Mouth Cancers: An Overview

What Are Mouth Cancers and Their Symptoms?

Mouth cancers are also called oral cavity or oral cancers. They belong to a group of head and neck cancers and are treated similarly to head and neck cancers. The symptoms of mouth cancer include:

• Difficulty in opening the mouth.

• Trouble in chewing and swallowing the food.

• Mobile teeth.

• Unusual growth of mass seen inside the oral cavity.

• Painful ulcers on the lips that do not heal.

• Altered speech.

• A white or red patch is seen along the inner lining of the oral cavity.

• Loss of sensation in lips.

What Are the Causes of Mouth Cancer?

The reasons include:

• DNA (Deoxyribose Nucleic Acid) Mutations: DNA present in the cell instructs the cell what to do; when mutations (changes) occur in DNA, the DNA loses control over the cell function. This leads to excess production of cells which accumulate as a lump or swelling over time. One important thing to be noted is that all the abnormal growth of cells is not cancerous. Some may be benign (non-cancerous). But when the tumor cells detach from the original site and spread to other areas of the mouth or other parts of the body, they are called metastatic tumors, and the process is called metastases. Metastatic tumors are cancerous.

• Squamous Epithelium: The oral cavity is lined by squamous cells, which are highly vascular, semipermeable, and keratinized (at certain places). The degree of keratinization varies according to the function and location of the mouth. Most of the cancers start in these squamous cells; hence they are called squamous cell carcinomas.

What Are the Predisposing Factors of Mouth Cancers?

Predisposing factors are also called risk factors. Anything that increases the chances of getting the disease is called a risk factor. The occurrence of risk factors does not specify that the person should have the disease. They just only increase the susceptibility to the disease. The risk factors for mouth cancers are:

• Tobacco use: Tobacco in any form is carcinogenic (which causes cancer). Tobacco is widely used in the making of cigarettes and cigars. Smokeless tobacco like hookah, snuff, and chewing tobacco are also dangerous. 75 % of mouth cancers occur in tobacco users.

• Human papillomavirus (HPV): HPV is one of the most commonly occuring sexually transmitted diseases; this virus is transmitted to the mouth through oral sex. HPV is known to cause mouth and throat cancers (oropharyngeal cancers).

• Alcohol consumption: Alcohol contains chemicals that destroy the DNA of the cells, thereby leading to cancer. Alcohol intake, when combined with smoking, increases the chances of mouth cancer.

• Sun Exposure: When lips are exposed to the sun for longer times, the UV (ultraviolet) rays of the sun damage the DNA leading to mouth cancer.

• Age: Mouth cancers are mostly seen in people above the age of 40 years.

• Genetics: If the first-generation relatives (parents, siblings, children) are suffering from mouth cancer, then the individual is more prone to the risk of getting cancer.

• Immunity: The body's defense mechanisms also play a vital role in cancer prevention. Poor immunity makes the individual acquire the diseases fastly. For example, patients suffering from AIDS (Acquired Immunodeficiency Syndrome) are at the highest risk of getting cancer.

How to Prevent Mouth Cancer?

There is no evidence to prevent mouth cancer, but following certain tips can reduce the chance of getting the disease. The following tips are:

• Regular Dental Check-Ups: Dental check-ups are advised once every six months; during this examination, the doctor checks for abnormalities such as abnormal tissue growth, over-keratinization of the tongue and lips, and white patches over the buccal mucosa, which are considered precancerous lesions. Early diagnosis could help in a better treatment outcome.

• Avoiding smoking: Tobacco products must be discontinued, as the chemicals in the tobacco are very dangerous cancer-causing agents.

• Limiting alcohol: Chronic and excessive alcohol users are more susceptible to mouth cancers due to continuous oral cavity irritation by alcohol. But some people get addicted in spite of knowing the risk; those people are advised to limit their alcohol intake.

• Protecting lips: It is always advised to apply sunscreen lotion with sun protective factor (SPF) 50 to 70. This helps in the protection of lips against the UV rays of sunlight. Wearing a broad hat, avoiding the sun whenever possible also helps protect the lips against sun exposure.

How to Diagnose and Treat Mouth Cancers?

Diagnosis is usually made by:

• Oral examination: The doctor physically examines the oral cavity for any sores, white patches, and areas of thickening (keratinization).

• Biopsy: After the physical examination, the doubtful areas are advised for biopsy. During a biopsy, a small piece of the suspected tissue is removed and transferred to a laboratory for microscopic investigations. In the laboratory, the tissue is sectioned and observed for any cancer cells or precancerous conditions that will develop into cancer.

Treatment: A treatment plan is suggested by taking into consideration the following factors:

• Age of the patient.

• Type of cancer (benign or malignant).

• Underlying health conditions (diabetes, hypertension, and any illness).

• Location and stage of cancer.

Keeping in mind the above conditions oncologist discusses the following treatment options with the patient:

• Surgery: In this procedure the cancerous tissue is surgically removed.
• Chemotherapy: The use of anticancer drugs to kill cancer cells. The surgery is carried out depending on the part of the oral cavity affected. For example, glossectomy (surgical removal of the tongue), mandibulectomy (surgical removal of the mandible).

• Neck dissection: If the cancerous cells from the oral cavity have spread into the lymph nodes present in the neck region, then surgical removal of lymph nodes is advised. This is called a neck dissection. Invasion of cancerous cells into the lymph nodes indicates that the cancer is metastatic and malignant.

• Reconstruction surgery: Certain amounts of cancerous tissues and bones are removed during surgery. This makes it very difficult for the patient to eat and talk. Reconstructive surgery helps build up the lost bone and tissues with the help of bone, skin, and muscle grafts taken from other parts of the body. This helps in improving facial esthetics apart from eating and drinking.

• Radiation Therapy: High beam X-rays are used to kill the cancer cells in the oral cavity. In some cases, radiation therapy is given along with the surgery to obtain maximum results.

• Chemotherapy: In chemotherapy, anti-cancer drugs are administered to kill cancer cells. Often chemotherapy and radiotherapy are given to the patient in a combined manner to improve the effectiveness of the treatment.

• Immunotherapy: Immunotherapy is advised in advanced stages of mouth cancer and also when a patient is not responding to other treatments. Modification in the immunity cells helps improve the body's disease-fighting mechanism.

Conclusion:

Mouth cancer is a major illness. Avoiding risk factors such as alcohol and tobacco consumption and regular visits to the dentist could prevent the disease. Absolute cure of mouth cancers is possible if diagnosed at early stages.