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Oral Cancer- Symptoms, Causes, Diagnosis, and Treatment

Cancer is one of the leading cause of deaths worldwide. According to recent data provided by Global Cancer Observatory (2018), Oral Cancer, also known as mouth cancer, is the second most common cancer in both the sexes. It is the most common cancer among men while fourth most common cancer in women. Squamous cell carcinoma is the most common cancer, accounting for more than 90% of all cancers occurring in the mouth and oral cavity. Cancer can occur anywhere in the mouth involving lips, tongue, gums, cheek area, palate etc. Let’s know about the various symptoms, diagnosis and treatment modalities, and causes of oral cancer.

Causes of Oral Cancer

There are several factors which cause this cancer. No single cause or factor has been clearly defined or accepted. Some external causes include tobacco smoke, alcohol, betel quid (paan), areca nut (supari), mishri application, sunlight (especially in lip cancer) etc. Internal causes include malnutrition, iron deficiency anemia, some hereditary conditions such as dyskeratosis congenita etc. Cancer may occur in the previously present pre-cancer condition. Other less common causes include chronic trauma from sharp tooth edges or dentures. Trauma may aggravate this condition or accelerate it. Let’s see various causative factors.

1. Tobacco Smoking

Tobacco smoke contains more than 70 cancer causing agents including nitrosamines, arsenic, benzene etc. Smoking produces free radicals and oxidants that destroy and counteract the protective effects of natural antioxidants. Occurrence of mouth cancer in smokers is about 5- 10 times greater than that among general people. Risk of developing cancer declines on quitting smoking. It’s one of the main causes of oral cancer.

2. Smokeless Tobacco

In smokeless tobacco users, cancer usually occur at the site where the tobacco is habitually placed. Use of dry snuff has higher risk of cancer than moist snuff and chewing tobacco. So, quit tobacco today and get a healthier life ahead.

3. Betel Quid (Paan)

Betel quid is a combination of natural substances (areca nuts, betel leaf, slaked lime, sometimes tobacco leaf) and gives psychostimulating effects. The tobacco and areca nut components are mainly responsible for cancer. Betel quid substitutes such as pan masala and gutkha etc have become increasingly popular. These cause pre-cancer conditions which may convert to cancer over long time.

4. Areca nut (Supari)

Areca nut is a well- known cause of oral submucous fibrosis which is a pre-cancer condition. The alkaloids present in the areca nut are mainly responsible. It results in progressively reduced mouth opening. Later on it may convert into cancer if the habit is not stopped.

5. Alcohol

Alcohol in combination with tobacco is a significant risk factor for cancer development. Individuals who consume more than four alcoholic beverages per day are at a significantly higher risk. Ethanol in alcoholic beverages is metabolized into acetaldehyde which is a known carcinogen. Alcohol also solubilize other cancer causing agents and increases the cancer risk. It also causes damage to the liver and increases the chances of cancer in both liver and mouth.

6. Sunlight

Chronic exposure to sunlight as in farmers etc increases the chances of cancer in the exposed parts of the body such as lip. The risk is higher in whites than blacks. Also there is a lesser risk of occurrence in females due to lower exposure to sunlight and partial protection from lipsticks.

7. Vitamin Deficiencies and Dietary factors

Iron deficiency, vitamin A deficiency etc are associated with increased with of mouth cancer. They impair the immunity and make the person highly susceptible for cancer. Beta- carotene or vitamin A has antioxidant properties which help in reducing the chances of cancer. So, deficiency of vitamin A may pose the person to higher risk of cancer. Other vitamins such as C, and E, folate, flavonoids, lycopene have anti- cancer effects. So high intake of fruits and vegetables decreases the risk for various cancer.

8. Bacteria, Viruses and Fungi

Some bacterial infections such as Syphilis, fungal infections eg- Candidiasis, viral infection eg- human papilloma virus, HIV virus etc increases the chances of mouth cancer.

7 Symptoms of Oral Cancer

The risk for oral cancer increases with age, especially among men. There is minimal pain in the early stages. Therefore people seek medical treatment at a later stage increasing the chances of complications and death at an earlier age.

1. Growth or Mass Formation in the mouth

There are different types of growth patterns and symptoms of mouth cancer. The growth can be outwards in the mouth or deep and inwards. A small growth appears first which rapidly increases in size. The growth or mass is usually fungating or cauliflower like. The colour of the mass varies from whitish to pink to red. Often there is an ulcer on the mass and the mass feels hard on touching. Little or no pain can be there in early stages. Pain may increase with duration.

2. Non- healing Ulcer

Mouth cancer can also occur as a non- healing ulcer. It gradually increases in size with pain. The ulcer can be of irregular shape, and depressed. In this type of growth, the cancer cells usually invade deep in the tissue.

3. Pain

Usually in early stages pain is not present. Later on pain may accompany other symptoms such as burning sensation, difficulty in eating and swallowing, bleeding etc. Pain in the teeth may also occur if the cancer is in the vicinity of the teeth. If it involves the nerve then loss of sensation can occur.

4. Looseness of teeth

Cancer spreading in the area of teeth may cause looseness of teeth. Pain may or may not accompany. Only burrowing ulcer and looseness of the teeth can occur.

5. Swelling

Swelling may occur due to the presence of growth or mass and it can also occur if the cancer invades deep in the mouth.

6. White Patch in the mouth

A white patch may be present in early stages that has not produced a mass or ulcer. It is usually painless. Burning sensation on eating may occur.

7. Red Patch or Combined Red and White Patch

In early stages, red patch or mixed red and white patch may be present. Pain may or may not accompany burning sensation on eating especially spicy foods.

Diagnosis of Oral Cancer

There are various methods for diagnosis of mouth cancer. With newer techniques early detection and potential for development of cancer can also be detected. Confirmation usually require surgical biopsy followed by histopathological examination.

1. VELscope

VELscope machine is an efficient diagnostic instrument to differentiate between pre-cancer and cancer. This aids in early detection of cancer. This machine uses a blue light and works on fluorescence activity. Pre- cancer and cancer reflect different colours.

2. Toluidine Blue Test

Toluidine blue is a stain. Cancer tissue takes up the toluidine blue stain when mouth is rinsed with it and appears dark blue. Thereby it helps in early detection of cancer. For confirmation biopsy is necessary.

3. Exfoliative Cytology

Exfoliative cytology is a quick and simple adjunct to biopsy. Routinely, cells shed from the body surfaces. In this technique the superficial cells are taken from the cancer suspected area. The cells are then stained and examined for cancerous changes. Although this helps in early detection of cancer but it’s not a substitute for biopsy.

4. Brush Biopsy

Brush biopsy is a very similar technique to exfoliative cytology but it provides more reliable results than exfoliative cytology. A brush is used to collect cells and cells are collected from the deeper layers. Cells of the deeper layers are more diagnostic for cancerous changes.

5. Biopsy

Biopsy and histopathological examination is the gold standard method for confirmation of cancer. A small tissue is cut surgically along with the adjacent normal area and examined. This shows the cancerous changes and how deep the cancer cells have reached. Based on the biopsy report, size of the tumour, involvement of other parts of the body stage of the cancer is decided. According to the stage, treatment modality is decided.

Treatment of Oral Cancer

Cancer stage guides the treatment of it. Treatment of mouth cancer basically involves surgery, radiotherapy and chemotherapy. Let’s see the various modalities.

1. Surgery

Surgery is the treatment of choice in early stages. The tumour area along with a wide normal margin is cut to minimize the chances of recurrence. Surgery can result in a large defect in very advanced case. Prosthesis can fill that defect. So after surgery, prosthesis helps in restoring the function.

2. Chemotherapy

In advanced cases or very advanced cases, chemotherapy along with radiotherapy is an adjunct to surgery to minimize the undesirable functional outcomes.

3. Radiotherapy

Radiotherapy is also an adjunct to surgery and chemotherapy. Brachytherapy is placement of tiny, radioactive seeds in the area to deliver additional radiation dose. It also minimizes the damage to neighboring areas.

Oral cancer is a major public health issue worldwide. It remains a disfiguring and highly lethal disease. There are various causes including tobacco, alcohol, arecanut, human papilloma virus etc. These causes may cause pre- cancer disease first which can transform into cancer with time. Age is also one of the factor, the chances of cancer increases with age and most of them occur after 40 years of age. If pre-cancer condition is identified at early stage, then the cancer risk can be minimized. Prevention is better than cure, so quit tobacco, arecanut, alcohol and smoking and minimize the cancer risk. Don’t ignore any problem occurring in the mouth, because it can result in any serious disease. So, always consult your dentist frequently, maintain oral hygiene, quit bad habits and live a healthy life.