What is Oral Cavity and Oropharyngeal cancer?
In India, squamous cell carcinoma of the head and neck region accounts for 12% of all malignancies. Male to female ratios are greater than 2:1, especially in laryngeal cancers where the ratio is more than 4-5 times the normal ratio.
Oral cavity includes the lips and its inside lining, cheeks and their inner lining, teeth, gums, floor of mouth below the tongue, bony roof of mouth, area behind the wisdom teeth and the front two thirds of tongue.
Oropharynx includes the back one third of tongue, tonsils, tonsillar pillar, soft palate and the back wall of the throat visible to the eye. Any cancer, which arises in these areas, is known as oral cavity or oropharyngeal cancer.
What are the causes?
Risk factors are those variables that increase a person’s chance of getting a disease. Having a risk factor means that the person is more likely to develop cancer than the general population. However, having these risk factors does not mean that a person will get cancer.
Head and neck cancer is mostly associated with tobacco, betel nut and alcohol abuse. In cancers of the mouth the results are additive and is 15 times greater than those who don’t drink, smoke or use betel nuts. Long-term irritation to the lining of the mouth caused by poorly fitting dentures has been suggested as one of the risk factor. Diet low in fruits and vegetables is associated with increased risk.
What are the symptoms?
- A sore or lesion in the mouth that does not heal
- A feeling that something is caught in the throat that does not go away
- Difficulty moving the jaw or tongue
- Numbness of any area in the mouth
- Pain in the mouth that does not go away
- Difficulty chewing or swallowing
- A lump or mass in the neck
- A persistent lump or thickening in the cheek
- Development of asymmetry, in the tonsils
What is the diagnosis?
Includes direct visual examination of the nose, mouth, throat and tongue and using a small mirror or a flexible lighted tube called endoscope for the voice box and roof of nose regions. The doctor will also feel the entire mouth using gloved finger.CT scan:
It is a series of detailed pictures of the head and neck created by computer linked to an X-ray machine.MRI:
It is a powerful magnet linked to a computer to create detailed pictures.Chest X-ray:
It is done to see if the cancer has spread to the lungs.Biopsy:
It is the only sure way to tell whether a person has cancer.
- Incisional Biopsy: The area around the lesion is numbed and a good tissue sample is obtained.
- Fine Needle Aspiration Biopsy (FNAB): If the patient has a neck mass a thin needle is introduced into the mass so that cells can be withdrawn to check under the microscope. It is done to find out whether or not the cancer has spread to lymph nodes in the neck.
What is staging?
It is a process to find out how far the cancer has spread. It is very important tool in planning treatment choices. The TNM staging is internationally accepted.
T- Describes the size of the mass and whether it has spread to nearby regions.
N- Describes spread to lymph nodes.
M- Describes spread to distant sites like lung, liver, brain etc.,
Numbers following T, N or M give details about each one of these. Example T2 N0 M0 is a cancer that is small and has not spread to the lymph nodes or to distant sites and so the potential for cure is high. In general the lower the number the less is the cancer spread.
What is the treatment?
After the cancer is staged treatment choices are provided. It is important to take time and think about the choices including the chances of cure, impact of treatment on speech, swallowing and respiration.
The treatment options are surgery, radiation therapy and chemotherapy. These are given alone or in combination depending on the stage of the cancer. Head and neck surgery often changes the patient’s ability to chew, swallow or talk. The face and neck may be swollen and also parts of the neck may be numb because nerves have been cut.
Radiotherapy involves use of high energy x-rays to kill cancer cells. It often causes unwanted side effects like redness, irritation of eyes and mouth, dryness of mouth, alteration in taste, thick saliva, decreased appetite etc.
Chemotherapy is used to kill cancer cells throughout the body. In cancer of the oral cavity it is used in conjunction with surgery or radiation therapy as its effect alone is dismissal.
Is follow-up necessary?
Regular follow up is very important to make sure that the cancer has not returned and that a new cancer has not developed since patients who have had head and neck cancer have an increased chance of developing a new cancer in head and neck region. Regular dental check up and CT or MRI scans are needed.
How can it be prevented?
Avoiding risk factors can prevent it. Tobacco in any form and alcohol are the most important risk factors. People or patients who do not smoke should never start and those who were smoking should do their best to quit the habit. Avoiding sources of irritation like ill-fitting dentures also helps. Eating fresh vegetables and fruits and eating fewer meats has also found to be useful.