Mouth cancer
Mouth cancer can appear anywhere in the mouth, including inside the cheeks and gums. It often falls under the category of mouth and pharyngeal cancer. Cancer of the mouth and pharynx affects the back of the mouth and the lining of the throat. The average age at diagnosis is 62 years, but about 25% of cases occur before the age of 55, according to ACS. The disease is more likely to affect males than females.
Symptoms
In the early stages, there are often no signs or symptoms of mouth cancer. Smokers and drinkers should have regular check-ups with their dentist, as tobacco and alcohol are risk factors for mouth cancer. Your dentist may be able to detect any signs at an early stage.
Signs that cancer may eventually develop include:
Leukoplakia: Where there are white spots in the mouth that do not disappear when rubbed.
Many mouth lesions may be cancerous. It doesn’t mean that someone has cancer, but people should talk to their doctor about any changes in the mouth.
Monitoring changes may help detect mouth cancer in the early stages when treatment is easier.
Pre-cancer
If cancer develops, a person may notice:
- Patches on the lining of the mouth or tongue, usually red or red and white
- Bleeding, pain or numbness in the mouth
- Mouth ulcers or sores that don’t heal
- Tooth decay for no apparent reason
- Swelling of the jaw
- sore throat or feeling that something is stuck in the throat
- Hoarse voice
- Difficulty chewing or swallowing
- Difficulty moving the tongue or jaw
Having any of these symptoms does not mean that a person has mouth cancer, but it is worth a doctor’s review.
Stages of cancer
The stage of cancer indicates how widespread it is. In the early stages, there may be non-cancerous cells that can eventually become cancerous. This is sometimes called stage 0 cancer, or topical cancer. Your doctor may advise you to stop smoking and monitor additional changes. Topical cancer affects only one area and does not spread to other tissues. Regional cancer spreads to nearby tissues and distant cancer spreads to other parts of the body, most likely the lungs or liver.
Mouth cancer may begin, if not treated, in one part of the mouth, then spread to other parts of the mouth. It may also spread to the head, neck and rest of the body. Treatment options and expectations depend, to some extent, on the stage of cancer.
Complications
Mouth cancer and treatment can lead to a range of complications. Complications after surgery include risks:
- Bleeding
- Infection
- Pain
- Difficulty eating and swallowing
Long-term problems may include:
- Carotid artery stenosis: It can result from radiation therapy and may lead to cardiovascular problems.
- Dental problems: These problems can occur if the surgery changes the shape of the mouth and jaw.
- Dysphagia: This can make it difficult to eat and may increase the risk of food inhalation and subsequent infections.
- Speech problems: Changes to the tongue, lips and other mouth features can affect speech.
- Mental health problems: Depression, irritability, frustration and anxiety may arise.
Causes
Cancer occurs when genetic change in the body leads to uncontrolled cell growth. As these unwanted cells continue to grow, they form a tumor. Over time, cells can migrate to other parts of the body. About 90% of mouth cancers are squamous cell carcinoma. It begins in the squamous cells that line the lips and inside the mouth.
Risk factors
Doctors do not know the cause of these changes, but some risk factors appear to increase the chance of developing mouth cancer. There is evidence that the following factors increase the risk:
- Smoking or chewing tobacco
- Excessive alcohol consumption
- HPV infection, especially HPV type 16
- Previous history of head and neck cancer
Other factors that may increase your risk of mouth cancer include:
- UV exposure to lips from the sun, solar lamps or sun loungers
- Gastroesophageal reflux disease
- Previous radiation therapy in the head, neck or both
- Exposure to certain chemicals, especially asbestos, sulfuric acid and formaldehyde
- Long-term wound or chronic trauma
A healthy diet that contains plenty of fresh fruits and vegetables can reduce the risk.
Diagnostic
If a person develops symptoms that may indicate mouth cancer, your doctor will:
Ask about symptoms
Physical examination
Ask about the patient’s personal and family medical history
If mouth cancer is possible, they may also recommend a biopsy, the doctor takes a small sample of tissue to check the cancer cells. If the biopsy reveals mouth cancer, the next task is to determine the stage.
Cancer tests include:
Endoscopy: The doctor passes a thin tube with light and a small camera beneath a person’s throat to see if the cancer has spread, and if so, to what extent.
Imaging tests: X-rays of the lungs will show, for example, whether the cancer has reached that area.
Treatment
Treatment depends on:
- Location, stage and type of cancer
- The public health of the individual
- Personal preferences
Surgery
Your doctor may recommend surgery to remove the tumor and part of the healthy tissue surrounding it. Removal surgery may include:
- Part of the tongue
- Jawbone
- Lymph nodes
If the procedure significantly changed a person’s appearance or ability to speak or eat, the patient may need reconstructive surgery.
Radiation therapy
Mouth cancers are sensitive to radiation therapy. This treatment uses beams of high-energy X-rays or radiation molecules to destroy DNA within tumor cells, eliminating their ability to reproduce.
External beam radiation: The machine targets the affected area with radiation beams.
Brachytherapy: The surgeon will use radioactive needles to deliver radiation to the tumor inside the body. Your doctor may recommend this for people with early-stage tongue cancer. The adverse effects of radiation therapy in the mouth may include:
- Tooth decay
- Mouth ulcers
- Bleeding gums
- Stiff jaw
- Fatigue
- Skin reactions, such as burns
Treatment is likely to be more effective in people who don’t smoke or who have already quit. A person with early-stage mouth cancer may only need radiation therapy, but your doctor may recommend combining it with other treatments to reduce the risk of cancer developing or repeating it.
Chemotherapy
If the cancer is widespread, your doctor may recommend a combination of chemotherapy and radiation therapy. Chemotherapy involves the use of powerful drugs that destroy the DNA of cancer cells. Drugs undermine the ability of cells to reproduce and spread. Chemotherapy drugs destroy cancer cells, but they may also damage healthy tissues sometimes. This can lead to severe adverse effects.
These effects may include:
- Fatigue
- Hair loss
- Weakened immune system and increased risk of infection
These effects usually disappear after a person has finished treatment.
Heat-raising therapy
In this emerging technique, the doctor heats the area above normal temperature to destroy and kill cancer cells. This treatment method can also increase the sensitivity of cancer cells to radiation therapy.
Prevention
To reduce the risk of mouth cancer, people should:
- Avoid using any form of tobacco products
- Avoid excessive alcohol consumption
- Regular dental check-up
- Monitor changes in the mouth and consult a doctor or dentist if they occur
- Taking vaccination to protect against HPV