Oral Cancer

Overview

Oral cancer or Mouth cancer is a type of cancer that occurs in any part of the oral cavity. This includes the gums, tongue, lips, roof of the mouth, inner lining of the cheeks, and the floor of the mouth (beneath the tongue). Oral cancer is most commonly diagnosed in people over 40 and affects men more than twice as often as women. The primary risk factors include tobacco use, excessive alcohol consumption, or a combination of both. Most throat cancers have also a link to the human papillomavirus (HPV).

What is Oral Cancer?

Oral cancer, or mouth cancer, is cancer that develops in the tissues inside the mouth. It may initially resemble common issues, such as white patches or sores on the lips or inside the mouth. However, unlike ordinary mouth issues, these changes remain for an extended period and do not heal over time. Delays in the treatment of oral cancer can lead to their spread beyond the mouth and throat to other areas in the head and neck. Early detection is key, as oral cancer is much easier to treat in its early stages. Recognising unusual or persistent changes in the mouth can make a significant difference.

Types of Oral Cancer

Oral cancers are classified by the area they affect and the types of cells involved:

Squamous Cell Carcinoma: It is the most common type of oral cancer, oral squamous cell carcinoma (OSCC) is a malignant tumour in the squamous epithelial cells of the oral cavity. It can develop on the gums, tongue, lips, and the floor of the mouth.

Verrucous Carcinoma: It is a rare but highly treatable cancer found in the oral cavity. It can also be occasionally found on the genitals or feet. It is most common in people who smoke, chew tobacco or consume excessive alcohol. Symptoms of this cancer often include persistent mouth sores.

Minor Salivary Gland Carcinomas: While most salivary gland tumours are benign, malignant salivary gland cancers are rare, making up less than 5% of head and neck cancers. These tumours vary widely in their behaviour and characteristics.

Lymphoma: Oral cancers developing in lymph tissue, a part of the immune system, otherwise known as lymphomas. Lymphoid tissue in the mouth is primarily located in the tonsils and the tongue’s base.

Mucosal Melanoma: Mucosal melanoma is a rare, aggressive cancer that originates in the mucosa, or mucous membrane. By the time of the diagnosis, mucosal melanoma has often spread (metastasised).

Symptoms of Oral Cancer

Oral cancer symptoms can appear in various parts of the mouth, including the gums, tongue, inner cheeks, and lips. Common signs include a sore on the lip or inside the mouth that doesn't heal, a lump or thickened area in the mouth or throat, and white, red, or speckled patches in the mouth.

Unexplained bleeding, pain, or numbness in the mouth or throat may also occur, as well as a chronic sore throat or the sensation of something caught in the back of the throat. Difficulty with chewing, swallowing, speaking, or moving the jaw or tongue can be another warning sign, along with hoarseness or changes in voice.

Additional symptoms include ear pain, swelling, pain, or stiffness in the jaw, and a lump in the neck. Changes in the way teeth fit together, loose teeth, or discomfort with dentures are also possible indicators. Other symptoms may involve sudden weight loss and persistent bad breath. Recognising these symptoms early can be critical for timely diagnosis and treatment.

Oral Cancer Causes

Oral cancer develops from genetic mutations in cells within the mouth, but several factors can increase their risk of occurrence:

Tobacco and Alcohol Use: Any form of tobacco, including cigarettes, chewing tobacco, cigars, pipes, electronic cigarettes, and snuff, raises the risk of oral cancer. Other than that, heavy alcohol consumption further increases this risk, and using both tobacco and alcohol amplifies the likelihood even more.

HPV Infection: Infection with human papillomavirus (HPV), particularly HPV type 16, is strongly linked to oral cancers. The transmission of this virus is commonly through sexual contact.

Age: The risk of oral cancer increases with age, most frequently affecting individuals who are over the age of 40.

Sun Exposure: Frequent sun exposure is a known cause of lip cancer, highlighting the importance of lip protection.

Poor Nutrition: Diets low in fruits and vegetables are associated with an elevated risk of developing oral cancer.

Genetics: Genetic predispositions, such as inherited mutations in specific genes, can significantly increase the likelihood of mouth and middle throat cancers.

Diagnosis of Oral Cancer

For oral cancer diagnosis, doctors may use the following tests and procedures:

Physical Exam: A doctor or dentist will carefully examine the lips and mouth to check for abnormalities, including areas of irritation, sores, or white patches (leukoplakia).

Biopsy (Removal of Tissue for Testing): If a suspicious area is detected, a biopsy may be performed to remove a sample of cells for laboratory analysis. During a biopsy, the doctor may use a cutting tool to extract a tissue sample or a needle to collect cells. In the lab, these cells help to identify cancerous or precancerous changes that may indicate a risk of future cancer.

Treatment for Oral Cancer

Oral cancer management and treatment vary based on the cancer’s location, stage, overall health, and personal preferences. Some patients may only require one type of treatment, while others may need a combination. Common treatment options include surgery, radiation, chemotherapy, targeted drug therapy, and immunotherapy. It is important to discuss these options in detail with the doctor:

Surgery: Surgery involves removing the tumour along with a margin of healthy tissue around it to ensure all cancer cells are eliminated. Smaller cancers may be removed with minor surgery, while larger tumours often require more extensive procedures. This may include removing a portion of the jawbone or tongue if the tumour is more advanced. Surgery carries risks, such as bleeding and infection, and can impact appearance, speech, eating, and swallowing.

Radiation Therapy: Radiation therapy uses high-energy beams, like X-rays or protons, to destroy cancer cells. It is typically delivered from an external machine (external beam radiation) but can also come from radioactive seeds or wires placed near the cancer (brachytherapy).

Radiation is often used after surgery or, in early-stage cancer, as a standalone treatment. Combining radiation therapy with chemotherapy, can enhance its effectiveness but also increase side effects. In advanced cases, radiation therapy may help relieve symptoms such as pain.

Chemotherapy: Chemotherapy uses drugs to kill cancer cells and can be administered alone, with other chemotherapy drugs, or in combination with other treatments. Combining chemotherapy with radiation therapy can enhance the effect of both, often used together for more advanced cases.

Targeted Drug Therapy: Targeted therapy focuses on altering specific characteristics of cancer cells that fuel their growth. These drugs can be used alone or alongside chemotherapy or radiation, offering a more targeted approach to cancer treatment.

Immunotherapy: Immunotherapy leverages the body’s immune system to fight cancer by interfering with proteins produced by cancer cells that hinder immune response. By disrupting this process, immunotherapy helps the immune system better recognize and attack cancer cells.

Preventive Measures for Oral Cancer

While not all cases of oropharyngeal (middle throat) and oral cavity (mouth) cancer can be prevented, it can significantly reduce the chances of development by taking proactive measures to avoid certain risk factors:

Avoid Tobacco and Alcohol: Steering clear of tobacco products and limiting alcohol consumption can greatly reduce the risk of developing these cancers.

Prevent HPV Infection: Reducing the risk of human papillomavirus (HPV) infection is crucial. Consider getting the HPV vaccine, which can help protect against certain strains associated with oral cancers.

Limit UV Light Exposure: Use protection from excessive exposure to ultraviolet (UV) light, particularly when it comes to tube lips, by using lip balm with SPF and wearing protective clothing.

Maintain a Healthy Weight and Diet: Adopting a balanced diet and maintaining a healthy weight can contribute to overall health and potentially lower cancer risk.

Schedule Regular Dental Check-ups: Regular visits to the dentist can help with the early detection of any abnormalities and contribute to maintaining good oral health.

Myths and Facts Related to Oral Cancer

Here is a list of the most important myths and facts related to oral cancer:

Myth 1: Only Smokers Get Oral Cancer.
Fact: While smoking increases the risk, non-smokers can also develop oral cancer due to factors like HPV, genetics, and excessive alcohol consumption.

Myth 2: Oral Cancer Only Affects Older Adults.
Fact: Although more common in older adults, rising HPV infection rates are contributing to cases among younger individuals.

Myth 3: There is Nothing to Do to Protect Oneself from Oral Cancer.
Fact: To lower the risk of oral cancer, consider quitting smoking, steering clear of alcohol, and increasing the intake of vegetables like broccoli, cauliflower, cabbage, and Brussels sprouts. Practising safe sex can also reduce the chances of contracting HPV strains associated with cancer.