Mouth cancer

Generality

Mouth cancer is a malignant neoplastic process that can affect any part of the oral cavity: gums, tongue, internal mucosa of the cheeks, palate, lips, salivary glands and oral floor.

Figure: depiction of the mouth and its main anatomical structures. From the site: foodpyramid.com

The precise causes are unknown, but according to researchers, tobacco, alcohol abuse, excessive exposure to sunlight and human papilloma virus infection play a fundamental role.

The symptoms of malignant tumors in the mouth are numerous and range from a persistent sore throat to leukoplakia.

Treatment includes tumor removal surgery, radiation therapy and sometimes even chemotherapy.

What is mouth cancer?

Mouth cancer is a malignant neoplasm that can affect the lips or any part of the oral cavity. Therefore, it can be formed at the level of:

Gums (cancer of the gums)
Language ( tongue tumor )
Inner wall of the cheeks (tumor of the oral mucosa)
Palate (tumor on the palate)
Oral floor (oral floor tumor)
Lips (lip cancer)
Salivary glands (salivary gland tumor)

WHAT IS A TUMOR?

In medicine, the term tumor identifies a mass of very active cells, able to divide and grow uncontrollably.

We speak of a benign tumor when the growth of cell mass is not infiltrative (that is, it does not invade the surrounding tissues) and even metastasizing.
One speaks instead of malignant tumor when the abnormal cell mass has the ability to grow very quickly and to spread to the surrounding tissues and the rest of the body.

Figure: tongue tumor.

From the site: en.wikipedia.org

The terms malignant tumor, cancer, carcinoma and malignant neoplasia are to be considered synonymous; therefore, cancer (malignant) in the mouth is also known as mouth cancer (or oral cancer) and as a carcinoma in the mouth (or oral carcinoma).

WHAT KIND OF CANCER IS IT?

Usually, mouth cancer is a spinocellular carcinoma (or squamous carcinoma ).

Spinocellular carcinomas are malignant tumors of the skin, other than melanoma, which originate in squamous cells (which, although devoid of keratin, are also present at the level of the oral mucosa).

Less commonly, mouth cancer has the same characteristics as Kaposi's sarcoma .

Epidemiology

In 2010, 124, 000 people died of mouth cancer worldwide. Twenty years ago, in 1990, there were 82, 000. Therefore, there has been a significant increase in mortality.

According to a German study, referring to Germany, the 5-year survival from the diagnosis of oral cancer is 55%.

In the United Kingdom, throat cancer is the 16th most common cancer and the 19th cause of cancer death. Its mortality rate exceeds that of more well-known cancers, such as Hodgkin's lymphoma, testicular cancer, laryngeal cancer and malignant melanoma.

Causes

Like any malignant neoplasm, even mouth cancer is the result of a series of genetic mutations that affect the DNA of the cells (in this case those that make up the tissues of the oral cavity).

These mutations, which usually affect only one cell, are responsible for the uncontrolled process of division and growth that characterizes a tumor.

But what triggers the DNA mutations responsible for the neoplastic process? The precise causes of these genetic alterations are currently unknown. However, doctors believe that a key role is played by:

Tobacco, in whatever way it is used. So cigarette, cigars, pipes, chewing tobacco etc.
Alcohol abuse
An excessive exposure to the UV rays of the sun, which favor the appearance of tumors on the lips.
Human papilloma virus (HPV) infections

Symptoms

Figure: mouth cancer in a person who has made extensive use of tobacco.

From the site: en.wikipedia.org

The typical symptoms and signs of mouth cancer are:

Persistent sore throat
Formation of an external swelling (on the skin) or inside the mouth.
Teeth fall
Appearance of white ( leukoplakia ) or red ( eritroplachia ) spots inside the mouth
Jaw pain and stiffness
Pain and difficulty during swallowing
Pain and difficulty during chewing
Sensation of something in the throat
Changes in tone of voice and difficulty speaking
Unusual blood loss from the mouth
Pain in holding the denture
Body weight loss

WHEN TO REFER TO THE DOCTOR?

It is advisable to contact your doctor if one or more of the above symptoms persist for more than two weeks.

Diagnosis

The diagnosis of a mouth tumor begins with a thorough physical examination, during which the doctor looks for and analyzes the abnormalities of the oral cavity. This is followed by a buccal biopsy, an endoscopy of the throat and diagnostic imaging tests.

BIOCIA BUCCALE

Buccal biopsy consists in the collection and analysis in the laboratory of a sample of cells from the tumor mass.

ENDOSCOPY AND EXAMINATIONS OF DIAGNOSTICS FOR IMAGES

Endoscopy and imaging are used to analyze the characteristics and severity of the tumor.

Endoscopy . Thanks to an instrument equipped with light and a camera (endoscope), the doctor inspects the patient's mouth and throat, to try to understand how far the tumor has spread.

Diagnostic imaging . Through CT (computerized axial tomography), nuclear magnetic resonance, X-ray or PET (positron emission tomography), the doctor can see if the tumor has spread to the neighboring lymph nodes and other organs of the body (tumor metastases).

TACs, X-rays and PET foresee an exposure to a very low dose of harmful ionizing radiation.

The severity of a tumor - which depends on the size of the neoplastic mass and the ability of the tumor cells to spread - can be classified into 4 stages, distinguished from each other by the first four Roman numerals. Stage I identifies the least severe tumors, confined to a precise location; Stage IV, on the other hand, identifies the most severe tumors, common in the lymph nodes and in the other organs of the body (usually the liver). Stages II and III identify tumors of intermediate severity.

Treatment

The type of therapy to be taken in case of mouth cancer varies depending on:

Location and stage of neoplasia
State of health of the patient

In general, the patient undergoes surgery (to remove the tumor mass), assisted by subsequent radiotherapy and chemotherapy treatments.

SURGERY

For stage I tumors, surgery is generally limited to removing the tumor; if instead the neoplastic mass has infiltrated the tissues of the neck (as happens in the most advanced tumor stages), the lymph nodes must also be removed.

Furthermore, since the operation may require the removal of part of the tongue, teeth, jaw etc., a reconstruction of the face may be necessary. For this purpose, the surgeon could perform grafts of skin, teeth or bones, not only for purposes and aesthetics, but also for a functional reason: it may happen, in fact, that the operated patients are unable to speak, chew, feed properly etc., due to the large resection of the tissues of the mouth.

RADIOTHERAPY

Radiation therapy involves exposing the tumor mass to a certain dose of high-energy ionizing radiation (X-rays), which are designed to destroy neoplastic cells.

Generally, it is practiced after surgery and may be associated with chemotherapy. If there are relapses due to safety issues, radiotherapy can be repeated.

CHEMOTHERAPY

Chemotherapy is the administration of drugs that can kill rapidly growing cells, including cancer cells.

Main side effects of chemotherapy

Main side effects of radiotherapy

Nausea

He retched

Hair loss

Sense of fatigue

Vulnerability to infections

Teeth fall

Sense of fatigue

Mandibular stiffness

Inflammation of the mouth

Bleeding gums

Dry mouth

OTHER ANTITUMOR DRUGS

There are anticancer drugs, such as Cetuximab, which act specifically against neoplastic cells, as these have very specific characteristics, different from those of healthy cells.

SOME IMPORTANT THERAPEUTIC RULES

In the case of mouth cancer, doctors advise against smoking and not drinking alcohol ; in fact, in addition to predisposing to neoplasms, these habits would slow down (especially tobacco) the healing process.

Prevention

Since the precise causes of mouth cancer are unknown, it is difficult to determine which is the most appropriate prevention. However, it is certainly useful:

Stop using tobacco or just avoid using it . The tobacco contains chemicals that are toxic to the cells of the mouth. The best thing would be to never start smoking.
Drink alcohol in moderate amounts and don't drink at all . Alcohol, especially when taken in large quantities and for long periods of time, is harmful to the cells of the mouth.
Eat fruits and vegetables . According to some scientific studies, fruits and vegetables contain vitamins and antioxidants that partially protect the cells of the mouth (and in general the whole organism) from tumors.
Avoid excessive exposure to sunlight . It is a good idea to avoid summer burns; do not expose yourself to the sun in the central hours of the hottest days; and finally, protect yourself with the appropriate sun protection creams.
Undergo a periodic dental check . Most mouth cancers are diagnosed by dentists, who, during follow-up visits, thoroughly inspect every area of the oral cavity.

Prognosis

The prognosis of oral cancer depends on the stage of the tumor at the time of surgery; in fact, a stage I mouth cancer is obviously more likely to be successfully treated, compared to a stage III or IV mouth cancer.

Complications of a tumor in the mouth: