and MRI helps in knowing how much the cancer has spread to the healthy tissues like muscles, bone, and lymph node. This furthermore helps in planning the treatment accordingly.

Management

Early mouth cancer (Stage I and II)

Radiation and surgery are used for treating early cancers. The choice of therapy depends on where tumor is situated, is it affecting the aesthetics of the person, patients age and which therapy he prefers

Most of the initial cancers are surgically removed or cells are killed using radiation therapy. Removal of the lymph nodes is done in some patients with stage I (tongue cancer) and stage II cancers.

External beam radiation and brachytherapy are the other treatment methods

New procedures like conformal and intensity radiotherapy decrease the side effects of radiation. These techniques deliver radiation only to the tumor while causing no damage to the healthy tissues.

Advanced Tumors (Stage 3 and 4)

A combined approach involving surgery, radiotherapy, and chemotherapy is done for advanced tumors of the mouth.

Radiation along with chemotherapy or without chemotherapy is done for advanced tumors without bone involvement. Surgery followed by radiation is done for deep tumors.

Prevention

Preventing tobacco and alcohol use and increasing the consumption of fruits and vegetables can prevent a vast majority of mouth cancers. Visiting your dentist regularly and self-examination using a mirror for early signs improves survival (prolongs life) in these patients.

References

1. Kademani D. Oral cancer. InMayo Clinic Proceedings 2007 Jul 1 (Vol. 82, No. 7, pp. 878-887). Elsevier.

2. Sankaranarayanan R, Ramadas K, Amarasinghe H, Subramanian S, Johnson N. Oral cancer: prevention, early detection, and treatment. DISEASE CONTROL PRIORITIES• THIRD EDITION. 2015 Nov 1:85.

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