Introduction:
Oral cancer is recognized as one of the most prevalent malignant tumors affecting the head and neck areas in individuals worldwide who have an increased susceptibility due to their habitual practices, such as nicotine use, tobacco smoking, substance abuse, chronic alcoholism, betel nut, or quid chewing. The majority of oral cancers fall under the category of oral squamous cell carcinomas (OSCC), which are typically linked to mucosal changes. These types of cancer, including oropharyngeal cancer, soft or hard palate cancer, lip cancer, tongue cancer, jaw bone cancer, and salivary gland cancer, commonly manifest in the lower part of the mouth or areas like the lips, tongue, gums, inner cheek, gingiva, oral base, facial skin mucosa, and other mucosal regions.
What Is the Clinical Significance of Oral Cancer?
Recent global statistics on oral cancers have revealed that maxillary sinus cancer is one of the frequently seen cancers that have been on the rise over the decades. These cancers are caused when an individual is predisposed to multiple risk factors or detrimental habits. These factors include long-term alcoholism, poor individual oral hygiene, excessive exposure to sunlight, betel nut, long-term or chronic period foreign body stimulation, malnutrition, mucosal leukoplakia (a type of pre-cancerous lesion) or erythema (oral mucosal lesion), or even persisting oral ulcers. A proper history of the lesion would help the maxillofacial surgeon or the oral oncologist to decipher the exact cause of oral cancer in the individual. Habit history elicited by the dentist or the maxillofacial surgeon would ensure that the patient's underlying cause of cancer.
This diagnosis is extremely crucial to ensure proper treatment and to improve the post-operative surgical rates of individuals post the tumor resection (removal) in the oral cavity.
Oral cancer not only tends to affect the appearance of the individual, but it can also be the cause of several oral or facial discomfort, resulting in troubles with chewing or swallowing or even with opening the mouth (limited mouth opening or trismus is a frequent symptom because of the oral tumor growth) and subsequently, these clinical afflictions can even endanger the individual life. Surgery is usually based on the size of the tumor, so the surgeon chooses the range of resection. In patients affected with lip or tongue cancer, esthetic and functional affliction would be possible even post-surgery because of the range of tumor resection in these areas.
What Is the Importance of Tumor Microenvironment in New-Age Treatments?
The new-age technologies or therapies that target oral cancer cells are dependent on the important factor of the tumor microenvironment responsible for oral cancer cell proliferation (multiplication).
When a solid oral tumor reaches a diameter greater than .07 inches, the cancer cells face difficulty in accessing the necessary oxygen and cellular nutrients from their surrounding environment. Consequently, these tumor cells release angiogenic factors (factors that give rise to new blood vessels) into the microenvironment, stimulating the development of new blood vessels. This process directly or indirectly involves the oral tumor cells in the formation of blood vessels that support the growth of cancer cells. In a cellular environment with low oxygen levels (hypoxia), the hypoxia-inducible factor (HIF) upregulates the expression of important genes such as VEGF (vascular endothelial growth factor a type of growth factor) and other angiogenic factors. This signaling mechanism triggers further proliferation or metastasis of cancer cells.
The combined influence of hypoxia and high pressure in these oral cancer or tumor microenvironments tends to not only accelerate tumor development but also aid in the deterioration of the surrounding healthy cells.
What Are the Different Types of New-Age Therapy for Oral Cancer?
Based on the review of the tumor microenvironment described above, the modern approaches of immunotherapy aim to eradicate oral cancer.
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Immunotherapy: This is a new strategy for oral tumor therapy that applies a combination of biotechnology and immunological methods to improve specific immune responses to oral cancer cells. Immunotherapy is often used by maxillofacial surgeons currently as an effective new-age technique to eliminate cancers. It also includes the application of adoptive cell immunotherapy, antibody-based therapy, cytokine therapy, tumor vaccine therapy, and gene therapy.
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Adoptive Cellular Immunotherapy (ACI): This is also a form of immunotherapy. This is an important technique in tumor biotherapies. ACI is a high-strength cancer elimination protocol that involves the elimination of tumor activity of immune cells, directly killing cancer or tumor by stimulating the body’s immune response to kill tumor cells. Rituximab was the first mAb (monoclonal antibody) that was approved by the FDA (Food and Drug Administration) for the immunotherapy of all B cell non-Hodgkin’s lymphomas (a type cancer of lymphatic system) in individuals. ACI has been widely used and implemented as standard treatment by many oral and maxillofacial surgeons or oncologists as a new-age method or treatment in collaboration with the clinical treatment employed for cancer patients. ACI would be a definite possibility or supplement to surgery, radiotherapy, and chemotherapy to eliminate oral cancers effectively.
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Another recent advance in the management of oral cancer cells is the FDA-approved high-dose cytokine drugs such as IL-2 (interleukin -2). These are also used for the treatment of melanomas and kidney cancers as well.
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Other Than Immunotherapy: Tumor vaccine is another specific and safe cancer treatment strategy that can be used for the treatment of oral cancers caused by the human papillomavirus (HPV) and hepatitis B virus. HPV is consistently detected in most oral cancers or oropharynx cancers as well. Tumor vaccines have been employed successfully by surgeons and are thought to have promising future potential for head and neck cancers.
Conclusion:
Timely diagnosis and management play the most important role in the prevention and management of these aggressive oral cancers. There are many treatment methods for oral cancer including the new age methods such as immunotherapy and tumor vaccines. These methods take over the conventional treatment methods, focusing on resection of the tumor or oral surgical therapy, radiotherapy, and chemotherapy intervention.
