Buccal Mucosa Cancer

What Is Buccal Mucosa Cancer?

The buccal mucosa is the inner soft tissue lining of the cheek or the inside of the cheek area. Buccal mucosa carcinoma or cancers constitute 1 to 2 % of all intraoral carcinomas. Though it is not a very prominent site for the occurrence of oral cancer, in India, particular risk factors like the widespread use of tobacco and betel nut make it a common and aggressive cancerous lesion. Heavy alcohol use, immunosuppressed patients, HIV (human immunodeficiency virus) and HPV (human papillomavirus) infections, and pre-existing chronic premalignant lesions or chronic oral irritations can be risk factors for buccal mucosa carcinomas.

Buccal mucosa cancers can be invasive and spread to the surrounding jaw muscles, cheeks, and adjacent structures of the face and neck that may make facial reconstruction by the surgeon more challenging. Buccal mucosa squamous cell carcinomas can be aggressive with a high recurrence rate, and diagnosis at an early stage after identifying the signs and symptoms would prove life-saving.

What Are the Clinical Features and Signs of Buccal Mucosa Cancer?

Though this cancer can occur in any age group, it most commonly affects the 50 plus age group with a higher incidence in men than in women and particularly in smokers and tobacco users.

Upon intraoral examination of the lesion, the buccal mucosa cancers are mainly of 3 types, that is,

• The exophytic type.

• The verrucous type.

• The ulcerative type.

1) White speckled patches or modulated ulcers on the inner side of cheeks with a verrucous or well-defined kind of growth.

2) The ulcers are often “exophytic” or deep excavating lesions along the occlusal lines of buccal mucosa and may rapidly invade the surrounding tissues.

3) Indurated painful lesions or ulcers in the inner side of the cheek that may reach the external surface of the face as a protruding nodular mass in the advanced form of cancer. Signs of this form of oral cancer may include the following if the white patches or indurated ulcers are accompanied by the following problems:

• White or red patches that persist for several days or weeks.

• Difficulty in mouth opening or trismus (may be sudden, acute, or chronic in onset).

• An observable change in the voice or hoarseness in the voice while talking.

• Persistent lumps in the cheek or neck (can be observed only in the later stages of cancer due to lymphatic spread to the neck).

• Unexplained bleeding in the oral cavity.

• Sudden weight loss is also a feature of some aggressive forms of buccal mucosa cancer.

• Tooth mobility without any apparent history of periodontal disease or gum infection.

• Dysphagia or difficulty in swallowing or gulping food and water.

How Are Buccal Mucosa Cancers Diagnosed?

Preliminary investigations like brush biopsy or FNAC (fine-needle aspiration cytology) of the affected or suspected tissue need to be carried out by the maxillofacial surgeon or dentist. Once the diagnosis of the lesion is clear, the procedure for the removal of the lesion via surgery and chemo or radiotherapy can proceed.

The following investigations are useful in diagnosing buccal mucosa cancers:

• FNAC (Fine-Needle Aspiration Cytology): A thin needle is placed in the mouth, and the cells are suctioned or aspirated correctly by the surgeon to be further examined in the laboratory by microscopy. Staining by a special stain called Papanicolaou stain is used for preparing a smear slide of the tissue to reveal the dysplastic or abnormal changes by cytology. It will reveal the malignancy (or non-malignant nature of the lesion if it is not a buccal mucosa cancer).

• Magnetic Resonance Imaging: This technology via the MRI machine uses a magnet, radio waves, and a computer to picture in detail the inside of the mouth and neck and also to study the spread of cancer within the head and neck region.

• Positron Emission Tomography Scan: In this scan, a small amount of radioactive glucose (sugar) is injected into a vein. The computerized pictures of the suspected area or site are clearly visualized by the scanner. Cancerous or malignant cells will absorb more radioactive glucose than normal cells, so the tumor is clearly investigated this way.

• X-Ray: To determine the accurate prognosis (of the patient concerning the cancer spread), an X-ray of the lungs may be required in addition.

• Computerized Tomography Scan: Contrast imaging by injection of dyes or swallowing pills will also help the surgeon diagnose cancer by highlighting the head and neck tissues.

• Others: Special investigations like immunocytochemistry, flow cytometry, and DNA probe analysis may be needed for the detection of poorly differentiated squamous cell carcinomas or critical oral malignant lesions.

How Can Buccal Mucosa Cancers Be Treated?

Buccal mucosa cancers can be aggressive and life-threatening if they progress from the first stage of malignancy (T1) to the progressive stages of cancer (like T2, T3, or T4). Hence the main modality of treatment is by a combination of the complete elimination of the cancerous tissue (by the maxillofacial surgeon or general surgeon under general anesthesia), chemotherapy, and by facial reconstruction at the site where the surgery is performed (if the facial structures are involved that can lead to scar formation). Surgical reconstruction of the parotid gland or gland preservation procedures or ductoplasty can be performed by the maxillofacial surgeon in case the tumor resection surgeries are invasive or cause trauma to the parotid salivary glands. Often during a routine dental examination by your surgeon, the patient comes to know about the presence of premalignant lesions or cancerous lesions more often when they are prone to risk factors of smoking, chronic alcoholism, betel nut, or areca nut chewing and repeated exposure to tobacco or nicotine-based products. Management for these patients depends primarily on the cessation of deleterious habits so that the cancers do not aggravate further or hamper the prognosis after surgery.

Conclusion:

Buccal mucosa carcinoma can be very aggressive if not diagnosed on time by the dental surgeon. Following a risk-free lifestyle by quitting tobacco, alcohol, and betel nut consumption (apart from patients with chronic illnesses) is advocated to prevent oral cancers. Management by the surgeon by reconstruction of the invaded tissue and chemo or radiotherapy as required is crucial to the success rate and survival of these patients.