This cancer that affects the inner lining of the cheeks or buccal mucosa can be life-threatening if not intervened by the maxillofacial surgeon and physician on time. Read the article to know the etiology, features, investigations, and management of this cancerous lesion.
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.
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.
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 lab 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.
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.
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.
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.
The inner lining of the cheeks, where we touch the teeth and the back of the lips, is known as buccal mucosa. When the cancer cells or tumor invade this area, it leads to carcinoma of buccal mucosa, a type of oral cancer. Initially, the squamous cells that are thin and flat turns into tumor cells, and then it spreads to the lips and the mouth.
Buccal mucosa cancers are relatively uncommon when compared to other oral cavity cancers such as carcinomas of the lips, tongue, and floor of the mouth. It is said that buccal mucosa cancers are the fourth most common site of cancer following mandible, tongue, and maxilla.
The most common sites of oral cancers are the floor of the mouth, tongue, hard palate, and buccal mucosa. Usually, oral cancers begin to develop from the squamous layer, which consists of flat, thin cells (squamous cells) that lines the lips and the inside of the mouth. So, the most common oral cancer is squamous cell carcinoma, but the reason behind the mutations in squamous cells leading to mouth cancer is unknown.
Buccal mucosa cancer can be curable when it is identified at an earlier stage. It is said that this type of cancer is more common in men when compared to women, and it is important to treat it immediately because it can spread to other parts of the mouth and distant parts of the body. Treatment often involves surgery which is performed by a head and neck surgeon.
The clinical signs of buccal mucosa cancer are as follows:
- Red and white patches in the mouth.
- Lump in the buccal mucosa.
- Severe ear pain
- Swelling of the jaw.
- Mouth pain.
- Pain around the teeth.
- Numbness of the mouth.
- Difficulty moving the jaw.
- Hoarseness of the voice.
- Sore throat.
- Mobile teeth.
- Ill-fitting dentures.
- Jaw pain.
Oral cancer tends to spread quickly, and most oral cancers belong to a type of cancer called squamous cell carcinoma. People who smoke, use tobacco and drink heavy alcohol have an increased risk for oral cancer. In order to know how fast and which areas they are spread, imaging tests such as the following are taken.
- X-ray - Spread of cancer cells to the jaw, chest, or lungs.
- CT scan - Tumors in throat, mouth, neck, or elsewhere in your body.
- PET scan - Determines the spread of cancer cells to lymph nodes or other organs.
Mouth cancers that involve the tongue will take around three to four weeks to recover, and it is treated by reconstructing the tongue with grafted tissue. When cancer has invaded deep inside the bones, then the affected areas or the parts of the jaw need to be removed. It is said that sixty percent of people who are treated for mouth cancer survive a period of 5 years or more.
Oral cancer usually starts with a lump or ulcer inside the mouth, which does not go away by itself within a few weeks. Also, excessive alcohol and smoking may develop this lump on the cheek into oral cancer so, if a growth that is painful and often bleeds on touch should be taken care of and should not be left untreated.
Treatment for oral cancer will depend on:
- Location of cancer.
- Stage of cancer.
- The overall health of the person.
- Personal preferences.
There may be one type of treatment or combination of cancer treatments suggested by the doctors, and the treatment options include:
When there is continuous pain, unexplained ulcer or lump in the cheek that persists for more than two weeks or does not heal, along with white or red patches inside the mouth, then it is important to visit a doctor.
Last reviewed at:
25 Nov 2021 - 4 min read
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