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Posted On : 04 Jan 2007

Oral cancer involves abnormal, malignant tissue growth in the mouth. Oral Cancer is a disease that starts as an uncontrolled growth of cells in the mouth. It leads to disfigurement of the face, debility of body and eventually death.

Causes, incidence, and risk factors
Oral or mouth cancer most commonly involves the tissue of the lips or the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinomas. These are malignant and tend to spread rapidly.

Smoking and other tobacco use are associated with 70-80% of oral cancer cases. Smoke and heat from cigarettes, cigars, and pipes irritate the mucous membranes of the mouth. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes. Heavy alcohol use is another high-risk activity associated with oral cancer.

Other risks include poor dental and oral hygiene and chronic irritation (such as that from rough teeth, dentures, or fillings). Some oral cancers begin as leukoplakia or mouth ulcers. Oral cancer accounts for about 8% of all malignant growths. Men are affected twice as often as women, particularly men older than 40.

Is it very common?
Oral cancer is the most common of cancers in India with as many as 64,460 cases reported each year. That makes it as common as cancer of the lungs, breast or cervix. As much as 7% of all cancer deaths in males and 4% in females have been reported to be due to oral cancer. The figure continues to rise rapidly because of bad oral habits such as chewing of gutka, tobacco, and smoking.

What are the early warning signs?
A white or red patch in the mouth or on the tongue, a painless ulcer which doesn't heal for over two weeks, difficulty in eating, drinking and speaking are some of the early signs of oral cancer. If these symptoms appear, you must see your dentist immediately.

Symptoms
Skin lesion, lump, or ulcer:

• On the tongue, lip, or other mouth area
• Usually small
• Most often pale colored, may be dark or discolored
• May be a deep, hard edged crack in the tissue
• Usually painless initially
• May develop a burning sensation or pain when the tumor is advanced

Additional symptoms that may be associated with this disease:

• Tongue problems
• Swallowing difficulty
• Mouth sores
• Abnormal taste

Signs and tests
An examination of the mouth by the health care provider or dentist shows a visible or palpable (can be felt) lesion of the lip, tongue, or other mouth area. As the tumor enlarges, it may become an ulcer and bleed. Speech difficulties, chewing problems, or swallowing difficulties may develop, particularly if the cancer is on the tongue.

A tongue biopsy, gum biopsy, and microscopic examination of the lesion confirm the diagnosis of oral cancer.

To perform the oral cancer self examination, just follow these 7 easy steps.

1. Head and Neck

   • Look at your face and neck in a mirror. Normally, the left and right sides of the face have the same shape. Look for any lumps, bumps, or swellings that are only on one side of your face.

2. Face

   • Examine the skin on your face. Do you notice any color or size changes, sores, moles, or growths?

3. Neck

   • Press along the sides and front of the neck. Do you feel any tenderness or lumps?

4. Lips

   • Pull your lower lip down and look inside for any sores or color changes. Next, use your thumb and forefinger to feel the lip for lumps, bumps, or changes in texture. Repeat this on your upper lip.

5. Cheek

   • Use your fingers to pull out your cheek so you can see inside. look for red, white, or dark patches. Put your index finger on the inside of your cheek and your thumb on the outside. Gently squeeze and roll your cheek between your fingers to check for any lumps or areas of tenderness. Repeat this on the other cheek.

6. Roof of the Mouth

   • Tilt your head back and open your mouth wide to see it there are any lumps or if the color is different than usual. Run your finger on the roof to feel for lumps.

7. Floor of the Mouth and Tongue

   • Stick out your tongue and look at the top surface for color and texture. Gently pull your tongue forward to look at one side first and then the other. Look for any swellings or color changes. Examine the underside of your tongue by placing the tip of the tongue on the roof of your mouth.

Look at the floor of your mouth and the underside of your tongue for color changes that are very different from what is normal. Gently press your finger along the underside of your tongue to feel for any lumps or swellings.

If you find anything out of the ordinary, particularly anything that does not heal or go away in two weeks, or that has recently changed, discuss it with your oral health professional or physician.

Early Clinical Indicators
A good dentist is trained to recognize the clinical symptoms of an early oral cancer:

• Leukoplakia
  It is raised white patch, which is associated with the constant chewing of tobacco and gutka. 2.8% of oral Leukoplakia results in cancerous growths.

• Oral submucous fibrosis
  It is the inability to open the mouth and /or a burning sensation which affects 9 per 10,000 Indians.

• Lichen Planus
  It is a deficiency of iron very common in India, which can lead to the development of oral cancer.

Treatment
If detected early, oral cancer is curable. The smaller the ulcer or affliction, the better the chances of cure.

Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough. Radiation therapy and chemotherapy would likely be used when the tumor is larger or has spread to lymph nodes in the neck. Surgery may be necessary for large tumors.

Rehabilitation may include speech therapy or other therapy to improve movement, chewing, swallowing, and speech.

Complications

• Postoperative disfigurement of the face, head and neck
• Complications of radiation therapy, including dry mouth and difficulty swallowing
• Other metastasis (spread) of the cancer

Prevention

• Minimize or avoid smoking or other tobacco use.
• Minimize or avoid alcohol use.
• Practice good oral hygiene.
• Have dental problems corrected.

• Have the soft tissue of the mouth examined once a year. Many oral cancers are discovered by routine dental examination.

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