What is oral cancer?

Cancers of the oral cavity and oropharynx begin in the mouth or throat. Knowing what to expect if you have one of these malignancies or are close to someone who does can help you manage. You may learn about oral cavity and oropharyngeal cancers, including risk factors, symptoms, how they’re detected, and how they’re treated, by visiting this page.

The lips, buccal mucosa (the inside lining of the lips and cheeks), teeth, gums, the front two-thirds of the tongue, the floor of the mouth below the tongue, the bony roof of the mouth (hard palate), and the area behind the wisdom teeth are all part of the oral cavity (called the retromolar trigone).

The oropharynx, located behind the oral cavity, is the central section of the throat. When your mouth is open wide, it is visible. The soft palate (the back section of the roof of the mouth), the tonsils, and the side and back walls of the throat make up the base of the tongue (the back third of the tongue).

The oropharynx and oral cavity assist you in breathing, talking, eating, chewing, and swallowing. Saliva (spit) is produced by minor salivary glands throughout the oral cavity and oropharynx, which keeps your mouth and throat wet and aids digestion.

Types of oral cancer

Many different types of cells make up the various sections of the mouth cavity and oropharynx. Each sort of cell has the potential to start cancer. These distinctions are significant because they can affect a patient’s treatment options and prognosis.

Squamous cell carcinoma of the oral cavity and oropharynx

Squamous cell carcinomas, commonly known as squamous cell cancers, account for nearly all malignancies in the oral cavity and oropharynx. Squamous cells, which are flat, thin cells that line the mouth and throat, are where these malignancies begin.

Carcinoma in situ is the earliest form of squamous cell cancer. This signifies that the cancer cells are exclusively found in the epithelium, a layer of cells (the top layer of cells lining the oral cavity and oropharynx). Invasive squamous cell cancer, on the other hand, occurs when cancer cells migrate past the epithelium and into the deeper layers of the oral cavity or oropharynx.

Most squamous cell malignancies of the oropharynx are caused by infection with particular high-risk strains of the human papillomavirus (HPV) (called HPV-positive cancer). Oral cavity cancer is quite infrequently linked to HPV. HPV-positive malignancies are more common in young persons who have never smoked or drank alcohol. These malignancies have a better prognosis (prognosis) than squamous cell cancers that aren’t caused by HPV (HPV-negative cancer). This is most likely due to the fact that when HPV-positive tumours are treated with chemotherapy and radiation, they decrease.

Verrucous carcinoma is a rare squamous cell cancer that mostly affects the mouth and cheeks. It’s a low-grade cancer (one that grows slowly) that rarely spreads to other parts of the body.

Salivary gland cancers

These malignancies can begin in the glands of the mouth and throat lining. Adenoid cystic carcinoma, mucoepidermoid carcinoma, and polymorphous low-grade adenocarcinoma are all examples of small salivary gland malignancies. To understand more about these cancers, as well as benign salivary gland tumours, please visit our website.

Lymphomas

The tonsils and base of the tongue contain immune system (lymphoid) tissue, where cancers called lymphomas can start. For more information about these cancers, see Non-Hodgkin Lymphoma and Non-Hodgkin Lymphoma in Children.

Benign tumors

Many types of benign tumors and tumor-like changes can start in the mouth or throat, such as these:

• Peripheral giant cell granuloma
• Fibroma
• Granular cell tumor
• Schwannoma
• Neurofibroma
• Pyogenic granuloma
• Oral hemangioma

These non-cancer tumors start from different kinds of cells and have many causes. Some of them may cause problems, but they’re not likely to be life-threatening. The usual treatment for these types of tumors is surgery to remove them completely since they are unlikely to recur (come back).

Risk factors of oral cancer

Understanding the variables that cause cancer will help in the prevention of the disease. Oral cancer has historically been associated with those over the age of 40, therefore age is commonly mentioned as a risk factor. The age of individuals diagnosed with cancer could imply a temporal component in the biochemical or biophysical processes of ageing cells that allows malignant transformation, or it could show that immune system competence declines with age. Recent data (late 2008-2011) lead us to conclude that non-smokers under the age of fifty are the fastest-growing segment of the oral cancer population, indicating a paradigm shift in the disease’s origin and the sites where it most frequently arises in the oral environment. Smoking-related cancers in the anterior of the mouth, tobacco-related cancers, and alcohol-related cancers have all decreased, but the posterior of the oral cavity sites connected with the HPV16 viral cause have increased. As a result, many people refer to these two very different malignancies (oral and oropharyngeal) as “oral cancer” when speaking to the general public, which is technically incorrect but regarded typical in general public messaging.

However, rather than immune system frailties or age, it’s more likely that cumulative harm from other factors like tobacco use, alcohol intake, and chronic viral infections like HPV are the main reasons. For example, the development of cancer may require several decades of smoking. Tobacco use in any form, however, is the leading cause of genuine oral cavity cancer in people over 50. Tobacco smokers account for at least 75 percent of individuals diagnosed at 50 and older in the past. This ratio is shifting, and specific percentages have yet to be determined and released, since fresh data relating to a reduction in cigarette use is rapidly changing the dynamic. Because cigarettes and alcohol act synergistically, your risk is considerably raised when you combine the two. Those who smoke and drink have a 15-fold higher risk of acquiring mouth cancer than those who do not. The HPV16 viral aetiology does not appear to require tobacco or alcohol to function synergistically, and HPV16 represents a fully distinct and independent disease process in the oropharynx.

Tobacco and alcohol are primarily chemical variables, but because we have some control over them, they can also be considered lifestyle issues. Aside from them, there are physical variables such as ultraviolet light exposure. Lip cancers, as well as other skin malignancies, are caused by this substance. Lip cancer is one type of oral cancer that has decreased in prevalence over the previous few decades. This is most likely due to improved awareness of the harmful effects of prolonged sun exposure and the usage of sunscreens to defend against it. Another physical factor is x-ray exposure. Radiographs were routinely obtained during examinations, and they are safe in the dental office, but keep in mind that radiation exposure builds up over time. It’s been linked to a number of head and neck cancers.

Biological factors include viruses and fungus, which have been linked to oral malignancies in the past. The human papillomavirus, particularly HPV16, has been definitively implicated in oropharyngeal cancers (Oropharynx, base of tongue, tonsillar pillars, and crypt, as well as the tonsils themselves. ), but only in a small population of people have they been implicated in oral cancers in the anterior of the mouth. HPV is a sexually transmitted virus that affects roughly 40 million people in the United States today. HPV comes in 200 different strains, the majority of which are regarded to be safe. Most Americans will be infected with HPV at some point in their lives, and some will even be exposed to oncogenic / cancer-causing strains. However, only about 1% of people infected have an immune response to the HPV16 strain, which is the leading cause of cervical cancer (together with HPV18), anus and penis cancers, and is now also a known cause of oropharyngeal cancer. As a result, we want to be clear. Even if you’re infected with a high-risk HPV virus, it doesn’t indicate you’ll get mouth cancer. The majority of people’s immune systems will remove the infection before a cancer develops. Changes in young adults’ sexual habits throughout the previous few decades, and which are still occurring now, are likely increasing the transmission of HPV and its carcinogenic variants. Other minor risk factors have been linked to oral malignancies but have yet to be firmly proven to play a role in their progression. Lichen planus, an inflammatory condition of the oral soft tissues, and genetic predispositions are examples of this.

Symptoms of oral cancer

One of the great hazards of this cancer is that it can go unnoticed in its early stages. It may be painless, and there may be few visible bodily changes. The good news is that, in many situations, your doctor or dentist can detect or feel the precursor tissue changes, or real cancer, when it is still very little or in its early stages. It can take the form of a white or red spot of tissue in the mouth, or a small indurated ulcer that resembles a canker sore. Because there are so many benign tissue changes that occur naturally in your mouth, and because something as simple as a bite on the inside of your cheek can mimic the appearance of a dangerous tissue change, it is critical to have any sore or discoloured area of your mouth examined by a professional if it does not heal within 14 days. Other signs and symptoms include a painless lump or mass inside the mouth or neck, pain or trouble eating, speaking, or chewing, any wart-like lumps, persistent hoarseness, or numbness in the oral/facial region. A chronic earache on one side can also be a warning indication.

The tongue and the floor of the mouth are common sites for oral cancer to grow at the front (front) of the mouth, aside from the lips, which are no longer a prominent site for occurrence. Chewing tobacco users are more likely to develop them in the sulcus between the lip or cheek and the soft tissue (gingiva) surrounding the lower jaw (mandible), where the tobacco plug is frequently held. A tiny number of malignancies specific to the salivary glands exist, as well as the extremely hazardous melanoma. While their frequency is dwarfed by the other oral malignancies, they account for a modest percentage of the overall incidence rate. Hard palate cancers are uncommon in the United States, but they are not unknown. Other areas where it is now more regularly observed, particularly in young non-smokers, include the base of the tongue at the rear of the mouth, the oropharynx (back of the throat) and on the pillars of the tonsils, as well as the tonsillar crypt and the tonsil itself. If your dentist or doctor suspects a questionable spot, the only way to be sure it’s not something dangerous is to perform a biopsy. This is not a painful procedure, it is affordable, and it takes only a few minutes. It’s critical to have a definitive diagnosis as soon as possible. It’s conceivable that your general dentist or medical doctor will send you to a specialist for the biopsy. This is not a cause for concern, but rather a typical component of the referral process that occurs between doctors of various disciplines.

Signs and symptoms of mouth cancer may include:

• A lip or mouth sore that doesn’t heal
• A white or reddish patch on the inside of your mouth
• Loose teeth
• A growth or lump inside your mouth
• Mouth pain
• Ear pain
• Difficult or painful swallowing

Diagnosis of oral cancer

Tests and procedures used to diagnose mouth cancer include:

• Physical exam. Your doctor or dentist will examine your lips and mouth to look for abnormalities — areas of irritation, such as sores and white patches (leukoplakia).

Removal of tissue for testing (biopsy). If a suspicious area is found, your doctor or dentist may remove a sample of cells for laboratory testing in a procedure called a biopsy. The doctor might use a cutting tool to cut away a sample of tissue or use a needle to remove a sample. In the laboratory, the cells are analyzed for cancer or precancerous changes that indicate a risk of future cancer.

Once mouth cancer is diagnosed, your doctor works to determine the extent (stage) of your cancer. Mouth cancer staging tests may include:

• Using a small camera to inspect your throat. During a procedure called endoscopy, your doctor may pass a small, flexible camera equipped with a light down your throat to look for signs that cancer has spread beyond your mouth.
• Imaging tests. A variety of imaging tests may help determine whether cancer has spread beyond your mouth. Imaging tests may include X-ray, CT, MRI and positron emission tomography (PET) scans, among others. Not everyone needs each test. Your doctor will determine which tests are appropriate based on your condition.

Mouth cancer stages are indicated using Roman numerals I through IV. A lower stage, such as stage I, indicates a smaller cancer confined to one area. A higher stage, such as stage IV, indicates a larger cancer, or that cancer has spread to other areas of the head or neck or to other areas of the body. Your cancer’s stage helps your doctor determine your treatment options.

Treatment of oral cancer

Treatment for mouth cancer is determined by the location and stage of the tumour, as well as your overall health and preferences. You may receive only one form of cancer treatment or a combination of cancer treatments. Surgery, radiation, and chemotherapy are all choices for treatment. Consult your doctor about your options.

Surgery

Mouth cancer surgery may comprise the following procedures:

Tumor removal surgery: To verify that all cancer cells have been eliminated, your surgeon may cut away the tumour and a margin of healthy tissue surrounding it. Minor surgery can be used to eliminate smaller malignancies. Larger tumours may necessitate more intensive surgery. A larger tumour, for example, may necessitate the removal of a bit of your jawbone or a portion of your tongue.

Surgery to remove cancer from the neck that has spread: Your surgeon may propose removing lymph nodes and related tissue in your neck if cancer cells have progressed to the lymph nodes in your neck or if there’s a significant danger of this happening due to the size or depth of your malignancy (neck dissection). Any cancer cells that have migrated to your lymph nodes are removed during a neck dissection. It can also help you figure out if you’ll need any more therapy after surgery.

Mouth reconstruction surgery: After your cancer has been removed, your surgeon may offer reconstructive surgery to restore your mouth so you can speak and eat again. To reconstruct your mouth, your surgeon may use skin, muscle, or bone transplants from other regions of your body. Dental implants can also be used to replace missing teeth.
Surgical procedures might result in bleeding and infection. The appearance of oral cancer surgery, as well as your ability to speak, eat, and swallow, might all be affected.

To help you eat, drink, and take medicine, you may require a tube. The tube can be put through your nose and into your stomach for short-term use. A tube may be put through your skin and into your stomach in the long run.

Your doctor may send you to a specialist who can assist you in adjusting to the changes.

Radiation therapy

To kill cancer cells, radiation therapy uses high-energy beams such as X-rays and protons. Radiation therapy is usually given by a machine outside your body (external beam radiation), but it can also be given by radioactive seeds and wires inserted near the cancer (brachytherapy).

Following surgery, radiation therapy is frequently employed. However, if you have early-stage oral cancer, it may be used alone. In some cases, radiation therapy and chemotherapy may be used together. This combination improves the efficiency of radiation therapy while simultaneously increasing the risk of negative effects. Radiation therapy may help reduce cancer-related signs and symptoms, such as discomfort, in advanced mouth cancer instances.

Dry mouth, tooth decay, and jawbone deterioration are all possible side effects of oral radiation therapy.

Before starting radiation therapy, your doctor would recommend that you see a dentist to ensure that your teeth are as healthy as possible. Any teeth that are unhealthy may need to be treated or removed. A dentist can also advise you on how to care for your teeth during and after radiation therapy to minimise the chance of issues.

Chemotherapy

Chemotherapy is a cancer-killing treatment that employs chemicals. Chemotherapy medications can be used alone, with other chemotherapy agents, or with other cancer treatments. Chemotherapy has been shown to improve the efficiency of radiation therapy, hence the two are frequently used together.

Chemotherapy side effects vary depending on the medications used. Nausea, vomiting, and hair loss are all common adverse effects. Inquire with your doctor about the possible adverse effects of the chemotherapy drugs you’ll be given.

Targeted therapy 

Drugs that target specific characteristics of cancer cells that feed their proliferation are used to treat oral cancer. Targeted medications can be used alone or in conjunction with chemotherapy or radiation therapy to achieve the best results.

In some cases, cetuximab (Erbitux) is a targeted therapy used to treat oral cancer. Cetuximab inhibits the action of a protein that is found in a variety of healthy cells but is more prominent in cancer cells. Skin rashes, itching, headaches, diarrhoea, and infections are all possible side effects.

If normal therapies aren’t working, other targeted medications may be a possibility.

Immunotherapy

Immunotherapy is a type of cancer treatment that makes use of your immune system. Because cancer cells create proteins that blind immune system cells, your body’s disease-fighting immune system may not attack your cancer. Immunotherapy works by interfering with the immune system’s natural processes.

Immunotherapy is often reserved for those with advanced oral cancer who have failed to respond to traditional treatments.