Oral Cancers: Risk Factors, Diagnosis, and Treatment

Oral Cancer

Oral cancer also called as mouth cancer, is the most widespread form of head and neck cancer. It usually affects people aged 60 and older. Oral cancer affects the lips, first parts of the tongue, mouth roof and floor. It also impacts the oropharnyx—the last part of the tongue and roof of the mouth—tonsils and the sides and back of the throat.

Oral cancer is an extensive term for cancer that impacts the inside of your mouth. Oral cancer may appear as a common problem with your lips or in your mouth, such as white patches or sores that bleed. 

The main difference between a common problem and potential cancer is these changes will not disappear. If left untreated, oral cancer can spread throughout the mouth and throat to other sections of your head and neck. Nearly 63% of people with oral cavity cancer are alive five years post-diagnosis.

Generally, about 11 people in 100,000 will develop oral cancer in their lifetime. Men are more presumably than women to develop oral cancer. White people are more likely to develop oral cancer than black people.

Which body parts are located within the oral cavity?

The oral cavity consists of the lips, gums, the lining of the inside of the cheeks, the first two-thirds of the tongue, the floor of the mouth, the first part of the roof of the mouth and the area right behind the wisdom teeth.

Causes of Oral Cancer

Though the accurate cause of oral cancer is not known, multiple factors are linked to increasing risk, including tobacco use, human papillomavirus (HPV) infection and alcohol consumption.

Risk Factors of Oral Cancer

Certain factors can increase the probability of developing oral cancer. The danger of oral cancer increases with age; nevertheless, people below the age of 55 may develop the disease, as well. The chances of men getting oral cancer are high compared to women.

Other risk factors for developing oral cancer are:

HPV infection: HPV consists of 200 similar viruses. Many HPVs cause warts, however few result in cancer. HPV is one of the main risk factors for cancer. People suffering from oral cancers associated with HPV tend not to be drinkers or smokers and typically have a good prognosis.

Normally, HPV infections in the mouth do not generate symptoms, and only a small percentage of these infections develop into cancer.

Gender: Oral cancer is more common in men compared to women. This difference may be linked to the use of alcohol and tobacco, which are the main oral cancer risk factors seen more usually in men compared to women.

Age: The average age at diagnosis for oral cancer is sixty three, and more than two-thirds of individuals with this disease are above the age of 55, even though it may occur to people of young age.

Poor Nutrition: Studies have highlighted a link between diets less in fruits and vegetables and increased oral cancer.

Ultraviolet Light: Cancer of the lip is more pronounced among people who work outdoors and visit tanning beds and those with extended sunlight exposure.

Tobacco Consumption: Around 85 per cent of patients with oral cancers use tobacco as cigarettes, chewing tobacco or snuff. The risk of developing oral cancer is based on the duration and frequency of tobacco products. 

Smoking may result in cancer in the throat or mouth, and oral tobacco products are linked with cancer in the gums, cheeks, and inner surface of the lips.

Alcohol: Around seventy per cent of people diagnosed with oral cancers are heavy drinkers. The risk is huge for people who use both tobacco and alcohol. For people who drink and smoke excessively, the risk of oral cancer may be thirty times higher than the risk for people who do not drink or smoke.

Genetic Syndromes: certain inherited genetic mutations, which create different syndromes in the body, have a high risk of oral cancer. These consist of Fanconi anemia is a blood condition caused by inherited abnormalities in multiple genes. 

Patients may experience symptoms early and can develop aplastic anaemia or anaemia. The risk of oral cancer among people with Fanconi anaemia is up to five hundred times higher than among the general population.

Dyskeratosis congenital is a genetically associated syndrome which may also cause aplastic anaemia and a high risk of oral cancer, starting at an early age.

Immune System Suppression: Consuming drugs that suppress the immune system, like those used to prevent the rejection of a transplanted organ or to treat particular immune diseases, can increase the risk of oral cancer.

Betel Leaf: People in Southeast Asia and other parts of the world chew betel leaf. it is from the betel plant wrapped around areca nut and lime. Chewing gutka, a combination of tobacco and betel quid, is also common. Both of these substances are linked with the heightened risk of oral cancer.

Lichen Planus: People with a severe case of this illness, which typically causes an itchy rash but sometimes appears as white spots or lines in the mouth and throat, may have a greater risk of oral cancer. Lichen planus typically impacts middle aged people.

Graft-Versus-Host Disease (GVHD): This condition may develop post stem-cell transplant, in which bone marrow is replaced after cancer occurs or is treated.

The new stem cells may create an immune response which attacks that attacks the patient’s cells, and tissues present in the body may be destroyed as a result. GVHD elevates the probability of oral cancer, which may develop as soon as two years later.

Symptoms of Oral Cancer

• A persistent sore on your lip or inside the mouth
• A lump or thickened area in the mouth or throat
• Unexplained bleeding in your mouth
• White, red or mixed patches in the mouth or throat
• Unexplained bleeding in the mouth
• Unexplained numbness or pain in your mouth or throat 
• Chronic sore throat or sensation of something struck in the throat
• Difficulty speaking, chewing, swallowing or moving the jaw or tongue.
• Ear pain
• Hoarseness or alteration in the voice
• Swelling, pain or stiffness in the jaw.
• A lump in the neck 
• Considerable weight loss
• Persistent bad breath

If any of these symptoms last more than two weeks, it is vital to inform your doctor or dentist.

Diagnosis of Oral Cancer

If you have oral cancer, your dentist will screen for it as part of your regular dental exam. Your dentist knows what a healthy mouth should look like and is most likely the best person to spot it. 

Your dentist will look for any irregular tissue changes or lumps in your neck, head, face and oral activity. In your mouth, your dentist will look for sores or discoloured tissue.

If they find something problematic, the next step is to take a tissue sample to check under a microscope. That is called a biopsy. They can refer you to a specialist or do the test themselves.

Various categories of biopsies are available, and your physician has the authority to determine which is most appropriate for your condition.

Oral brush biopsy: This involves collecting cells by gently scraping the specific area using a specialized brush.

Incisional biopsy:  It entails the doctor cutting out a small portion of tissue. Based on their assessment of the suspicious spot, they may opt to remove it completely, along with some surrounding tissue.

Fine Needle Aspiration: It is a diagnostic procedure performed to examine a lump in the neck or lymph node. In this procedure, your doctor uses a thin, hollow needle to extract a sample of cells using a specialized syringe.

Oral Cancer Staging

If a biopsy indicates the presence of oral cancer, additional tests will be done to find if the cancer has spread to other areas of the body. Consequently, the tumour will be classified into a specific stage depending on its size and extent of spread. While not all patients will need all tests, some common ones are:

• Endoscopy.
• Imaging tests, including MRI and CT scans.
• HPV test.

Oral Cancer Treatments

Treatment for oral cancer normally involves a combination of surgery, radiation therapy, and drug treatments to eliminate cancerous cells, similar to the approach taken for various other types of cancer. The following are the treatments for oral cancer.

• Surgery
• Radiation therapy
• Medication therapy
• Chemotherapy
• Immunotherapy 
• Targeted therapy 

Conclusion

Regular dental check-ups twice a year and monthly self-examinations are important in detecting oral cancer early for successful treatment. Avoiding tobacco products is key to preventing oral cancer. 

FAQs