Oral cancer

Oral cancer is a prevalent form of cancer influenced by various risk factors, which can be categorized into the following groups:

Modifiable Factors:

• Tobacco Use: Includes both smoking and chewing, which is the leading cause of head and neck cancers, contributing to approximately 85% of cases.
• Betel Quid: Commonly used in some regions, it significantly increases the risk of oral cancer.
• Alcohol Consumption: Excessive alcohol intake raises the likelihood of developing oral cancer.
• Diet and Nutrition: Poor dietary habits and nutritional deficiencies may contribute to the disease.
• Mouthwash: Some types of mouthwash containing alcohol have been linked to an increased risk.
• Maté: A tea-like beverage, frequently consumed in certain cultures, is considered a potential risk factor.
• Poor Oral Health: Inadequate dental care and hygiene can elevate the chances of developing oral cancer.

Non-Modifiable Factors:

• Family History: A family history of oral cancer increases the risk.
• Gender: Men are more prone to oral and oropharyngeal cancers compared to women.
• Fair Skin: Individuals with fair skin have a higher susceptibility to lip cancer.
• Age: Although oral cancer can occur at any age, it is more frequently diagnosed in people over 45.

Environmental Factors:

• Viral Infections: HPV, Epstein-Barr Virus (EBV), and Herpes Simplex Virus Type 1 (HSV-1) have been linked to oral cancers.
• Fungal Infections: Certain fungal infections may also contribute to the development of oral cancer.
• Prolonged Sun Exposure: Increases the risk of lip cancer.
• Syphilis: This sexually transmitted infection can raise the risk of oral cancer.
• Radiation Exposure: Prior radiation treatments may elevate the likelihood of oral cancer.
• Immunosuppression: A weakened immune system increases the risk of oral cancer.

Detecting oral cancer at an early stage significantly improves the chances of successful treatment. The TNM staging system (Tumor, Node, and Metastasis) is commonly used for classifying mouth cancer, as follows:

Primary Tumor (T):

• TX: Tumor cannot be evaluated.
• T0: No visible signs of the primary tumor.
• Tis: Carcinoma in situ (CIS) – abnormal cells are present only in the location where they initially developed.
• T1: Tumor size is 2 cm or smaller.
• T2: Tumor measures between 2 cm and 4 cm.
• T3: Tumor is larger than 4 cm.
• T4a: Indicates moderate local disease progression.
• T4b: Represents advanced local disease.

Regional Lymph Nodes (N):

• NX: Lymph nodes cannot be assessed.
• N0: No signs of cancer spread to regional lymph nodes.
• N1: Cancer has spread to a single lymph node (ipsilateral), measuring 3 cm or less.
• N2: Categorized into:
• N2a: Cancer in one ipsilateral lymph node larger than 3 cm but no more than 6 cm.
• N2b: Multiple ipsilateral lymph nodes affected, none exceeding 6 cm.
• N2c: Cancer in bilateral or contralateral lymph nodes, none larger than 6 cm.
• N3: Cancer in a lymph node larger than 6 cm.

Diagnostic Methods

Physical Examination:

• External Examination: The doctor inspects the external areas such as the lymph nodes, salivary glands, and lips for abnormalities.
• Internal Examination: The inside of the mouth is checked for signs of swelling, thickening, or irregularities.

Histopathological Examination:

• Vital Staining Techniques: Tolonium chloride (toluidine blue) is used to detect mucosal abnormalities in the oral cavity.
• Biopsy: A sample of tissue is surgically extracted from the affected area and analyzed under a microscope.
• Brush Biopsy: Cells are collected by scraping the surface of the lesion for examination.
• Exfoliative Cytology: A non-invasive method where cells are collected from the oral mucosa for early cancer detection.
• Incisional Biopsy: A representative tissue sample is carefully selected and removed for precise diagnosis.

Imaging Techniques:

• Magnetic Resonance Imaging (MRI): Provides detailed images of the oral structures and adjacent areas. MRI is effective in evaluating the extent of local and regional tumor spread and lymph node involvement.
• Computed Tomography (CT): Uses X-rays and a computer to create cross-sectional images of the body, helping to locate the tumor and assess its spread.
• Positron Emission Tomography (PET): Identifies the spread of cancer cells to lymph nodes or other parts of the body.
• Radiological Techniques: X-rays, such as orthopantomogram (OPG), are used to detect the spread of cancer to nearby organs.
• Optical Imaging Techniques: Include optical coherence tomography and tissue fluorescence imaging, which effectively differentiate between cancerous and non-cancerous tissues.

Biomarker Detection:

• Biomarkers play a vital role in the early identification of oral cancer.
• These are cellular components present in body fluids or tumors that are overexpressed during the disease's onset.

Other Diagnostic Techniques:

• Recent technological advancements have introduced rapid and accurate methods for detecting cancer biomarkers, including:
• Raman Spectroscopy: A non-invasive technique that provides detailed chemical information about tissues without damaging them.
• Confocal Microscopy: A light-based imaging method that offers high-resolution images of cellular and structural features, aiding in the diagnosis of squamous cell carcinoma (SCC).

Distant Metastasis (M):

• MX: Metastasis cannot be assessed.
• M0: No distant metastasis detected.

Although the precise cause of oral cancer remains unclear, its development is often influenced by multiple factors. Adopting a healthy lifestyle is the most effective way to reduce the risk of cancer. Other preventive measures include:

1. Undergo Regular Cancer Screenings

Early cancer detection allows for more successful and cost-effective treatment, lowering the chances of cancer-related complications and fatalities.

Contrary to popular belief, cancer is not always fatal. It can be treated and even cured, especially when identified early and managed with appropriate medical care.

2. Self-Examine Your Oral Cavity

• Use a flashlight to inspect the inside of both cheeks.
• Feel the areas with your fingers for any irregularities.
• Check the floor of your mouth (beneath the tongue) with a flashlight and gently probe the area with your fingers.
• Stick out your tongue and examine the top, sides, and underside with a flashlight.

3. Regular Dental Check-Ups

Routine dental visits can help detect abnormal lumps, sores, or irregularities early, enabling timely intervention and improving the likelihood of successful treatment.

4. Avoid Tobacco in All Forms

Chewing or smoking tobacco significantly increases the risk of oral cancer. Smokeless tobacco products can cause leukoplakia—grayish-white patches in the mouth—which may become cancerous over time.

5. Reduce Alcohol Consumption

Frequent or heavy alcohol use is linked to an increased risk of oral and oropharyngeal cancers. Reducing or eliminating alcohol intake can significantly lower the chances of developing these cancers.

6. HPV Vaccination

The human papillomavirus (HPV), particularly HPV16, is associated with oropharyngeal cancers, mainly at the back of the mouth. Getting vaccinated before becoming sexually active is the most effective way to prevent HPV infection. Safe sexual practices also help reduce transmission.

7. Protect Lips from Sun Exposure

• Avoid direct sunlight during peak hours.
• Use a lip balm with SPF protection when outdoors.
• Reapply the balm after eating or drinking.
• Wear wide-brimmed hats to shield your face from the sun.

8. Consider Chemoprevention

Chemoprevention involves using specific medications or substances to reduce the risk of developing cancer or prevent its recurrence.

9. Incorporate Probiotics into Your Diet

Probiotics are beneficial microorganisms that may offer protection against cancer by modulating immune responses and inhibiting cancer cell activity.

10. Take Protective Supplements

Certain dietary supplements, such as vitamins C, E, and A, omega-3 fatty acids, and carotenoids, are believed to help reduce the risk of oral cancer.

Specialists Involved in Oral Cancer Care

Since cancer is a complex condition, it requires a multidisciplinary team of healthcare professionals to provide comprehensive care. Specialists involved in oral cancer diagnosis and treatment include:

• Dentists: They can detect early signs of oral cancer during routine check-ups, improving the chances of early diagnosis and successful treatment.
• Otolaryngologists (ENT specialists): Experts in conditions affecting the ears, nose, and throat, they play a key role in diagnosing and managing oral cancers.
• Oncologists: Physicians specializing in cancer diagnosis and treatment, including formulating individualized care plans.
• Radiation Oncologists: Doctors who specialize in using radiation therapy to treat cancer.
• Medical Oncologists: Physicians who use chemotherapy, immunotherapy, and targeted therapy to treat cancer.

Treating oral cancer typically involves a combination of surgery, chemotherapy, and radiation, depending on the stage and severity of the disease.

1. Surgical Treatment

• Primary Tumor Surgery: Early-stage tumors are often treated with surgery alone, while advanced cases may require surgery followed by chemoradiotherapy. The surgical approach depends on the tumor's size and location.
• Neck Dissection Surgery: This procedure is used to assess and remove lymph nodes that may be affected by cancer, helping to prevent further spread.

Other surgical procedures include:

• Glossectomy: Partial or complete removal of the tongue.
• Mandibulectomy: Surgical removal of part of the jawbone affected by cancer.
• Maxillectomy: Removal of all or part of the bony roof of the mouth (maxilla).

2. Surgery for Recurrence

Recurrent oral cancer occurs in approximately 30% of cases. Salvage surgery, also known as rescue surgery, is performed when initial treatments fail to control the cancer.

3. Reconstruction Procedures

Reconstructive surgery aims to restore the form and function of the oral cavity, addressing speech, swallowing, and appearance concerns. The procedure is customized according to the site and extent of the defect.

4. Radiation Therapy

Radiotherapy uses high-energy rays to destroy or damage cancer cells. It is typically used for locally advanced oral cancers.

Types of radiation therapy include:

• External-beam radiation: Delivered from a machine outside the body, this is the most common form of radiation therapy.
• Internal radiation (brachytherapy): This involves placing radioactive implants near the tumor site to deliver concentrated doses of radiation.

5. Chemotherapy

Chemotherapy uses anti-cancer medications that circulate through the bloodstream to target cancer cells throughout the body.

Commonly used drugs include:

• Cisplatin
• Carboplatin
• 5-Fluorouracil (5-FU)
• Paclitaxel (Taxol)
• Docetaxel (Taxotere)
• Hydroxyurea

Less frequently used medications:

• Methotrexate
• Capecitabine

Types of chemotherapy:

• Adjuvant chemotherapy: Administered after surgery (sometimes with radiation) to eliminate any remaining cancer cells and reduce recurrence risk.
• Neoadjuvant chemotherapy: Given before surgery (sometimes with radiation) to shrink larger tumors, making them easier to remove.

6. Chemoradiation

Chemoradiation refers to the simultaneous use of chemotherapy and radiation therapy. This combination is effective for shrinking tumors that are too advanced for surgery but have not metastasized extensively.

7. Targeted Therapy

This treatment uses drugs designed to specifically target proteins or molecules that promote cancer growth, slowing down or destroying the cancer cells.

The most commonly used targeted therapy drug for oral cancer is:

• Cetuximab

8. Immunotherapy

Immunotherapy enhances the body's immune system, helping it identify and destroy cancer cells more effectively. This treatment generally focuses on specific proteins involved in immune regulation, boosting the body's natural defenses.

Oral cancer can lead to complications due to the disease itself or as a result of treatments such as surgery, chemotherapy, or radiation. These complications include:

1. Surgical Complications

• Failure of the tissue flap used for reconstruction
• Nerve damage, leading to sensory or motor issues
• Vocal cord paralysis
• Restricted jaw movement
• Impaired speech
• Poor wound healing
• Prolonged need for feeding tubes
• Extended stays in intensive care units

2. Chemotherapy or Radiation Complications

• Pain and inflammation of the mouth’s mucosa
• Bleeding
• Osteoradionecrosis (bone death due to radiation)
• Persistent dry mouth (xerostomia)
• Difficulty with swallowing and speaking
• Reduced oral intake, causing malnutrition
• Increased risk of infections due to weakened immunity

When considering complementary or alternative treatments, it is essential to consult with healthcare providers, as some therapies may interfere with conventional treatments. One promising alternative therapy is:

Photodynamic Therapy (PDT)

PDT uses a photosensitizing agent that becomes active when exposed to specific wavelengths of light, helping destroy cancer cells.

• Effective for superficial tumors (up to 2 mm deep)
• For deeper tumors (more than 10 mm), interstitial PDT (iPDT) can be applied
• Note: PDT is only a supportive therapy and does not replace standard medical treatments.

Various plant-based products are traditionally used as home remedies and dietary supplements, offering potential anti-cancer benefits. Some of the herbs known for their cancer-fighting properties include:

• Turmeric (Haldi): Contains curcumin, which inhibits tumor activity, thereby reducing tumor growth and metastasis.
• Ginger (Adrak): Exhibits therapeutic potential for treating UV-induced skin conditions, including lip cancer.
• Saffron (Kesar): Demonstrates antioxidant, anti-inflammatory, anti-cancer, antidepressant, and memory-enhancing effects in animal studies.
• Cinnamon (Dalchini): Known for its antibacterial, anti-inflammatory, antioxidant, anti-diabetic, and anti-tumor properties.

Coping with oral cancer can be challenging, but a strong support system and positive mindset can significantly improve quality of life. Here are some helpful tips:

1. Seek Emotional Support

Receiving an oral cancer diagnosis can lead to stress, anxiety, or depression. Emotional support from family, friends, religious groups, support networks, or professional counselors can be beneficial.

2. Prioritize Post-Treatment Follow-ups

Regular follow-ups are essential to detect recurrences or new cancers early.

Typical follow-up schedule:

• Every 1–3 months during the first year
• Every 2–6 months during the second year
• Every 4–8 months during the third to fifth years
• Annually after the fifth year

3. Emphasize Palliative Care

Oral cancer can cause physical, emotional, and spiritual distress. Palliative care focuses on symptom management and enhancing the patient’s quality of life.

Supportive measures include:

• Pain management
• Nutritional guidance
• Emotional and spiritual counseling
• Participation in enjoyable activities

4. Quit Smoking

Tobacco use significantly increases the risk of oral cancer recurrence. Quitting smoking is essential, even for those with early-stage cancer, as it lowers the likelihood of developing another smoking-related cancer.

5. Rehabilitation is Key

Cancer treatments can affect speech, swallowing, and hearing. Rehabilitation therapies can help patients regain these functions:

• Speech Therapists: Assist with speech and swallowing difficulties
• Audiologists: Address hearing impairments caused by treatment

6. Maintain Medical Records and Health Insurance

Keeping organized medical records and maintaining health insurance coverage is crucial for ongoing care, follow-ups, and handling any unexpected expenses.

7. Manage Cancer-Related Expenses

Cancer treatment can be financially draining. Patients and their families can seek financial aid through social workers, government grants, or non-profit organizations. These resources can help reduce the financial burden.

Tips for Caregivers

• Offer emotional and mental support
• Understand the treatment plan and its effects
• Communicate with empathy and positivity
• Assist with household chores and daily activities
• Manage insurance claims and handle billing matters
• Ensure timely administration of medications and assist with symptom management
• Help the patient maintain personal hygiene and care
• Accompany the patient to medical appointments