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Oral cancer or mouth cancer comprises multiple different types of tumors affecting various regions around the oral cavity. Research by the National Institutes of Health – National Institute of Dental and Craniofacial Research has shown that 10.5 per 100,000 adults will develop oral cancer. It occurs more frequently in men and increases n incidence with age.

Sites of oral cancer

  • Lip
  • Tongue
  • Buccal mucosa or the inner lining of the teeth
  • Gums
  • Roof and floor of the mouth
  • Throat
  • Larynxor voice box

Risk factors for oral cancer

Symptoms of oral cancer

The symptoms vary depending on the site of the cancer. The primary tumor may go unnoticed if small. The following are frequently encountered symptoms

  • Non healing ulcer in the oral cavity
  • Pain
  • Discomfort or pain while swallowing
  • Hoarseness
  • Otalgia or ear pain, this can occur from spread of the tumor towards the ear canal
  • Neck swellings, due to enlarged lymph nodes in the neck
  • Weight loss can occur with extensive spread of the cancer

Evaluation of oral cancer

The diagnosis of an oral cancer may be suspected from the symptoms after correlating with risk factors. The following steps will be taken to aid diagnosis:

  • Physical exam: A complete examination of the face, oral cavity, ears  and neck will be done. Indirect laryngoscopy using a mirror is done to view the back of the throat and the vocal cords.
  • Direct flexible laryngoscopy: A tube with a camera and light source is inserted into the mouth and voice box to visualise the back of the throat down to the vocal cords.
  • Imaging: A CT scan, MRI, PET or a combination  is done to look at local spread of the tumor in addition to looking for spread through the body.
  • Biopsy: A fine needle aspiration biopsy (FNA) is done to confirm and determine the type of tumor. Biopsy of enlarged neck nodes is helpful to determine local spread.

The findings from the exam and lab tests allow for accurate staging of the cancer.

Management of oral cancer

The approach to management depends on the stage of the cancer. A multidisciplinary approach is helpful with involvement of the Ear Nose Throat (ENT) specialist, Oncologist, Onco-surgeon and Radiation oncologist. The major modalities of treatment are as follows:

  • Surgery: surgical removal of the tumor is done in all cancers that have not metastasised (spread through the body) extensively. This may be curative in small, limited tumors. A resection of the neck nodes is also done.
  • Radiation Therapy (RT): These can be used alone for small tumors, and is often used post surgery in locally advanced tumors.
  • Chemotherapy: Chemotherapy with medications may be added to a treatment plan after surgery along with RT

In cancers that are not amenable to be resected, a combination of RT and chemotherapy alone may be given, This is however palliative and is only done to improve on local symptoms.

Prognosis of Oral Cancer

Oral cancers that are picked up early are often cured by surgery alone or combined with RT. All patients who have undergone surgery are followed up intensely in the first 2-4 years when during which recurrence rates are high.

The side effects of the surgery, RT and chemotherapy also need to be managed appropriately. In advanced tumor, rehabilitation is required to attain normal function of the mouth after extensive surgery. 

References

  •  Gloeckler Ries LA, Miller BA, Hankey BF, Kosary CL, Harras A, Edwards BK, eds. SEER cancer statistics review, 1973-1991. Bethesda, Md: US Department of Health and Human Services, Public Health Service, National Cancer Institute, 1994. Report no. NIH-94-2789.
  • Rivera C. Essentials of oral cancer. International Journal of Clinical and Experimental Pathology. 2015;8(9):11884.
  • Licitra L, Bernier J, Grandi C, Merlano M, Bruzzi P, Lefebvre J-L. Cancer of the oropharynx. Crit Rev Oncol Hematol. 2002 Jan;41(1):107–22.
  • More Y, D’Cruz AK. Oral cancer: review of current management strategies. Natl Med J India. 2013 Jun;26(3):152–8.

Oral cancer, Dentistry


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