Introduction:
Oral cancer results in more deaths nationwide than melanoma, leukaemia or cervical cancer. 8 new cases are identified in Ireland every week and most are detected through examinations by dentists so it is important to regularly attend your dentist who will screen for oral cancer as part of their examination.
Mouth cancer may originate anywhere in the mouth, and various types exist: e.g. adenocarcinoma derived from a salivary gland, lymphoma from tonsillar or lymphoid tissue, or even melanoma from the pigment producing cells of the oral tissues.
While several types exist, about 90% of oral cancers are known as squamous cell carcinomas, originating in the tissues that line the mouth and lips. Oral cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gums, lips, or palate. Most oral cancers look very similar under the microscope and are called squamous cell carcinoma. These are malignant and tend to spread rapidly.
Signs & Symptoms
- Skin lesion, lump, or ulcer:
- On the tongue, lip, or other mouth area
- Usually small
- Most often pale colored, may be dark or discolored
- Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth
- Usually painless initially
- May develop a burning sensation or pain when the tumor is advanced
Additional symptoms that may be associated with this disease:
- Tongue problems
- Swallowing difficulty
- Mouth sores that do not resolve in 14 days
- Pain and paraesthesia are late symptoms.
Causes of Mouth Cancer
The exact cause is often unknown. Regardless of the cause, treatment is the same surgery, radiation with or without chemotherapy. Risk factors that predispose a person to oral cancer have been identified in studies. India, being a member of the International Cancer Genome Consortium, is leading efforts to map oral cancer’s complete genome.
In many Asian cultures chewing betel, paan and Areca is known to be a strong risk factor for developing oral cancer. In India where such practices are common, oral cancer represents up to 40% of all cancers, compared to just 4% here in Ireland and the UK.
Some oral cancers begin as a ‘white patch’ (leukoplakia), ‘red patch(es)’ (erythroplakia) or non healing sores that have existed for more than a fortnight. In the USA, oral cancer accounts for about 8% of all malignant growths. Men are affected twice as often as women, particularly men older than 40-60.
Tobacco
Smoking and other tobacco use are associated with about 75% of oral cancer cases, caused by irritation of the mucous membranes of the mouth from smoke and heat of cigarettes, cigars and pipes. Tobacco contains over 60 known carcinogens, and the combustion of it, and by products from this process, is the primary mode of involvement. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes.
Alcohol
Alcohol is another high-risk factor associated with oral cancer. There is known to be a strong synergistic effect on oral cancer risk when a person is both a heavy smoker and drinker. Their risk is greatly increased compared to a heavy smoker, or a heavy drinker alone. Recent studies in Australia, Brazil and Germany point to alcohol-containing mouthwashes as also being etiologic agents in the oral cancer risk family.
Management
Surgery to remove the tumour is usually recommended if the growth is small enough, and if surgery is likely to result in a functionally satisfactory result. Radiation therapy with or without chemo is often used in conjunction with surgery, or as the definitive radical treatment, especially if the tumour is inoperable.
Survival rates for oral cancer depend on the location of the cancer, and the stage of the cancer at diagnosis. Overall, survival is around 50% at five years when all stages of initial diagnosis are considered. Survival rates for stage 1 cancers are 90%, hence the emphasis on early detection to increase survival outcome for patients.
Treatment of oral cancer will usually be by a multidisciplinary team, with treatment professionals from the realms of radiation, surgery, chemotherapy, nutrition, dental professionals, and even psychology all possibly involved with diagnosis, treatment, rehabilitation, and patient care.
