Oral Cancer - Symptoms, Causes, Images, Stages & Treatment

Oral cancer is a malignancy that occurs in the mouth and oral cavity. It typically manifests as abnormal growths or sores that do not heal and may cause pain or difficulty in swallowing.

It often develops in the tissues of the mouth and oral cavity, including the lips, tongue, gums, inner cheeks, roof and floor of the mouth, and tonsils. It arises from the uncontrolled growth of abnormal cells in these areas.

Oral cancer can be classified into different types based on the type of cell where the cancer originates and the specific location within the oral cavity. Understanding these distinctions is important for accurate diagnosis and appropriate treatment planning. 

Here are the types of oral cancer.

1. Squamous Cell Carcinoma: This is the most common type of oral cancer, accounting for most cases. 

1. It develops from the thin, flat cells called squamous cells that line the oral cavity, including the lips, tongue, gums, and the inner lining of the cheeks and throat.

2. Sarcoma Cells: Sarcoma is a rare oral cancer that arises in the connective tissues, such as muscles, bones, blood vessels, or fat. 

1. Unlike squamous cell carcinoma, sarcomas in the oral cavity are less common.

3. Adenocarcinoma: Adenocarcinoma is a less common type of oral cancer that arises from the salivary glands.

1. It can occur in major salivary glands, such as the parotid gland, or in minor salivary glands found throughout the oral cavity.

2. Adenocarcinoma may present as a painless mass or swelling in the affected gland.

4. Mucoepidermoid Carcinoma: Mucoepidermoid carcinoma is another type of oral cancer originating from the salivary glands.

1. A combination of mucous-producing and squamous cells characterises it.

2. Mucoepidermoid carcinoma can occur in major or minor salivary glands, and its behaviour can range from low-grade to high-grade malignancy.

5. Verrucous Carcinoma: Verrucous carcinoma is a rare subtype of oral cancer, accounting for approximately 5% of cases.

1. It is characterised by a slow-growing, warty, or cauliflower-like growth on the oral mucosa.

2. Verrucous carcinoma is less aggressive than other types of oral cancer and tends to have a better prognosis.

Types of oral cancer as per region:

1. Tongue Cancer: Tongue cancer refers to cancer that develops on the surface or underneath the tongue.

1. It can occur on the tongue's front, back, or sides.

2. The most common type of tongue cancer is squamous cell carcinoma, often associated with risk factors like tobacco and alcohol use.

2. Lip Cancer: Lip cancer refers to cancer that develops on the lower or upper lip.

1. It is more common in individuals with prolonged exposure to sunlight, especially the lower lip.

2. Two main lip cancer types include squamous and basal cell carcinoma.

3. Buccal Mucosa Cancer: Buccal mucosa cancer, also known as cheek cancer, develops on the inner lining of the cheeks.

1. It can present as a whitish or reddish patch, ulcer, or growth in the mouth.

2. The most common type of buccal mucosa cancer is squamous cell carcinoma.

4. Gum Cancer: Gum cancer, also called gingival cancer, develops on the gums or gingiva.

1. It can cause swelling, pain, or bleeding in the affected area.

2. Squamous cell carcinoma is the most common type of gum cancer.

5. Palate Cancer: Palate cancer develops on the roof of the mouth, including the hard palate (front part) and the soft palate (back part).

1. It can present as a sore or growth that doesn't heal.

2. Squamous cell carcinoma is the most common type of palate cancer.

6. Oropharyngeal Cancer: Oropharyngeal cancer refers to cancer that develops in the back of the throat, including the tonsils and base of the tongue.

1. It is often associated with risk factors like tobacco and alcohol use, as well as human papillomavirus (HPV) infection.

2. Squamous cell carcinoma is the most common type of oropharyngeal cancer.

Oral Cancer Stages

Oral cancer is staged to determine the extent of the disease and guide treatment decisions. Staging helps healthcare professionals understand the size of the tumour, its spread to nearby tissues or lymph nodes, and whether it has metastasised to other parts of the body. 

The TNM system is employed to classify oral cancer stages based on the size and location of the primary tumour (T), the presence of lymph node involvement (N), and the presence of distant metastasis (M). 

The oral cancer stages are determined by the size of the tumour, as follows:

1. Stage 0 (Carcinoma in situ): This stage indicates abnormal cells are only present in the top layer of cells lining the oral cavity. Cancer has not invaded deeper tissues or spread to nearby lymph nodes or distant sites.

2. Stage I: In this stage, the tumour is small (2 cm or less) and confined to the primary site. Cancer has not spread to nearby lymph nodes or distant sites.

3. Stage II: The tumour is larger (2 to 4 cm) but still localised to the primary site. Cancer has not spread to nearby lymph nodes or distant sites.

4. Stage III: In this stage, the tumour is larger (>4 cm) and may have invaded nearby tissues or structures. Cancer may have spread to nearby lymph nodes but not to distant sites.

5. Stage IV: Stage IV is divided into two subcategories: IVA and IVB.

1. Stage IVA indicates a locally advanced tumour with extensive invasion of nearby tissues or structures.

2. Stage IVB indicates cancer that has spread to nearby lymph nodes or distant sites such as the lungs, liver, or bones.

It is essential to understand oral cancer symptoms as knowing the symptoms of oral cancer may help individuals identify potential issues and seek prompt medical attention. 

Here are the most common symptoms of oral cancer:

1. ​​Soreness in the Face, Neck, or Mouth: Persistent soreness in the face, neck, or mouth areas can indicate a potential oral health concern.
   It may manifest as a dull ache, tenderness, or discomfort that doesn't subside with time.

2. Difficulty Chewing or Swallowing: Oral cancer can impact the functionality of the mouth and jaw, leading to difficulties in basic functions such as chewing, swallowing, speaking clearly, and even moving the jaw or tongue properly.

3. Hoarseness or Chronic Sore Throat: Individuals experiencing persistent hoarseness or a chronic sore throat that doesn't improve with time or standard remedies should consult a healthcare professional for a thorough evaluation.

4. Ear Pain: Oral cancer can sometimes cause referred pain in the ears. A healthcare provider should examine unexplained or persistent ear pain to rule out underlying conditions.

5. Swellings on the Lips or Gums: Visible abnormalities such as swelling on the lips or gums can be potential signs of oral cancer.
   It is advised to regularly check the oral cavity for any unusual growths or changes in texture and seek professional advice if detected.

6. Swelling or Pain in the Jaw: Persistent swelling or pain in the jaw area can indicate oral health problems, including oral cancer.
   It's crucial to have such symptoms assessed by a healthcare professional to determine the underlying cause and receive appropriate treatment.

7. Changes in Alignment of the Teeth or Dentures: Oral cancer can cause changes in the alignment and positioning of the teeth or dentures.
   If there is a sudden or unexplained change in how teeth or dentures fit together, it is advisable to seek dental evaluation for further assessment.

8. Velvety White or Red Patches in the Mouth: Oral cancer may manifest as velvety white or red patches inside the mouth, known as leukoplakia and erythroplakia, respectively. 

1. These patches can be persistent and fail to resolve on their own. 

2. Oral cancer images can provide visual references for identifying these abnormal patches. 

9. Numbness in the Face, Mouth, or Neck: Oral cancer may lead to a loss of sensation or numbness in the affected areas.
   If there is persistent numbness or loss of feeling in the face, mouth, or neck, it's important to seek medical attention for further evaluation.

10. Unexplained bleeding: Bleeding from the mouth that occurs spontaneously or after minor injury. 

11. Pain in the Face or Neck: Oral cancer can cause localised pain or tenderness in the affected areas. Ongoing pain or tenderness that cannot be attributed to any other known cause should prompt individuals to consult a healthcare professional for a comprehensive examination.

If any of these changes are noticed, contacting a healthcare professional immediately for further examination and diagnosis is essential.

Understanding the causes of oral cancer is paramount for individuals and healthcare professionals. By knowing the causes, individuals can take proactive steps to reduce their risk, seek timely screenings, and promote early detection, leading to improved outcomes and better overall oral health.

The exact causes of oral cancer are not fully understood. However, one potential cause is genetic manipulation or changes in the DNA of cells within the oral cavity. These genetic alterations can lead to uncontrolled cell growth and the formation of cancerous tumours. However, genetic factors alone are not solely responsible for oral cancer.

Oral Cancer Risk Factors

Several risk factors contribute to the development of oral cancer, highlighting the importance of understanding and addressing these factors for preventive measures. By recognising the risk factors associated with oral cancer, individuals can take proactive steps to mitigate these risks. These risk factors include.

1. Tobacco Use: Smoking cigarettes, cigars, or pipes, as well as using smokeless tobacco products like Gutka, Tambaku, etc., significantly increases the risk of oral cancer.

2. Alcohol Consumption: Heavy and frequent alcohol consumption is a known risk factor for oral cancer, especially when combined with tobacco use.

3. Gender: Men are at a higher risk of developing oral cancer than women. Men's higher rates of tobacco and alcohol use and hormonal differences contribute to their increased risk of developing oral cancer.

4. Age: Oral cancer is more common in older adults, with the risk increasing significantly after age 40.

5. HPV Infection: Certain strains of the human papillomavirus (HPV), particularly HPV-16 and HPV-18, are associated with an increased risk of oral cancer.

6. Sun Exposure: Prolonged and unprotected exposure to the sun's ultraviolet (UV) rays can increase the risk of lip cancer.

7. Poor Oral Hygiene: Neglecting oral hygiene practices, such as regular brushing, flossing, and dental check-ups, can contribute to the risk of oral cancer.

8. Weakened Immune System: Certain medical conditions or medications that weaken the immune system can contribute to oral cancer.

9. Poor Diet: A diet lacking in fruits and vegetables and low in certain nutrients, such as vitamins A, C, and E, as well as minerals like zinc and selenium, may increase the risk of developing oral cancer.

10. Family History of Cancer: A family history of cancer, including oral cancer, can contribute as a risk factor for developing oral cancer. 

1. Genetic factors passed down through generations may increase an individual's susceptibility to developing cancer. 

2. Individuals with a family history of cancer must be vigilant about their oral health and undergo regular screenings.

Oral cancer prevention is critical for maintaining good oral health and overall well-being. While various risk factors are associated with oral cancer, several steps can be taken to reduce the risk of developing this disease.

1. Regular Dental Check-Ups are essential for maintaining excellent oral health and discovering problems early on. Oral cancer screening is advised every three years for persons aged 20 to 40.
   Individuals should also talk to their healthcare professionals about their mouth cancer risk factors.

2. Protect Yourself from UV Rays: Wearing UV-AB-blocking sunscreen on the face and using sunblock on the lips can help reduce the risk of lip cancer.

3. Avoid Alcohol Consumption: Avoiding alcohol is crucial for preventing oral cancer, as excessive alcohol consumption is a significant risk factor. 

1. Alcohol can damage the cells in the mouth, making them more susceptible to cancerous changes. 

2. By abstaining from alcohol or limiting its intake, the risk of developing oral cancer can be significantly reduced.

4. Get Vaccinated for HPVs: Vaccines are available to prevent infection with these strains of HPV, and individuals can discuss vaccination with their healthcare providers.

5. Quit Smoking and Chewing Tobacco: It is important to quit smoking and chewing tobacco. People who have difficulty quitting should talk to their doctors about smoking cessation programs or support groups.

6. Maintain a Balanced Diet: A well-balanced diet with plenty of fruits and vegetables may help reduce the risk of oral cancer. Reducing processed foods, red meats, and sugary drinks is also advised.

Regular check-ups serve as a crucial opportunity to identify possible indications of oral cancer. Dentists are skilled in recognising subtle signs, prompting referrals to specialist practitioners such as head and neck surgeons for further assessment. 

A range of diagnostic tests tailored to individual cases may be employed to diagnose oral cancer and determine appropriate treatment strategies accurately. Various tests may be used to diagnose oral cancer, including:

1. Visual Examination: A comprehensive assessment of the oral cavity, including the mouth, head, face, and neck, is conducted by a healthcare professional to identify any suspicious signs or symptoms of precancerous or cancerous lesions.

2. Brush Biopsy: Utilising a small brush or spatula, healthcare providers gently scrape the targeted area to collect cells for examination under a microscope, aiding in detecting cancerous cells.

3. Incisional Biopsy: Small tissue samples are surgically removed from the affected area to obtain cells that are then analysed in the laboratory, helping to confirm the presence of oral cancer.

4. Direct Pharyngoscopy and Laryngoscopy: In some cases, an endoscope—a flexible tube with a light and viewing lens—is used to visualise hard-to-reach areas of the throat and mouth, providing a more detailed examination to aid in diagnosing oral cancer.

5. Indirect Laryngoscopy and Pharyngoscopy: Using a specialised instrument, such as a small mirror on a long, thin handle, healthcare providers examine the throat, tongue base, and larynx to assess any abnormalities that may indicate oral cancer.

How to Prepare for the Doctor's Consultation?

Here are a few advisory tips on how to prepare for a doctor consultation:

1. Make an Appointment: Schedule a meeting with the doctor in advance. This will help you avoid waiting in long queues and save you time.

2. Gather Information: Before your appointment, write down any questions or concerns about your health. List all medications you're taking, including over-the-counter drugs, supplements, and vitamins. Also, write down your medical history, including past surgeries, illnesses, and allergies.

3. Bring Necessary Documents: Bring your insurance card, ID, and any relevant medical records or test reports to the appointment. This will help your doctor make an exact diagnosis and recommend appropriate treatment.

4. Dress Comfortably: Wear comfortable clothes to your appointment to easily move around if required during the physical examination.

5. Be Open and Honest: During the consultation, be open and honest with your doctor. Share all of your concerns and symptoms, and answer all questions truthfully.

What to Expect From the Doctor?

When visiting a doctor for a consultation, you can expect the following from them:

1. Questions about Medical Concerns: The doctor will ask you about your medical issue. They may ask about the symptoms, how long you have been experiencing them, and if there are any triggers or patterns.

2. Questions about Medical History: The doctor may also ask about your medical history, like any past illnesses, surgeries, or medical conditions. They may also inquire about your family's medical history.

3. Physical Examination: The doctor can perform a physical examination to assess the symptoms you are experiencing. This may include checking vital signs such as blood pressure, heart rate, and temperature. They may also use a stethoscope or other medical tools to examine your body.

4. Diagnostic Tests: Based on your symptoms and physical examination, the doctor may recommend diagnostic tests such as blood tests to help determine the root cause of your medical issue.

5. Treatment Recommendations: After assessing your symptoms and diagnostic test results, the doctor may suggest a course of treatment. This could include medications, lifestyle changes, or further medical procedures.

What Questions Should You Ask the Doctor?

Freely interacting with the doctor is important. It helps one better understand the problem and know how to look after oneself. Here are a few questions patients should put up with the doctor during the consultation:

1. How can I prevent the progression of my condition?

2. What are the risks involved with the proposed treatment?

3. What symptoms should I note to monitor my condition?

4. How long is the expected recovery time?

5. Why is surgery necessary? Are there any alternative treatments available?

6. Can my condition be managed without surgery?

7. Given my specific condition, what is the optimal time for me to undergo surgery?

8. Can I make any lifestyle changes or modifications to support my treatment?

9. What can be the possible side effects of the treatment, and how can they be managed?

10. What is the long-term outlook for my medical condition, and what follow-up care will be required?

Embarking on the journey to combat oral cancer requires a personalised approach tailored to each individual's condition. Various treatment options, including surgeries, are available to target the primary tumour and manage its potential spread effectively.

Ayurvedic Treatment For Oral Cancer

Ayurvedic treatment for oral cancer focuses on holistic healing, aiming to balance the body, mind, and spirit. It involves a personalised approach based on an individual's unique constitution. Some Ayurvedic treatments for oral cancer may include:

1. Herbal Remedies: Ayurvedic practitioners may prescribe specific herbs like turmeric, neem, ashwagandha, and tulsi, known for their anti-cancer and immune-boosting properties.

2. Detoxification Therapies: Panchakarma, a set of Ayurvedic detoxification procedures, may be recommended to eliminate toxins from the body and enhance overall healing.

3. Ayurvedic Medicines: Ayurvedic formulations, such as herbal decoctions, oils, and powders, may be prescribed to address specific symptoms and promote healing.

Homoeopathic Treatment For Oral Cancer

Homoeopathic treatment for oral cancer aims to stimulate the body's self-healing abilities and restore balance. Homoeopathic remedies are selected based on an individual's unique symptoms, constitution, and overall health. Some commonly used homoeopathic remedies for oral cancer include:

1. Carcinocinum: This remedy is often prescribed for various types of cancer, including oral cancer, and aims to support the body's response to the disease.

2. Conium may be recommended for oral cancer with hardened growths, difficulty swallowing, and pain radiating to the ears.

3. Thuja: This remedy is considered when there are warty growths, foul breath, and sensitivity to touch in the affected area.

4. Hydrastis Canadensis: It may be prescribed for oral cancer with ulceration, excessive salivation, and a sensation of rawness.

5. Phytolacca: This remedy is used for oral cancer with intense pain, difficulty in opening the mouth, and swollen lymph nodes.

Surgeries for Oral Cancer Treatment

The doctor may recommend one of the following surgical treatment methods for oral cancer based on the stage of cancer and other factors.

1. Glossectomy: A specialised procedure where healthcare providers partially or completely remove the tongue, aiming to eradicate the affected area and minimise the spread of oral cancer.

2. Mandibulectomy: Surgical intervention specifically designed to address oral cancer located in the jawbone involves removing the affected portion, ensuring effective treatment and preservation of oral functionality.

3. Primary Tumour Surgery: A surgical intervention that involves the removal of tumours either through the oral cavity or by making an incision in the neck, allowing healthcare providers to eliminate the source of the cancerous growth precisely.

4. Sentinel Lymph Node Biopsy: A crucial diagnostic test aiding healthcare providers in determining the potential spread of oral cancer beyond the primary site, offering valuable insights for devising an effective treatment plan.

5. Maxillectomy: A surgical approach that focuses on removing part or the entire hard palate, the bony roof of the mouth, aiming to eliminate oral cancer while preserving the essential structures and functions.

6. Reconstruction: After removing significant tissue areas affected by the tumour, reconstructive surgery becomes vital to restore form and function. This procedure may involve using healthy bone and tissue from other body parts, filling gaps left by the tumour and facilitating oral rehabilitation.

7. Neck Dissection: An intricate surgical procedure performed to remove affected lymph nodes from the neck region, helping control oral cancer's spread and prevent its progression.

Other Ways to Treat Oral Cancer

In addition to surgeries, several other effective approaches to combat oral cancer aim to target cancer cells and promote healing. 

1. Chemotherapy: Including anti-cancer drugs, chemotherapy is an effective treatment method to kill cancer cells throughout the body, including oral cancer. It may be used with other therapies or as a standalone approach tailored to each individual's unique condition.

2. Radiation Therapy: Harnessing the power of focused energy beams, radiation therapy destroys cancer cells or impedes their growth. Often combined with other treatment modalities, this therapy plays a crucial role in eradicating cancer cells and preventing their regrowth.

3. Immunotherapy: Engaging the body's immune system to combat cancer, immunotherapy has emerged as a revolutionary treatment option. 

1. By stimulating the immune response, this therapy activates the body's natural defence mechanisms to target and destroy cancer cells, providing a promising avenue for oral cancer treatment.

4. Targeted Therapy: Leveraging the advancements in medical science, targeted therapy employs specialised drugs or substances to specifically identify and attack particular types of cancer cells while minimising damage to healthy cells. 

Cost of Oral Cancer Treatment

The cost of oral cancer treatment is generally influenced by several factors, including the stage and type of oral cancer, the type of technique recommended, the patient’s age, the patient’s comorbidities, the location and type of hospital, the doctor’s expertise, insurance coverage and much more.

One must consult their doctor to know the exact cost of oral cancer treatment. However, the table below also provides an approximate cost of different oral cancer treatment methods.

Oral Cancer Survival Rate

The survival rate of oral cancer varies depending on several factors, including the stage at diagnosis, the location of the tumour, and the overall health of the individual. 

It's important to note that survival rates are estimates and can vary from person to person. Here is some information on the survival rates of oral cancer based on various stages:

1. Localized Stage: When oral cancer is detected in its early stages and is localized, meaning it has not spread to nearby lymph nodes or distant sites, the survival rate is relatively high. 

1. According to the American Cancer Society, the five-year relative survival rate for localized oral cancer is about 84%. 

2. This means that on average, about 84% of people diagnosed with localized oral cancer will survive for at least five years after their diagnosis.

2. Regional Stage: Regional stage oral cancer refers to cancer that has spread to nearby lymph nodes or tissues. 

1. The five-year relative survival rate for regional oral cancer drops to about 66%. 

2. This lower survival rate is due to the increased likelihood of the cancer spreading beyond the primary site. However, with appropriate treatment, including surgery, radiation therapy, and chemotherapy, the chances of successful outcomes can still be significant.

3. Distant Stage: Distant-stage oral cancer refers to cancer that has spread to distant organs or distant lymph nodes. 

1. The five-year relative survival rate for oral cancer at this stage is about 39%. 

2. The spread of cancer to distant sites poses significant challenges for treatment, but advancements in systemic therapies, such as targeted therapies and immunotherapies, have improved outcomes for some individuals.

Oral cancer can have serious risks and complications, especially if left untreated. There are some risks and complications associated with this are given below:

1. Spread of Cancer: If left untreated, oral cancer can spread to other body regions, including the lymph nodes in the neck, making treatment more difficult.

2. Difficulty in Eating: Oral cancer can cause significant pain and difficulty in eating. The presence of tumours or ulcers in the mouth can make chewing and swallowing uncomfortable and challenging. 

3. Difficulty in Speaking: Oral cancer can also impact speech due to its effect on the mouth, tongue, or vocal cords. Tumours or surgical interventions can cause changes in speech clarity, volume, or pronunciation.

4. Disfigurement: Treatment for oral cancer, such as surgery or radiation therapy, may result in disfigurement of the face, neck, or mouth.

5. Dental Problems: Oral cancer treatment might result in dental issues such as dry mouth, gum disease, and tooth decay.

6. Secondary Cancers: Oral cancer survivors are more likely to acquire secondary cancers such as lung or oesophagal cancer.

7. Emotional and psychological effects: The diagnosis and treatment of oral cancer can cause emotional and psychological distress, such as depression, anxiety, and fear of recurrence.

8. Dysphagia: Dysphagia, or difficulty swallowing, is a common risk associated with oral cancer. Tumours or ulceration in the mouth or throat can obstruct the passage of food, causing pain and discomfort during swallowing, and may necessitate medical interventions to manage this symptom effectively.

When to See a Doctor?

Early detection and timely treatment are crucial in improving outcomes for oral cancer. It's important to be vigilant and seek medical attention if you experience any signs or symptoms that could be indicative of oral cancer. Here are some situations when it is recommended to see a doctor:

1. Persistent mouth sores or ulcers.

2. Unexplained red or white patches

3. Abnormal growth or lumps

4. Difficulty Swallowing or Persistent Sore Throat

5. Changes in Voice or Speech

The diet for oral cancer patients should focus on maintaining adequate nutrition and hydration to support the body's healing and recovery. Here are some dietary guidelines for oral cancer patients:

1. Eat Small, Frequent Meals: Oral cancer and its treatments can cause a loss of appetite, nausea, and difficulty swallowing. Its treatments may also cause nausea, vomiting, and trouble swallowing.
   Eating small, frequent meals daily might help you stay nourished and avoid losing weight.

2. Choose Nutrient-Dense Foods: Patients with oral cancer should eat meals high in protein, vitamins, and minerals. Some examples are lean meats, fish, eggs, dairy products, fruits, vegetables, whole grains, and legumes.

3. Avoid Spicy, Acidic, and Crunchy Foods: These can irritate the mouth and throat and make swallowing difficult. Patients should avoid chips, crackers, citrus fruits, and spicy dishes.

4. Moist and Soft Foods: Soft, moist foods such as soups, stews, mashed potatoes, and smoothies can be easier to swallow than solid foods. Patients can also try adding sauces, gravies, or broths to moisten their food.

Understanding the complexities of oral cancer is crucial for early detection, effective treatment, and improved outcomes. By familiarising ourselves with the stages, symptoms, and images associated with this disease, we empower ourselves to recognize potential warning signs and seek timely medical attention.  

Treatment options for oral cancer may include surgeries, radiation therapy, targeted therapy, chemotherapy, and immunotherapy. Each approach aims to eliminate cancer cells, minimise their spread, and restore oral health. Our seasoned professionals at HexaHealth can provide you with dedicated consultation and guide you toward the best course of action. Speak to our experts and get started with your treatment today!

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