Oral cancer is the cancer that starts from the lining (mucosa) of the oral cavity. The oral cavity consists of the mucosa lining of the lips and cheeks, the teeth, gums, two-thirds of the tongue, the floor of the mouth, and the posterior of the teeth.
Cancer of the oral cavity is one of the most common malignancies in the world. Worldwide, 405,000 new cases of oral cancer are diagnosed every year, especially in countries like Sri Lanka, India, Pakistan, Bangladesh, Hungary and France and are the leading countries with oral cavity cancer. Oral cancer is more common in men than in women.
CAUSES FOR ORAL CAVITY CANCER:
- Tobacco smoking is the main cause, betel chewing and tobacco chewing is also a cause, mostly in Asian countries.
- Smokeless tobacco like beetle nut, locally called gutka, nass, mawa, naswar and pan masala, oral snuff, is also a cause. 50% of oral cancers in India is on account of smokeless tobacco.
- In the last 15 years there is a decrease in this cancer because of decrease in smoking.
- Heavy consumption of Alcohol is another reason for oral cavity cancer even in non smokers.
- Lack of vegetables and fruits account to 15 to 20% of oral cancers.
- Other factors are poor oral hygiene, exposure to wood dust, deficiencies in diet, consumption of red meat and salted meat.
- Tobacco smoking, combined with alcohol and smokeless tobacco increases the risk of oral cancer.
- Recently HPV infection also causes oral cancer.
- Chronic trauma, from sharp teeth, dentures can contribute to oral cancer.
ORAL SQUAMOUS CELL CARCINOMA (OSCC):
Among all the cancer oral cancer accounts to 2 to 4% in the world, whereas in India it is around 45%. Oral cancer, a group of neoplasms that affect any region of the oral cavity, and salivary glands.90% of the oral neoplasms are OSCC. Cases of OSCC is increasing among youngsters, between the age group of 18 And 44 years. Generally, OSCC is diagnosed in advanced stages.
In the initial stages it painless so goes unnoticed. OSCC, can develop on the lips, tongue and on the floor of the tongue. OSCC presents like a lump, a red lesion or a mixed red and white lesion. The greatest risk factor is tobacco smoking and alcohol, apart from other factors. Early diagnosis is the best way for a successful treatment, through different therapies.
STAGES OF ORAL CAVITY CANCER:
- TNM describes the stages—Tumor-(T) depends upon the size and location.
- Node(N)—if the tumor has spread to the lymph nodes, where and how many?
- Metastasis(M)—if the cancer has spread to the other parts of the body, where and how much?
- T,N, and M is combined to stage the oral cancer:
- Stage1: The tumor is 2cm or smaller, and the dept is 5mm or less. At this stage the cancer has not spread to lymph nodes or the other parts of the body.
- Stage 11:The tumor’s size is the same or larger than 2cm up to 4cm and the dept is between 5 and 10mm and the cancer has not spread.
- Stage 111: The tumor is larger than 4cm and the dept is more than 10mm and has not spread.
- Stage IVA: The tumor has spread in the mouth, jaw or to the skin of the face. The cancer is 3cm smaller and has not spread to the other parts of the body.
- Stage IVB: The tumor is any size and the cancer is in the lymph node and the size is 6cm and has grown into the surrounding tissue.
- Stage IVC: The cancer has spread to the lungs, liver or bone. This stage is called metastatic oral cancer.
RECURRENT ORAL CANCER:
When the cancer comes back after treatment is called recurrent cancer. Then again tests and scans are done to know about its extent. If it comes back in the same place where it first started, it’s known as local recurrence. If it comes back in the tissue or lymph nodes where it first stated, it is known as regional recurrence. If it comes back in another part of the body, it is known as metastasis or distance recurrence.
TESTS SUGGESTED: X-rays, CT scan, PET scan, MRI, an endoscopy.
TREATMENT FOR ORAL CANCER:
Treatment for oral cancer will depend on the type, location and stage of the cancer.
–In advanced stages, surgical treatment is the main therapy.
–in the early stage external beam therapy (EBRT) and brachytherapy are successful.
–in postoperative cases with advanced oral cancer, adjuvant therapy is given.
–In advanced stage, recurrent and metastatic head and neck cancer, now a combination of chemotherapy with radiation therapy and surgery.
–Early cancers of the lip, with surgery or radiation is 90% to 100% curable.
–Moderately advanced and advanced cancers of the lip can be controlled by surgery or radiation therapy or a combination of both.
–Local implantation is done by intraoral cone radiation therapy.
–Patients who smoke are counseled before radiation therapy begins.
–Dental status and advise is also taken before therapy is performed.
SURVIVAL RATE OF ORAL CANCER:
60% of the people with oral cancer will survive for five years or more. If diagnosed the survival rate is more, this is for stage 1 and 2 oral cancers.
Nutritious diet is also important for patients with oral cancer, during treatment. Many treatments make it difficult or painful to eat and swallow, resulting in poor appetite and weight loss. A nutritionist can help to the necessary food with calories, vitamins and minerals needed, as a part of treatment and to heal. As apart from the treatment keeping the mouth moist and teeth and gums clean is important.
KNOWLEDGE AND AWARENESS OF ORAL CANCER:
Smokers have more knowledge about the risks of oral cancer than non-smokers. Hence non-smokers need to be educated. Patients who consume liquor are also aware of the risk Factors. It is a public health concern of international importance to educate the people about oral cancer in the risk factors, and diagnosis of oral cancers.