Oral cancer is not only the sixth most common form of cancer in India; it’s also the most common cancer among Indian men. The burden is too great to the point that our country could become the ‘mouth cancer capital of the world’. Read to know about the causes, diagnosis, treatment, and more about oral cancer.
What is mouth cancer?
Mouth cancer, or oral cancer, is one of the most common types of cancer in India. It refers to the uncontrolled multiplication of abnormal cells in any part of your mouth.
What are the types of mouth cancer?
- Primary oral cancer: this type of cancer originates in the mouth itself. Based on how the cells appear in the microscope, they are categorised into different types (squamous cell carcinoma, which originates from the lining cells of the mouth; adenocarcinoma – originates from salivary gland cells; malignant melanoma, which originates from pigmented cells called melanocytes; lymphoma, which originates from the cells of the lymphatic system etc.)
- Secondary oral cancer: cancers originating in any other body parts such as the lungs, the kidneys, the liver, the prostate, the breast, etc. can spread to the mouth and present as an ulcer or lump
What are the causes and risk factors for mouth cancer?
- Chewing tobacco and areca nuts
- Smoking
- Long-standing injury from a sharp tooth
- Overexposure to the sun leads to cancer of the lips
- Human papillomavirus (HPV) infection
- Family history of cancer
- Alcohol abuse: Alcohol by itself does not cause oral cancer but it acts as an adjuvant to other causative factors
What is a precancerous lesion?
Precancerous lesions refer to the changes that occur in the tissues that have the potential to transform into full-blown cancer. These changes could present as white patches, erosions, blanching, etc. These changes occur as a response to exposure to tobacco, areca nuts, etc. Sometimes, discontinuing the habit that caused these changes and seeking appropriate treatment completely cures these changes. The presence of these changes does not mean that you will definitely have cancer, but that your risk of cancer is more significant compared to those who do not have such lesions. These precancerous changes include:
- Leukoplakia (a non-scrapable white patch seen among smokers and those who chew tobacco)
- Erythroplakia (red, velvety patches)
- Lichen planus (white radiating patches characterised by a burning sensation)
- Oral submucous fibrosis (blanching of the inner lining of the cheeks, limited mouth opening, burning sensation of the mouth, etc.)
- Actinic cheilitis (rough, scaly, discoloured patches on the areas of the lips which are overexposed to sunlight. Most frequently occur in the lower lip)
What are the symptoms of mouth cancer?
Symptoms that can be present in the mouth include:
- Long-standing non-healing ulcers
- Lumps and swelling
- White or red patches
- Tingling sensations or numbness
- Difficulty swallowing and chewing
- Pain or burning sensation
- Uncommonly, you can experience other symptoms such as ear pain or a loose tooth.
When should I see the doctor if I have the symptoms of mouth cancer?
How is mouth cancer diagnosed?
If you report to your doctor with symptoms of mouth cancer, your doctor will ask you about the history of the symptoms, history of using tobacco, areca nut etc. and will perform a thorough physical examination. You will be advised to take the following tests:
- Blood tests
- Imaging – X- rays, CT, MRI, PET scan
- Biopsy – A small portion of the suspicious tissue is surgically removed under local anaesthesia and examined under the microscope to see if cancer cells are present. Sometimes a part of this tissue is subjected to ‘immunohistochemistry’, which identifies certain proteins (antigens) present in the cells
What is the staging of mouth cancer?
The most commonly used staging for mouth cancer is called ‘TNM Staging’.
- ‘T’ stands for the size of cancer
- ‘N’ denotes involvement of lymph nodes
- ‘M’ denotes metastasis, which means the spread of cancer to other parts of the body
Stage I – a small-size cancer lesion that has not spread to any other part
Stage II – larger cancer with or without the involvement of one lymph node
Stage III – much larger cancer, maybe with the involvement of multiple lymph nodes
Stage IV – Very extensive cancer that has spread to other parts of the body
How is mouth cancer treated?
The treatment of oral cancer is based on its site, extent, and stage at the time of diagnosis.
- Stage I – Radiation therapy or surgery
- Stage II – Surgery with the removal of neck lymph nodes, (neck dissection) with or without radiation therapy
- Stage III – Surgery with the removal of neck lymph nodes followed by radiation therapy with or without chemotherapy
- Stage IV – Extensive surgery with the removal of neck lymph nodes with radiation therapy and chemotherapy
If the cancer is not at a site where surgery is possible, if the patient is too weak to withstand surgery or if cancer has extensively spread to multiple body sites, then the patient would be given chemotherapy and radiation therapy to reduce the tumour size. Treatment in such cases is mostly palliative, which is aimed at improving the quality of life.
What are the complications of oral cancer treatment?
Complications of surgery:
- Bleeding
- Infections
- Loss of function in certain areas of the mouth
- Paralysis of certain areas of the mouth
Complications of radiation therapy:
- Redness, erosion, and ulcers in the area of the mouth exposed to radiation (radiation mucositis)
- Decreased salivary flow and dryness of the mouth
- Fibrosis of the cheeks
- Radiation-induced cancer
Complications of chemotherapy:
- Nausea, Vomiting
- Hairfall
- Loss of appetite and weight loss
- Diarrhoea
- Changes to nails and skin
Can mouth cancer recur?
Depending on the type of cancer and its stage at the time of diagnosis, the recurrence rate of oral cancer is highly variable. There are always some chances of recurrence even after treatment, and it may recur at the same site or appear elsewhere. Thus, it’s important that you do not resume habits of smoking, areca nut usage, alcohol consumption, etc. after cancer treatment. You must follow up with your cancer specialist for a regular check-up and follow the instructions properly to avoid recurrence and to ensure its detection at the possible time if it occurs.
How will mouth cancer treatment impact my life?
Oral cancer and its treatment have a tremendous impact on how you eat, speak, and look. You would experience difficulty chewing, swallowing and tasting food during the treatment. Your teeth may be removed as a part of the treatment. Your doctors will help you and guide you to specialists for dentures and obturators that improve your speech and function. You may also require help from speech therapists to improve your pronunciation. You will gradually get used to these changes. Remember to avail the support of your family and friends to cope well.
How do I prevent mouth cancer?
- Abstain from smoking, using tobacco, and eating areca nuts in any form
- Consult a dentist and address any sharp teeth
- Avoid too much exposure to the sun
- Eat healthy food rich in antioxidants
- Consult a dentist if you experience any symptoms of oral cancer
