What Is Oral Cancer?
Oral cancer refers to cancer that develops in the tissues of the mouth or throat. It usually begins as a small sore or growth in the mouth that doesn't go away. The most common type of oral cancer is squamous cell carcinoma, which originates in the flat cells lining the mouth's surface. Risk factors for oral cancer include tobacco and alcohol use, human papillomavirus (HPV) infection, excessive sun exposure (for lip cancer), and a history of oral precancerous lesions. Early detection is crucial for better treatment outcomes, so regular dental check-ups and awareness of potential symptoms are essential. If you suspect any oral health concerns, seek prompt evaluation by a healthcare professional.
What Is the Need for Evaluation of Oral Cancer?
Oral cavity squamous cell (a type of cell layer) cancers are responsible for a significant percentage of oral cancers worldwide. In the Indian continent, oral squamous cell carcinomas (OSCC) comprise the highest percentage of oral cancer, leading to increased death rates if not detected early. The incidence of oral cancer is 20 individuals per 100,000 population. The predominant risk factors are tobacco chewing and chronic alcoholism.
While clinical examination by the oral physician allows direct visualization, a prominent issue is that cancer spread and extension evaluation takes more time. Further, if left untreated, cancer can aggravate significantly and metastasize (spread) to distant body parts. With the advent of proper evaluation and imaging, accurate information about the extent and depth of disease can help the oral physician decide the appropriate management strategy. Moreover, timely detection also helps improve the outcome in individuals affected by oral cancer. Early cancers are treated with a single modality, such as surgery or radiotherapy. On the other hand, advanced cancers need a combination of surgery, radiotherapy, and chemotherapy. Hence, prompt evaluation of oral cancer can be life-saving in cancer patients.
What Are the Various Steps in Oral Cancer Evaluation?
A. Obtaining History: A careful history taken by the dentist ensures all diagnostic possibilities for the patient. History is mandatory before establishing a definitive diagnosis (disease determination). In addition, it also provides near estimates of the patient's prognosis while aiding in planning the treatment strategy.
B. Assessing the Oral Cavity Anatomy: The oral physician must assess the oral cavity thoroughly. It is essential to know the mouth anatomy to understand the involvement of the oral cavity. The oral cavity extends from the lips, gums, and teeth to the papillae on the tongue. The oral cavity is divided into “the oral cavity proper” and “the vestibule.” The oral cavity proper consists of the tongue, the hard palate, the lateral walls (upper and lower jaw bone covered by gum mucosa), and the floor of the mouth. The oral vestibule is a space comprising the cheek mucosa on the sides. The importance of the assessment of oral anatomy by the dentist is that SCC arising from the cheek mucosa may spread to other regions.
C. Physical Examination: The oral physician correlates the physical findings with the patient's clinical presentation and plans treatment by inspecting and palpating (feeling) the suspected or involved area of cancer. Special attention is given to the abnormalities of the texture and color evident in the oral cavity.
D. Medical Examination: The oral physician reviews the medical records, past medical history, and the results of laboratory and biopsy/cytology tests. Communication with the patient's primary care physician can help the examiner identify possible medical comorbidities. Assessment of lymph nodes (cluster of immune system cells) is further done according to the staging and grading that helps in treatment planning. The advent of fiberoptic techniques and video examination is beneficial in educating patients. Following the medical examination, the disease changes are explored by biopsy (removal of tissue and microscopic visualization), cytology (cell study), or exfoliative cytology (study of the cells that shed). Furthermore, staining of the tissues is an important adjunct for investigating oral cancer. The dyes stain nucleic acids and abnormal cancer tissues. Staining has been used for a long time in the identification of cervical mucosal abnormalities and oral cavity cancer.The severity of the co-morbidity is determined by the patient's complaints and objective findings (the doctor elicits) that indicate a definitive prognosis.
E. Identifying Metastasis: Head and neck cancers are considered regional diseases which tend to spread to adjacent tissues (local metastasis). Hence, it is important that the dentist does not overlook the possibility of distant metastasis in the patient.
F. Psychosocial Assessment: Many oral cancer patients may suffer mental fears associated with disfigurement compared to other cancer patients. Further, they may also have feelings of stigma and social embarrassment. The dentist and family’s moral support is essential to boost the patient’s confidence and prevent the stigma regarding the disfigurement. The physician must also address low self-esteem and self-image concerns.
G. Addressing the Psychosocial Concerns Associated With Habits: Many oral cancer patients are associated with tobacco or alcohol abuse. These risk factors are capable of creating a negative psychosocial impact. While alcohol abuse can lead to psychological problems in patients during cancer treatment, tobacco abuse patients can have a poor postoperative prognosis if they continue the detrimental habit. Hence, cessation of undesirable habits should be initiated by the physician. One must note that nicotine (an addictive substance present in tobacco) withdrawal may lead to anxiety, sleep disturbance/ insomnia, and headache. Hence, appropriate counseling helps encourage patients to participate in the planned treatment.
H. Radiographic Examinations: Computed tomography (CT), cone beam computed tomography (CBCT), and magnetic resonance imaging (MRI) are important radiographic modalities used by dentists and concerned doctors to stage, determine, and study the extent of cancer growth in the jaw and bony erosions.
Conclusion
To conclude, the evaluation of proper oral hygiene status can prevent the rising risk of oral cancers globally. It is because the timely detection of oral cancer can increase the probability of cure and success rates of treatment along with decreased impairment and facial deformity. Regardless of the outcome of these steps, newer technology and its marketing can positively impact dentistry by encouraging clinicians to routinely perform thorough oral cancer exams.
