Cancer of the oral cavity: mucosa, gums, palate, cheeks — symptoms, treatment
Oral cancer – the concept is rather a collective, including malignant neoplasms of epithelial origin, growing on the lips, buccal mucosa, palate, gums, floor of the mouth, tongue. Each type of tumor has its own distinctive features and peculiarities of the course, but they are all with delayed diagnosis pose a serious threat to the life of the patient.
Total frequency of neoplasms of the oral cavity does not exceed 3%, but their number is constantly growing. Only in Russia the number of cases during the year, close to 30 thousand, and the countries of South-East Asia have surpassed the 50 thousand mark in the number of new cases of oral cancer annually. In many ways, the risk of tumors associated with lifestyle, habits, hygiene, nutrition and the influence of external adverse factors.
Among patients with cancer of the oral cavity is significantly dominated by men, the number of which is 4-5 times more than women. Patients – often elderly people living over 50 years, but occasionally the disease is recorded even in children.
The danger of this cancer is that tissue krovosnabjaemah well endowed with a large number of lymphatic vessels, and, therefore, the spread of the tumor will go pretty intense (metastasis). It is also impossible to discount the closeness of the brain, airway, major vascular and nerve trunks, involvement which often leads to tragic consequences.
Favorite localization of tumors of the oral cavity is the tongue, which affects more than half of the cases. Neoplasms of the tongue is quite dangerous, neoplasia can quickly increase in size and actively metastasize, and therefore requires early diagnosis and treatment. Characteristics of tongue cancer in a separate article, which describes the variety, the disease and methods of combating it.
In most cases the tumor is detected by the patient, and the symptoms of distress can appear quite early, but only by especially vigilant and responsible patients to immediately seek medical attention, while others give the cancer a chance to reach severe stages, when the diagnosis is not too difficult, but the treatment is ineffective. Meanwhile, detected a malignant tumor of the oral cavity rather responds well to treatment, and the patient measured more than one year of life after successful therapy. It is necessary to know and remember, at least periodically inspecting the oral cavity for the presence of any change, taking care of the mucous membrane of the mouth and in a timely manner when visiting the dentist.
Why does cancer occur?
Causes of oral cancer are:
- Smoking and use of smokeless tobacco mixtures.
- The use of alcohol.
- Excessive exposure to the sun and open air.
- Professional harmful factors.
- Radioactive radiation.
- Eating hot food.
- Virus infection.
Among all the risk factors of oral cancer the focus was on Smoking and use of tobacco in other forms, and 90% of patients indicate that their addiction to tobacco products. Smokers risk more than 6 times greater than non-smokers, it does not matter a pipe, cigars or regular cigarettes are keen on the media habits, but can vary the location of the tumor. Prolonged exposure tube in the mouth develops mouth cancer, while use of chewing tobacco – cancer of the gums, cheeks, lips. It also doesn’t matter and the form of cigarettes the concentration of nicotine or the level of filtering of the inhaled smoke.
Different types of chewing or snuff tobacco, tobacco blend, nasvai, snuff and increase the likelihood of cancer of the lips, cheeks, gums 50 times. This predominance compared to conventional Smoking is because harmful carcinogens are in direct contact with the mucosa for extended periods of time, providing a pronounced damaging effect and leading to chronic inflammatory processes.
The proportion of patients successfully undergoing cancer treatment and not give up their bad habits, and one third of them subsequently developing a tumor at other sites (tongue, larynx, palate, etc.).
It is worth Recalling that passive Smoking harms the health of others and can contribute to the appearance of the tumor in non-smokers.
Alcohol passing through the mouth, has on the mucous membrane carcinogenic effect, increasing frequent, in combination with Smoking. Up to 80% of patients note the use of significant amounts of alcohol-containing substances. Use caution when applying mouthwash for oral cavity containing alcohol, which can also be a risk factor for cancer.
Long stay under the influence of sunlight is most often associated with professional activity and about a third of patients. Other professional factors that cause cancer of the mouth, are considered to be contact in paint, dust, soot, work in high temperatures.
Eating habits associated with regular eating too hot food, spicy and with lots of spices, traumatic and irritating the mucous membrane of the oral cavity. A lack of products of vitamin A causes atrophic changes of the epithelium, disturbance of regeneration and the emergence of precancerous processes with high risk of malignancy.
Some viruses are able to multiply and to live in multi-layer flat epithelium, may have a carcinogenic effect. Thus, the carriers of human papillomavirus infection more of a risk, so should pay more attention to the condition of the oral cavity. Of course, if they are aware of the presence of such problems.
The constant irritation of the surface of the gums, cheeks, tongue, sharp edges or atomtime teeth, ill-fitting fillings or crowns, too, to a certain extent, endanger cancer, so visiting the dentist and caring for teeth should be a prerequisite for those who do not want to get cancer of the mucous membrane of the oral cavity.
Among the causes of cancer, which we are not able to modify, you can specify age and gender. In the elderly the likelihood of cancer is generally higher, and men are more susceptible to bad habits, so and swelling to strike more often. Adverse family history, when close relatives suffered from tumors of the oral cavity, should also be considered as a risk factor.
Precancerous changes and cancers of the oral cavity
Precancerous changes of the mucous membrane of the oral cavity are leukoplakia, erythroplakia and diplasia epithelium.
Leukoplakia is suspected in the case of white painless spots in a particular division of the oral cavity and it is characterized by the appearance of keratinization similar to that which normally occurs in the skin.
Erythroplakia looks like red foci with an abundance of blood vessels. After microscopic examination, about half of erythroplakia is a malignant tumor, so this condition requires early diagnosis and treatment.
Dysplasia is a precancerous, when cells acquire some features of malignancy, impaired their maturation and structure. The next stage of development of the dysplastic process is directly a malignant tumor.
Since most of the oral cavity is lined by stratified squamous epithelium, it is logical to expect then the development of squamous cell carcinoma of varying degrees of differentiation. From the small salivary glands of the tongue, cheeks, pharynx possible growth of glandular tumors – adenocarcinomas.
In appearance, the tumor often represents nonhealing ulcer defect with a pronounced and rather rapid introduction into the surrounding tissue. When nodular form tumor looks like a seal, which is growing even faster than the plague. The papillary type of cancer is characterized by the appearance of papillary growths that may hang in the mouth when placed on the palate, tongue, throat. For this form is not typical of the active ingrowth of the surrounding tissue, so the treatment is quite effective.
Signs and symptoms of oral cancer
In the initial stage of the disease, not every patient deem it necessary to consult a doctor attributed her symptoms to dental problems, chronic tonsillitis or laryngitis. Meanwhile, the presence of ulcers, fissures, nodular changes are very typical for the early stages of tumor development, and the absence of pain syndrome can not be complacent.
In the detailed stage of growth neoplasia joins the pain, which initially restricted the growth of cancer cells, and over time acquired a common – gives the ear, temporal region, head.
In advanced cases the tumour invaded adjacent organs and tissues, destroying them actively metastasizes. Because the oral cavity is inhabited by different kinds of microorganisms, and many of them constantly get into it from the external environment, for cancer of this localization is characterized by early accession of secondary infection with formation of foci of purulent and even a putrid character, which further exacerbates the patient’s condition, enhances the intoxication, pain syndrome.
In order to prevent severe forms of mouth cancer, you need to carefully monitor the condition of its cavity, teeth, and early symptoms, indirectly indicating the possibility of growth of the malignant process must always be the reason for going to the doctor. Such signs include:
The presence of the above symptoms, which persisted for 2 or more weeks, especially with unexplained weight loss, decreased performance, fatigue should be a serious cause for concern.
Of course, not all changes indicate cancer, so don’t succumb to unnecessary panic, but to distinguish precancerous or inflammatory process from the early stages of carcinoma can only be a doctor, and delaying a visit to him or, God forbid, self-medication is fraught with adverse developments.
Symptoms of oral cancer are similar in many ways with different localization, but there are features in the defeat of a division. The first signs of the tumor, regardless of the place of its formation are confined to a area of ulceration, compaction or swelling without significant pain, and over time join:
- The pain is intermittent or constant pain at the site of the neoplasia growth, and the damage to her nerves – numbness, loss of sensitivity. Later – pain in the ear, the head, the temple.
- Bleeding without a clearly established cause.
- Difficulty chewing, swallowing, speech production which lie the limitation of the jaw, tongue.
One of the worst localization is the cancer of the floor of the mouth. This area has a quite complex structure with lots of muscles, blood and lymph vessels, contains the salivary glands, so the tumor early and quickly grows these tissues and actively metastasizes. At first the patient feels the presence of a foreign education, and subsequently joined salivation, pain, impaired mobility of the tongue, difficulty swallowing. In ulceration of the tumor may hemorrhage, metastases amaze submandibular, and cervical lymph nodes.
Cancer of the cheeks usually appears in the corner of the mouth, along the line of occlusion, i.e. where injury is more likely, contact with damaged teeth or poorly installed crown. Ulcerative form prevails here, and the symptoms are pain when chewing, swallowing and speaking. With a significant size of the cancerous ulcer, the patient becomes difficult to open your mouth. Histological examination of the tumor tissues is most often found squamous cell carcinoma.
Sky cancer is a fairly rare form of the disease and is found mostly glandular tumors (adenocarcinomas) of the hard palate of the patient in view of the number of small salivary glands located in this area, while the soft palate is most often affected with squamous cell carcinoma.
Glandular tumors of the hard palate for quite a long time can remain limited outside of the salivary glands, appearing as encapsulated infiltration without obvious pain. With increasing tumor size, it ulcerate, the pain increases, and associated infection with the development of the inflammatory process. Next, the tumor is embedded in the surrounding tissue and bone structures, forming the basis of the hard palate. Squamous cell carcinoma is much rarer, but early ulcerate and can therefore be detected at an early stage.
Cancer of the soft palate in most cases presented squamous cell variant, which is less aggressive than adenocarcinoma, so it is best treatable. With the growth of such a tumor, patients experience discomfort when swallowing, talking, speech becomes slurred, the pain and foreign body sensation.
Cancer of the gums is rare and mostly found on the surface of the mucous membrane of the lower jaw. Most likely the reason for its development – problems with teeth, and its histological type – squamous cell carcinoma.
Diagnosis and treatment of oral cancer
For the detection of oral cancer is important to inspection by the patient mucosa. After a careful study it is possible to detect the tumor at an early stage of development. Since not all areas of the oral cavity available for inspection in the home, at least every six months, it is recommended to visit the dentist, who with the help of special tools and mirrors will conduct a more thorough inspection.
In addition to the visual evaluation of the mouth, the doctor will palpate regional lymph nodes, which can be metastases.
Possibilities of instrumental and laboratory methods are limited in cancer of the oral cavity, but can be applied ultrasonic techniques in lesions of the soft tissues, chest x-ray to clarify the nature of the ingrowth of the tumor into the bone tissue, CT or MRI with additional contrast.
The most accurate information is provided by the histological examination of fragments of the tumor, which can be obtained using conventional cytometry or extracted needle or a scalpel with the pre-anesthesia.
Treatment of oral cancer more effective than previously diagnosed tumor. Apply all the basic methods of dealing with cancer – surgery, radiation, chemotherapy.
Surgical treatment is basic and involves the removal of tumor tissue. Given the localization of neoplasia, most patients require subsequent plastic operation, so it is very important for sparing approach to resection. Thus, in cancer of lips can be applied to the so-called micrographic removal of the tumor when tissue is excised in layers with histological control of each portion. So it is possible to achieve removal of only the affected area without the seizure of «excess» amounts of fabric lips.
Often tumors of the oral cavity require excision and bone areas of the jaw, which creates additional difficulties in the rehabilitation and subsequent reconstruction of parts of the facial skull.
Removal of lymph nodes is an integral stage of surgical treatment in the distribution of the tumor, but it is fraught with damage to the nerves, of which in this area quite a lot. Side effects of lymph node dissection can be numbness of the skin of the ear, face, impaired mobility of the masticatory and facial muscles, etc.
Radiation therapy can be administered independently for early forms of cancer, and in addition in the operation. In some cases brachytherapy is the introduction of radioactive elements directly into the tumor. The background radiation may damage the tissues not only of the mouth but thyroid with reduced hormone levels, so often patients need to consult an endocrinologist, the appointment of hormonal drugs.
It is known that many diseases are easier to prevent than to treat, so preventive measures should be known to everyone:
The prognosis after treatment of oral cancer depends on the stage, on which was detected a tumor, and shape of growth of the neoplasia. Thus, virtually all patients with stage 0 have a chance to live 5 years or more, while in stages III-IV, the average is 20-50%. Ulcerative form of cancer occurs more malignant, metastasizes faster and more often leads to an unfavorable outcome. Frequent recurrence of the tumor, especially when gentle techniques of treatment, therefore continuous monitoring and supervision of oncologist – a prerequisite after treatment of the tumor.