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Oral Cancer

Clinical OncologyOtolaryngology

The "oral" region comprises multiple sites, including the lips, tongue, floor of the mouth, hard palate, and gums, as well as the oral mucosa, buccal mucosa, and salivary glands. Any malignant tumour growing in these locations is collectively referred to as oral cancer, which is also one of the types of head and neck cancer.

Symptoms

Like other cancers, the development of oral cancer is related to DNA (deoxyribonucleic acid). When the DNA of the lip or oral cells undergoes mutations, the affected cells continue to grow and divide uncontrollably, while healthy cells may die. If these abnormal oral cells continue accumulating, they can form a tumour, known as oral cancer, with the potential to spread to the head or neck.

Symptoms of oral cancer include:

Oral ulcers or non-healing sores: Persistent oral ulcers, especially sores that do not heal over an extended period.
Abnormal lumps in the oral cavity: Unusual lumps or swelling appearing in the oral cavity.
Pain or discomfort: Ongoing pain, burning sensations, or discomfort in the oral cavity.
Difficulty breathing or swallowing: Oral cancer may affect breathing and swallowing functions.
Voice changes: Oral cancer can impact the voice, leading to hoarseness or a deepened voice.

Factors

As of now, the exact reasons for DNA mutations leading to oral cancer remain unclear. However, the medical community has identified several factors that can increase the risk of developing oral cancer:

Prolonged and heavy use of any form of tobacco, such as cigarettes, cigars, pipes, etc.
Long-term betel nut chewing or the consumption of Gutka (especially in Southeast Asia), a combination of betel nut and tobacco.
Chronic alcohol consumption (the American Cancer Society notes that approximately 70% of oral cancer patients have a history of heavy alcohol use).
Prolonged exposure of the lips to intense sunlight.
Poor oral hygiene or the presence of cavities.
Infection with HPV (human papillomavirus) through sexual contact.
GVHD (graft-versus-host disease) triggered by stem cell transplantation.
Weakened immune system.

Diagnosis

If oral cancer is suspected in a patient, the doctor will conduct the following examinations:

Clinical Examination	The doctor examines the patient's lips and the interior of the oral cavity, observing for any abnormalities such as white patches or swelling.
Biopsy	If the doctor suspects oral cancer, a small tube with a camera is inserted into the patient's throat to look for signs of cancer cell spread.
Endoscopy	X-rays create detailed images of internal soft tissues, providing information about the tumour's volume, location, and whether it has spread to nearby tissues, lymph nodes, or the lungs.
CT Scan	X-rays create detailed images of internal soft tissues, providing information about the tumour's volume, location, and whether it has spread to nearby tissues, lymph nodes, or the lungs.
MRI	MRI uses radio waves and strong magnets like a CT scan to obtain detailed images of the patient's internal soft tissues. It helps examine whether cancer cells have spread to the neck, brain, or spinal cord.
PET Scan	Also known as positron imaging, this method utilizes the characteristics of cancer cells to absorb more sugar than normal cells. A radioactive sugar is injected into the patient's body, and a PET scan is performed to examine the radiation distribution inside the body, revealing whether cancer cells have spread to other locations.

taging

After the tests mentioned above, the doctor will determine the stage of oral cancer based on the tumour's volume and extent of spread. The detailed classification is as follows:

Stage 0	The cancer is confined to the surface layer of oral cells and has not spread to nearby lymph nodes or distant tissues.
Stage I	The tumour has a diameter of no more than 2 cm and has not invaded nearby tissues, lymph nodes, or distant locations.
Stage II	The tumour has a diameter of more than 2 cm but less than 4 cm, and it has not invaded nearby tissues, lymph nodes, or distant locations.
Stage III	The tumour has a diameter exceeding 4 centimetres but has not spread to lymph nodes or distant locations.
Stage IV	Any tumour volume that has grown into other nearby tissues, including the jawbone, deep muscles of the tongue, facial skin, etc.

Early-stage oral cancer may be curable through various treatment methods. However, if the cancer cells are diagnosed in the late stage, the possibility of a complete cure is lower. The goal of treatment is to stop tumour spread, relieve symptoms, and improve the patient's quality of life. The doctor will choose the most appropriate treatment method based on the tumour stage, development trend, and the patient's overall health. Standard treatment methods for oral cancer include:

Surgery	Surgical procedures aim altogether to remove cancer cells from the patient's body. The scale of the surgery depends on the tumour's size. Smaller tumours can be removed through simple surgery or laser, while larger tumours may require more extensive procedures, potentially leaving scars on the face or neck.
Radiotherapy	Radiation therapy typically requires a combination of surgery or chemotherapy unless the oral cancer is in the early stage. High-energy rays, such as X-rays or protons, destroy cancer cells. Radiation therapy can be performed externally or internally, depending on the patient's needs.
Chemotherapy	Chemotherapy involves the administration of drugs, either orally or through intravenous injection, to fight cancer cells that may have spread to other locations. Chemotherapy may be combined with radiation therapy for optimal results. Side effects may include skin pain, oral or throat pain, taste loss, loss of appetite, dry mouth, and hair loss.
Photodynamic Therapy	Photodynamic therapy involves injecting photosensitive drugs into the patient's bloodstream. A specific wavelength of laser light then activates these drugs to destroy the surrounding cancer cells. After treatment, patients may be susceptible to light, and sun exposure should be minimized.

FAQ

Oral cancer refers to cancer cells growing in locations such as the lips, tongue, hard palate, etc., while throat cancer refers to cancer cells growing in positions like the soft palate, back of the tongue, tonsils, etc. Since these locations are very close, their causes, risk factors, and treatment methods are generally similar. Patients should seek professional advice from a doctor based on their circumstances.

As mentioned in the text, symptoms of oral cancer, including difficulty swallowing, tooth pain, facial swelling, etc., may not necessarily be caused by cancer. Some common diseases could lead to these conditions. Therefore, if you notice such symptoms, there's no need for excessive worry. If the situation persists or worsens, seek medical attention promptly to understand the underlying reasons and the likelihood of cancer.

Cancer inevitably affects emotions, but with guidance from doctors and appropriate treatment, there is a chance of recovery or relief. Therefore, patients do not need to be overly anxious. Seeking professional advice from the doctor, including prognosis and treatment recommendations, can help make more informed arrangements. If needed, communicate with family, friends, social workers, etc., to let them understand your situation and feelings, assisting you in overcoming challenges.

Both surgery and radiation therapy can affect the movement of the mouth, tongue, and throat, causing difficulties in eating. This is a normal phenomenon. Patients can try soft foods such as scrambled eggs, cheese, etc., and avoid spicy and stimulating foods. As the tissues heal, swelling will gradually diminish, and patients can return to a regular diet. If eating difficulties persist, consult the doctor to understand the reasons.

Oral cancer and its treatment involve changes in the lips, teeth, tongue, or soft palate, inevitably affecting a patient's speech. Generally, these effects are not profound, and some individuals may need help with specific sounds. With time and tissue recovery, speech ability will entirely or largely return to normal. If problems persist after treatment, patients should consult with the doctor or seek advice from a speech therapist for professional guidance.