Oral Cancer

What is Oral Cancer?

Mouth cancer, also referred to as oral cavity or oral cancer, may grow in any part of the mouth that include –

  • Floor of the mouth
  • Lips
  • Tongue
  • Roof of the mouth
  • Gums
  • Inside lining of the cheeks

Types of Oral Cancer

The most common type of oral/mouth cancer is squamous cell carcinoma. This specific type of cancer can be found in a number of places in the body that also include under the skin and inside of the mouth. Other not so common types of mouth cancer are –

  • Adenocarcinomas: This rare type of mouth cancer grows within the salivary glands.
  • Oral Malignant Melanoma: This is also a rare type of mouth cancer that begins in cells known as melanocytes. These melanocytes are responsible for providing the skin its color.

Symptoms of Oral Cancer

Invasive Breast Cancer: Invasive breast cancer develops when cancer cells spread outside the lining of lobules or ducts into the nearby tissue of the breast. Invasive breast cancer can be categorized into different types –

  • - Dramatic weight loss
  • - Bumps or lumps, thickenings/swellings, rough spots or eroded areas or crusts on the gums, lips and/or other areas within the mouth
  • - Ear pain
  • - Persistent sores on the mouth, face or neck that causes bleedings and that do not heal within two weeks
  • - A change in the way the dentures or teeth fit together
  • - Pain, unexplained numbness, loss of feeling in any area of the neck, face or mouth
  • - Change in voice, hoarseness or chronic sore throat
  • - Unexplained bleeding in the mouth
  • Problem in speaking, moving the tongue or jaw, swallowing or chewing
  • The development of velvety red, white or speckled patches inside the mouth
  • A feeling that something is there in the back of the throat

Stages of Oral Cancer

Stage 0 (Carcinoma in Situ) : This stage is considered as the pre-cancer stage. In this stage, there are cancer cells that are inside the lining of the mouth that have not yet spread. If this stage is left untreated then it can develop into an invasive cancer.

  • i. Stage 1: This is considered as the early stage of invasive cancer. Now the cancer has started to develop through the mouth lining and also in the deep tissues below. The cancer has not spread close to other organs, tissues or lymph nodes and this cancer is not beyond 2 cm across.
  • ii. Stage 2: In the second stage, the tumor is more than 2cm but is less than 4cm. Other organs or lymph nodes are remains unaffected by this cancer.
  • iii. Stage 3: One or more conditions are true in this stage- first; the tumor is of any size that has spread to 1lymph nodes on the same side of the neck. Second, the cancer is more than 4 cm that has not spread to any part of the body or to any lymph nodes.
  • iv. Stage 4: This stage is known as the advanced stage of oral cancer that is categorized into three stages –
    • a. Stage 4A: This stage is marked by the growth of the cancer through the tissues around the mouth and lips. At this stage, it is possible that lymph nodes may or may not possess any cancer cells.
    • b. Stage 4B: This stage is marked by the spread of the cancer to any lymph node which is bigger than 6 cm or to lymph nodes on both neck sides, or to more than one lymph node on the same side of the neck.
    • c. Stage 4C: This stage is marked by the spread of the cancer to different body parts that include bones or lungs.

Diagnosis of Oral Cancer

A number of tests are performed for diagnosing mouth cancer that include –

  • Biopsy: A small tissue sample is taken in biopsy that is further sent to a laboratory for determining the type of cells and whether they are cancerous or non-cancerous.
  • Throat and Mouth Examination: A special instrument known as flexible laryngoscope is used for viewing within the throat and mouth.

Certain other tests are also required for determining the spread of the cancer. These tests are –

  • A Barium Swallow and Meal Test: This test requires a patient to swallow a drink having barium. An x-ray will present images of abnormal growths in the digestive system down to the stomach.
  • X-rays: X-rays are done of the lower and upper jaw or a chest x-ray can also be done. Endoscopy: This test helps in viewing the body from within. An endoscope (a narrow and flexible tube having a telescopic camera) is used for performing this test.
  • Certain other biopsies of nearby lymph nodes are also done.

Treatment of Oral Cancer

The treatment options of oral cancer have been categorized into surgical and non-surgical treatments.

  • Surgery : The affected tissue is removed with the help of surgery that also includes the use of lasers. The surgical procedure may also involve the removal of certain affected tissues in the mouth or lymph nodes in the neck. The removal of a small tumor in the mouth may not result in any problems. On the other hand, the removal of large tumor may also require removing of a part of jaw, palate or tongue. All the cancer cells can be destroyed if the surgery is followed by radiotherapy or chemotherapy.
  • Non-surgical Treatments
    Biological Therapy: The activity of the cancer cells is changed with the help of biological therapy. A type of biological therapy is known as Cetuximab that is also referred to as a monoclonal antibody. The surface of the cancer cells that triggers the development of cancer cells is blocked with the help of Cetuximab.
  • Chemotherapy: This therapy makes use of drugs for destroying the cancer cells. The injection of these drugs is done into a vein. Chemotherapy can also be combined with radiation therapy. Chemotherapy destroys the cancer cell that may have traveled somewhere else in the body while radiotherapy destroys the cancer area.
  • Radiotherapy: This therapy makes use of radiation for destroying cancer cells. This therapy shrinks the tumor by targeting a beam of radiation onto the cancer cells. Rarely, a radioactivity source can be implanted in the mouth that is known as Brachytherapy. The nearby tissues are not damaged by this therapy.
  • iv. Invasive Breast Cancer is described in stage IIB where –
    • a. A tumor is more than 5cms that has not spread to the axillary lymph nodes
    • b. A tumor is more than 2cms but not larger than 5cms; breast cancer cells small groups- that are bigger than 0.2 millimeter but are not more than 2 millimeters that can be seen in the lymph nodes
    • c. A tumor is more than 2cms but not bigger than 5cms; here cancer has spread to 1-3 lymph nodes surrounding the breast bone
  • v. Stage III : IIIA, IIIB and IIIC are the three sub-categories of stage 3. The invasive breast cancer described in stage IIIA where
    • a. A tumor is more than 5cms and cancer has spread to the 1-3 lymph nodes surrounding the breast bone
    • b. A tumor can be of any size or there could also be no tumor at all. Cancer is there in 4-9 lymph nodes surrounding the breast bone
    • c. A tumor is more than 5cms where breast cancer small groups can be seen in the lymph nodes
  • vi. The invasive breast cancer described in stage IIIB where –
    • a. The cancer has spread to lymph nodes surrounding the breast bone
    • b. A tumor does not have any particular size that has spread to the breast skin or chest wall resulting in an ulcer or swelling
    • c. The cancer has spread to around 9 axillary lymph nodes
  • vii. The invasive breast cancer described in stage IIIC where –
    • a. The cancer has spread to lymph nodes surrounding the breast bone
    • b. A tumor does not have any particular size that has spread to the breast skin or chest wall resulting in an ulcer or swelling
    • c. The cancer has spread to around 9 axillary lymph nodes
  • viii. Stage IV: In this stage, the invasive breast cancer has spread to surrounding lymph nodes to the organs that include bones, brain, lungs, skin or distant lymph nodes and beyond the breast.
  • Diagnosis of Breast Cancer

    Physical examination of a patient is done that include armpits, chest area, breasts and neck area. A number of tests are performed for diagnosing breast cancer that include –

    • Sentinel lymph node biopsy is performed for checking the spread of cancer to the lymph nodes
    • Breast ultrasound that will view the presence of lump in fluid-filled or solid form - Mammography is also performed in order to indentify the breast lump or to screen for breast cancer
    • CT scan is done for checking the spread of the cancer
    • Breast biopsy is performed by using different methods that include stereotactic, needle aspiration or ultrasound guided
    • PET scan for checking the spread of the cancer

    Types of Breast Cancer Surgery

    A number of breast cancer surgeries are performed that depend on the characteristics of the tumor, the quantity of healthy tissue that is removed along with tumor or the tumor has metastasized or not. Sometimes the removal of the lymph nodes below the arm is done while performing the operation in order to see the presence of cancer cells. The different types of breast cancer surgery are –

    • Radical Mastectomy
    • Lumpectomy (wide local excision)
    • Modified Radical Mastectomy
    • Quadrantectomy, partial or segmental mastectomy
    • Total Mastectomy

    Breast Cancer Treatment

    There are a number of treatment options are available for treating breast cancer that include

    • Radical Mastectomy: The chest wall muscle along with the breast and the axillary lymph nodes are removed in this surgery.
    • Mastectomy: The removal of all the breast tissue is done while performing a mastectomy
    • Radiation Therapy: This therapy uses high energy rays for destroying cancer cells. Radiation therapy is administered in two ways –
    • External Beam Radiation: Here an external machine is used for focusing a beam of radiation on the affected area. The extent of this surgical procedure is determined by seeing whether the lymph nodes are affected or not.
    • Brachytherapy: This therapy uses radioactive pellets or seeds. These radioactive pellets or seeds are implanted into the breast just next to the cancer.
    • Chemotherapy: In this therapy medications are used that travel through the bloodstream to the cancer cells. These medications are given either through the mouth or by intravenous injection.
    • Modified Radical Mastectomy: The surgical procedure is performed for removing axillary lymph nodes along with the breast tissue.
    • Hormone Therapy: Hormone therapy is used for reducing the risk of cancer reoccurrence after the completion of the surgery. A hormone produced by the ovaries known as estrogen helps in promoting the growth of breast cancers.

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