Oral cancer is a malignant tumor that can affect any area in the mouth such as the inside of cheeks, the tongue, lips, the palate, and the floor of the mouth. Oral cancer mostly occurs after the age of 40. The risk is more than twice high in men as it is in women. The number of oral cancer cases is increasing worldwide, health experts see nicotine and alcohol use are the primary cause.
Causes of Oral Cancer
In 90-95% of cases, oral cancer is caused by a genetic mutation from some factors such as smoking and alcohol drinking. This genetic mutation leads to uncontrolled cells growth and abnormal tissue formation. The remaining 5-10% of cases are due to inherited genetics. However, the causes of this genetic mutation are still not clear. In other words, you can’t prove that smoking is responsible for oral cancer.
Risk Factors for Oral Cancer
Researchers suggest that oral cancer is triggered by several factors, include:
- Smoking: tobacco smoking or chewing is number one in the list of risk factors. If tobacco is combined with alcohol, the risk increases significantly. People who smoke and drink alcohol are 30 times more likely to develop oral cancer than other people.
- Prolonged exposure to sunlight: prolonged exposure to ultraviolet radiation on lips from the sun or sunbeds may lead to the development of lip cancer.
- Human papillomavirus: the HPV is associated with some cases of oral cancer.
- Poor diet: a diet low in fruits and vegetables can be a risk factor.
- Genetic predisposition.
- Age: it usually occurs in people over the age of 40. Oral cancer may occur due to:
- The aging process of cells may allow malignant change.
- The immune system decreases with age.
Signs and Symptoms of Oral Cavity
Changes in the oral mucosa such as non-healing wounds may be the first indication of oral cancer. These changes are often painless in the early stages. If the following symptoms persist for more than 2 weeks, you should consult a doctor or dentist:
- White or red spots in the mouth that can’t be wiped or scraped.
- Sores in the mouth that often bleed easily and don’t heal.
- Mouth swelling.
- Loose teeth with no reason.
- Painful chewing or swallowing.
- Difficulty speaking.
- Decreased mobility of the tongue.
- Numbness of the tongue, lip, or chin.
- Jaw pain.
- A sore throat.
- Neck lump.
- Unwanted weight loss.
- Poorly fitting dentures.
Having one or more of these symptoms doesn’t mean that a person has oral cancer. You should consult your doctor if these symptoms persist for more than 2 weeks.
Diagnosis of Oral Cancer
All patients with an unclear oral lesion that persist more than 2 weeks should visit the doctor for examination. Your doctor or dentist will examine your mouth and perform some tests to diagnose oral cancer, include:
- Physical examination: the doctor or the dentist will examine the entire mouth and the lymph node in the neck in order to look for abnormal tissue formation, sores, or non-healing wounds.
- Biopsy: the doctor or the dentist will take a tissue sample from the suspected area. In the laboratory, the tissue sample will be examined under the microscope to make a reliable diagnosis.
If oral cancer is diagnosed, the doctor will perform other tests to determine the stage of cancer, include:
- Endoscopy: the doctor will use a small camera with light to see how far oral cancer has spread.
- Imaging tests: they provide clues to whether the tumor has grown into the bone or may have already metastasized to other organs, or to the lymph node. These tests may include:
- Computerized tomography (CT).
- Magnetic resonance (MRI).
Treatment of Oral Cancer
It is impossible to predict how the disease will progress. The treatment of oral cancer depends primarily on the extent of the disease. The decision to undergo surgery, radiation therapy, or chemotherapy depends on the type, extent, and location of the tumor. Also, a combination of surgery, radiotherapy, and chemotherapy are possible. The treatment options should be discussed in detail with your doctor.
During the surgery to remove oral cancer the surgeon removes the tumor with a healthy tissue margin. In the advanced stage of oral cancer, the tumor often spreads to the adjacent lymph nodes. In order to improve the chances of the survival rate of the patient, the lymph nodes and related tissues in the neck will be surgically removed.
Oral surgery involves risks and complications. The defect in the oral cavity after the removal of the tumor can cause changes in the appearance of the face, difficulty, eating, drinking, swallowing and speaking, reconstructive surgery may be necessary. Also, oral surgery may result in injury to other structures such as nerves and blood vessels which can cause bleeding. Also, infections are possible, especially in the area of the wound. In the worst case, this may lead to blood poisoning.
Radiotherapy may be used before or after the surgery. Also, it can be combined with chemotherapy, if necessary. Radiotherapy uses radiation particles to destroy the tumor tissue. Radiation at a certain dose causes damage to the DNA inside oral cancer cells, destroying their ability to reproduce.
Radiation exposure causes irritation of the skin and oral mucosa. Side effects of radiotherapy include:
- If the radiotherapy affects the function of the salivary gland, it can lead to dry mouth.
- Inflammation and bleeding gums.
- Tooth decay.
- Jaw stiffness and pain.
- Radiation damage to the skin is similar to a very strong sunburn (radiation dermatitis).
Chemotherapy may be used before or after the surgery. Chemotherapy involves using cytotoxic drugs that inhibit cell growth or cell division. Chemotherapy not only damages oral cancer cells but also the healthy tissue. Side effects of chemotherapy include:
- Nausea and vomiting.
- General fatigue.
- Allergic reaction.
- Hair loss.
- Weakened immune system.
Prognosis of Oral Cancer
The prognosis of oral cancer depends on the type and location of the tumor as well as the tumor stage at the time if diagnosis. Also, the size, extent, a possible lymph node involvement, and the presence of metastasis in other organs are important in the prognosis.
After successfully treated oral cancer, regular check-ups must be carried out in order to detect anything out of the ordinary (the recurrence of cancer). The regular check-ups will usually consist of:
- Physical examination.
- Blood tests.
- X-rays and CT scans.
Reconstruction and Rehabilitation after Oral Cancer Treatment
After the treatment of oral cancer, regular check-ups are necessary so the doctor can check the healing process. In the first two years, these examinations are recommended every three months and every six months in the third to fifth year. In the advanced stage of oral cancer, the surgical removal of the tumor can cause a defect in the oral cavity leading to difficulty eating, drinking, swallowing, and speaking, a reconstructive surgery and some rehabilitation are needed. Reconstructive surgery may involve:
- Dental implants.
- Bone graft to repair missing tissues.
- Artificial palate.
Speech-language therapist and physiotherapist should assess the tumor, treatment-related impairment of speech, and swallowing ability to provide an appropriate treatment until you reach the maximum level of improvement.
Prevention of Oral Cancer
To reduce the risk of oral cancer, you should make lifestyle changes, these include:
- Quit smoking.
- Avoid alcohol drinking.
- Avoid prolonged sunlight exposure.
- Use a sunscreen.
- Avoid junk foods and processed meats.
- Eat a diet high in fruits and vegetables.
- Visit your doctor or dentist immediately, if you notice mucosal changes, sores, or non-healing wounds that persist more than 2 weeks.