Dr. Pawan Gupta

Oral Cancer

What is oral cancer?

Oral cancer refers to cancer that develops in any part of the mouth, including the lips, tongue, cheeks, gums, floor of the mouth, hard and soft palate, and the pharynx (throat).


Types of Oral Cancer

 

The most common type of oral cancer is squamous cell carcinoma, which begins in the flat, thin cells that line the lips and the inside of the mouth. Other, less common types include:

 

       Verrucous carcinoma

       Minor salivary gland carcinomas

       Lymphomas

What are the symptoms of oral cancer?

       A sore or ulcer in the mouth that doesn't heal

       Persistent pain in the mouth

       A lump or thickening in the cheek

       White or red patches on the gums, tongue, or lining of the mouth

       Difficulty chewing, swallowing, or moving the tongue or jaw

       Numbness of the tongue or other areas of the mouth

       A feeling that something is caught in the throat

       Swelling of the jaw

       Unexplained weight loss

       Changes in voice or persistent hoarseness

 

What are the risk factors causing oral cancer?

Several factors can increase the risk of developing oral cancer:

       Tobacco Use: Smoking cigarettes, cigars, or pipes, as well as using smokeless tobacco (like chewing tobacco or snuff), significantly raises the risk.

       Alcohol Consumption: Heavy drinking, especially when combined with tobacco use, increases the risk.

       HPV Infection: Certain strains of the human papillomavirus (HPV), particularly HPV16, are linked to oral cancers.

       Prolonged Sun Exposure: This mainly increases the risk of lip cancer.

       Poor Diet: A diet low in fruits and vegetables may contribute to oral cancer risk.

       Family History: A family history of cancer can increase the likelihood of developing oral cancer.

Age and Gender: Oral cancer is more common in older adults, particularly men.

How common are oral cancers in India?

Oral cancers are quite common in India, accounting for a significant portion of the global burden of the disease. India has one of the highest rates of oral cancer in the world, with nearly one-third of all global cases occurring in the country.

Key Statistics:

       Prevalence: Oral cancer is the most common cancer among men in India and the third most common among women.

       New Cases: Approximately 77,000 new cases of oral cancer are diagnosed in India each year.

       Mortality Rate: Oral cancer causes around 52,000 deaths annually in India, making it one of the leading causes of cancer-related deaths in the country.

Age Group: It is more prevalent among older adults, particularly those aged 50 and above, but cases in younger individuals are also increasing due to lifestyle factors.

How can I reduce my risk of developing oral cancers?

      Quit tobacco and avoid all tobacco products

      Limit/avoid alcohol consumption

      Eat a healthy diet rich in fruits, vegetables, whole grains, lean proteins to strengthen the immune system. avoid processed food, red meat, high fat diet, sugar rich foods.

      Exercise regularly for at least 150 minutes a week

      Practice good oral hygiene. brush twice daily. visit the dentist regularly

      Protect yourself from HPV through vaccination

       Limit sun exposure

       Perform regular self examination

      Avoid exposure to environmental carcinogens

      Manage underlying health conditions like GERD to reduce risk of cancers

Be aware of any family history. Some cancers can be genetic

What is the treatment process for Oral cancers?

The treatment process for oral cancers varies depending on the type, location, and stage of the cancer, as well as the patient's overall health. Here is a general overview of the treatment process:

1. Diagnosis

       Physical Examination: The process usually begins with a physical exam where a doctor or dentist checks for lumps or irregular tissue in the mouth, throat, and neck.

       Biopsy: If any abnormalities are found, a biopsy (removal of a small sample of tissue for analysis) is performed to confirm whether the cells are cancerous.

       Imaging Tests: Tests such as X-rays, CT scans, MRI, and PET scans may be used to determine the extent and stage of the cancer.

2. Treatment Planning

       Multidisciplinary Team: Treatment is often managed by a team of specialists, including a surgeon, radiation oncologist, medical oncologist, and a dental specialist.

       Staging: Based on the results of the diagnostic tests, the cancer is staged (from I to IV), which helps guide treatment decisions.

3. Surgical Treatment

       Tumor Removal: The primary treatment for many oral cancers involves surgery to remove the tumor. The extent of the surgery depends on the size and location of the tumor.

       Lymph Node Dissection: If the cancer has spread to nearby lymph nodes, these may also be removed.

       Reconstructive Surgery: In cases where significant tissue is removed, reconstructive surgery may be necessary to restore appearance and function.

4. Radiation Therapy

       External Beam Radiation: This is the most common form of radiation therapy, where high-energy beams are directed at the cancer site.

       Brachytherapy: In some cases, radioactive seeds may be placed directly in or near the tumor.

5. Chemotherapy

       Systemic Treatment: Chemotherapy uses drugs to kill cancer cells and is often used in combination with radiation therapy, especially for more advanced stages or if the cancer has spread.

       Neoadjuvant or Adjuvant Therapy: Chemotherapy may be given before surgery to shrink the tumor (neoadjuvant) or after surgery to kill any remaining cancer cells (adjuvant).

6. Targeted Therapy

       Targeted Drugs: These drugs target specific molecules involved in cancer growth. For example, Cetuximab is a targeted therapy used in some cases of oral cancer.

7. Immunotherapy

       Immune System Activation: Immunotherapy drugs help the body's immune system recognize and attack cancer cells. This is often used in cases where cancer has spread or recurred.

8. Rehabilitation

       Speech and Swallowing Therapy: After treatment, patients may need therapy to help with speech, swallowing, and other functions affected by the cancer and its treatment.

       Physical Therapy: Physical therapy may also be needed to regain strength and mobility, especially if the surgery was extensive.

9. Follow-Up Care

       Regular Monitoring: After treatment, patients require regular follow-up visits to monitor for recurrence and manage any side effects.

       Lifestyle Changes: Patients are often advised to quit smoking, reduce alcohol consumption, and maintain a healthy diet to reduce the risk of recurrence.

10. Psychological Support

       Counseling: The emotional impact of oral cancer treatment can be significant, so psychological counseling or support groups may be beneficial for patients and their families.

Treatment for oral cancer is complex and personalized, so it's crucial to work closely with a healthcare team to develop the most appropriate treatment plan.

What is the treatment process for head and neck cancers?

The treatment process for head and neck cancers depends on various factors, including the type, location, stage of the cancer, and the patient’s overall health. Here’s a general outline of the treatment process:

1. Diagnosis and Staging

       Physical Examination: A thorough examination of the head, neck, and throat to detect abnormal lumps, sores, or other signs.

       Imaging Tests: CT scans, MRI, PET scans, and X-rays are used to determine the size and spread of the cancer.

       Biopsy: A tissue sample is taken from the suspicious area to confirm the presence of cancer and determine its type.

       Endoscopy: A flexible tube with a camera is inserted into the nose, throat, or mouth to get a closer look at the affected areas.

2. Treatment Planning

       A multidisciplinary team, including oncologists, surgeons, radiologists, and other specialists, develops a personalized treatment plan based on the patient’s condition.

3. Primary Treatment Options

       Surgery:

       The goal is to remove the tumor and some surrounding healthy tissue to ensure all cancerous cells are removed. Depending on the location and size, surgeries might involve removing parts of the mouth, throat, or voice box (larynx).

       In some cases, reconstructive surgery is needed to restore function and appearance.

       Radiation Therapy:

       High-energy beams, such as X-rays or protons, are used to kill cancer cells. Radiation may be used as the primary treatment, post-surgery to eliminate residual cancer cells, or to shrink tumors before surgery.

       It can also be used to treat areas that cannot be surgically removed.

       Chemotherapy:

       Chemotherapy involves using drugs to kill cancer cells. It is often used in combination with radiation therapy (chemoradiation) to increase the effectiveness of the treatment.

       It may be given before surgery (neoadjuvant therapy) to shrink the tumor, or after surgery (adjuvant therapy) to reduce the risk of recurrence.

       Targeted Therapy:

       Targeted drugs focus on specific molecules involved in cancer growth, such as the EGFR (epidermal growth factor receptor) protein in some head and neck cancers.

       This treatment is often used in conjunction with chemotherapy or radiation.

       Immunotherapy:

       Immunotherapy boosts the body's immune system to fight cancer. It is typically used for advanced head and neck cancers that haven’t responded well to other treatments.

4. Rehabilitation

       Speech and Swallowing Therapy: Post-surgery or radiation therapy, patients may need therapy to regain normal speech, swallowing, and breathing functions.

       Nutritional Support: Dietitians help manage diet and nutritional intake during and after treatment to maintain strength and recovery.

       Physical Therapy: Assists in regaining strength and mobility, particularly if extensive surgery or radiation therapy has affected movement or function.

5. Follow-Up Care

       Regular Monitoring: Post-treatment, regular check-ups are necessary to monitor for any signs of recurrence or complications.

       Supportive Care: Psychological support, pain management, and social services are provided to help patients cope with the emotional and physical impact of cancer treatment.

6. Clinical Trials

       Patients may have the option to participate in clinical trials to access new and potentially more effective treatments.

Each patient's treatment process is unique, and the approach will be tailored to best address the specific needs of the individual.

What are the side effects of head and neck cancer?

side effects of head and neck cancer treatment can vary widely depending on the type of treatment, the location of the cancer, and the individual’s overall health. Here are some common side effects associated with the primary treatment options:

1. Surgery

       Pain and Discomfort at the surgical site, requiring pain management with medication.

       Temporary Swelling and Bruising around the surgery area.

       Difficulty with Speech and Swallowing, If surgery involves the mouth, throat, or larynx

       Changes in Appearance: Depending on the extent of surgery, there may be visible changes, especially if part of the jaw, tongue, or throat is removed.

       Nerve Damage: Surgery can sometimes lead to numbness, weakness, or paralysis in parts of the face or neck.

       Difficulty Breathing: If a tracheostomy (an opening in the windpipe) is required, it may affect breathing initially.

2. Radiation Therapy

       Skin Irritation: Redness, soreness, or peeling of the skin in the treated area, similar to a sunburn.

       Dry Mouth (Xerostomia)

       Sore Throat

       Loss of Taste

       Hoarseness or Voice Changes

       Fatigue

       Painful Mouth Sores or ulcers

       Tooth Decay

       Difficulty Swallowing (Dysphagia)

       Jaw Stiffness (Trismus): Reduced ability to open the mouth due to radiation affecting the jaw muscles.

3. Chemotherapy

       Nausea and Vomiting

       Hair Loss

       Increased Risk of Infection due to reduction in WBCs count

       Mouth Sores

       Persistent Fatigue that can last for weeks or months after treatment.

       Anemia

       Loss of Appetite

       Diarrhea or Constipation

4. Targeted Therapy

       Skin Rash: Common with drugs targeting EGFR, can be severe in some cases.

       Diarrhea

       General tiredness and lack of energy.

       Sores or ulcers in the mouth.

       Brittle, painful nails, and changes in nail color or texture.

       Similar to chemotherapy, targeted therapy can also suppress the immune system, increasing risk of infection.

5. Immunotherapy

       Persistent tiredness

       Rashes, itching, and inflammation.

       Fever, chills, and muscle aches can occur.

       Autoimmune Reactions: Immunotherapy can sometimes cause the immune system to attack healthy cells, leading to inflammation in organs like the lungs (pneumonitis), liver (hepatitis), or intestines (colitis).

       Thyroid dysfunction or other hormonal imbalances can develop.

6. General Side Effects

       Emotional and Psychological Impact: Anxiety, depression, and stress are common due to the impact of the diagnosis and treatment on daily life.

       Nutritional Challenges: Difficulty eating due to mouth sores, dry mouth, or loss of appetite can lead to weight loss and malnutrition.

       Lymphedema: Swelling in the neck or face if lymph nodes are removed or damaged during treatment.

Most of these side effects can be managed with supportive care and medications. It's important to communicate with the healthcare team to address any side effects promptly and to receive appropriate treatment or adjustments in therapy.

What are the side effects of oral cancer treatments?

The side effects of oral cancer treatments can vary depending on the type of treatment, the location and stage of the cancer, and the patient’s overall health. Here’s an overview of common side effects associated with each treatment type:

1. Surgery

       Post-surgical pain and swelling in the mouth, throat, or face are common. This usually subsides with time, but pain management may be necessary.

       Depending on the extent of surgery, there may be temporary or permanent difficulty with speech and swallowing.

       Surgery may alter the appearance of the face or neck, particularly if large amounts of tissue are removed.

       Nerve damage during surgery can lead to numbness or weakness in the face, tongue, or lips.

       As with any surgery, there is a risk of infection at the surgical site.

       If the jawbone is affected or reconstructed, chewing may become difficult.

2. Radiation Therapy

       Dry Mouth (Xerostomia)

       Mouth Sores

       A reduction or alteration in taste is common, and food may taste bland or metallic.

       Jaw Stiffness (Trismus): Radiation can cause stiffness in the jaw muscles, making it difficult to open the mouth fully.

       General tiredness

       The skin in the treated area may become red, sore, or blistered, similar to a sunburn.

3. Chemotherapy

       Nausea and Vomiting

       Hair Loss

       Can have painful sores in the mouth and throat.

       Increased Risk of Infections

       Persistent tiredness and weakness

       Loss of Appetite leading to weight loss

4. Targeted Therapy

       Skin Rash: Some targeted therapies can cause acne-like rashes or other skin problems.

       Diarrhea

       Fatigue

5. Immunotherapy

       Rashes, itching, and other skin issues can occur.

       Might experience fever, chills, and muscle aches.

       Autoimmune Reactions: In some cases, immunotherapy can cause the immune system to attack healthy tissues, leading to inflammation in organs like the lungs, liver, or intestines.

6. Rehabilitation Side Effects

       Speech and Swallowing Issues: Post-treatment, rehabilitation may be required to address difficulties with speech and swallowing.

       Nutritional Challenges: Some patients may need a feeding tube temporarily or permanently if swallowing becomes too difficult.

7. Psychological and Emotional Side Effects

       Depression and Anxiety: The physical changes, along with the stress of treatment, can lead to emotional challenges such as depression or anxiety.

       Body Image Concerns: Changes in appearance due to surgery or treatment can affect self-esteem and body image.

8. Long-Term and Late Effects

       Dental Problems: Radiation can lead to long-term dental issues, including tooth decay and gum disease.

       Osteoradionecrosis: Radiation therapy can reduce blood supply to the jawbone, leading to bone damage (osteoradionecrosis), which can be a serious and long-term complication.

       Secondary Cancers: Rarely, radiation or chemotherapy can increase the risk of developing another type of cancer later in life.

Managing these side effects is an important aspect of oral cancer treatment. Patients should work closely with their healthcare team to address any side effects and improve their quality of life during and after treatment.

Is follow-up care necessary in oral cancer? What does it involve?

Yes, follow-up care is crucial after treatment for oral cancer. It helps monitor for any signs of recurrence, manage side effects of treatment, and support overall recovery and quality of life. Here’s what follow-up care typically involves:

1. Regular Medical Check-ups

       Frequency: Initially, follow-up visits may be scheduled every 1-3 months during the first year after treatment. As time goes on, the frequency may decrease to every 4-6 months and eventually to once a year after five years if no recurrence is detected.

       Physical Exams: During these visits, your doctor will perform a thorough physical examination, focusing on the head, neck, and mouth to check for any signs of cancer returning.

       Imaging Tests: Depending on the case, imaging tests like X-rays, CT scans, MRIs, or PET scans may be ordered to monitor for recurrence or metastasis.

2. Dental Care

       Dental Check-ups: Regular visits to a dentist are essential, especially if you've had radiation therapy, which can affect oral health. The dentist will check for any dental issues, such as tooth decay or gum disease, and help manage any complications from treatment, like dry mouth or jaw stiffness.

       Fluoride Treatments: Fluoride treatments may be recommended to prevent tooth decay, particularly if radiation therapy has affected your salivary glands.

3. Managing Side Effects

       Rehabilitation Therapy: If you have difficulties with speech, swallowing, or jaw movement after treatment, ongoing therapy with a speech-language pathologist or physical therapist may be necessary.

       Nutritional Support: A dietitian may help you maintain proper nutrition, especially if you experience difficulties eating or swallowing.

       Pain Management: If you experience chronic pain as a result of treatment, your doctor may prescribe medications or refer you to a pain specialist.

4. Monitoring for Secondary Cancers

       Screening: Since individuals who have had oral cancer are at higher risk for developing other cancers in the head, neck, or other parts of the body, your doctor may recommend regular screenings for other types of cancer.

5. Psychosocial Support

       Counseling: Emotional and psychological support is important. Counseling or therapy can help you cope with any emotional challenges, such as anxiety, depression, or body image issues that may arise after treatment.

       Support Groups: Joining a support group for cancer survivors can provide emotional support and help you connect with others who have had similar experiences.

6. Lifestyle Modifications

       Quitting Smoking: If you smoke, it's essential to quit, as continued tobacco use significantly increases the risk of recurrence.

       Limiting Alcohol: Reducing or eliminating alcohol consumption can also lower the risk of cancer returning.

       Healthy Diet and Exercise: Maintaining a healthy diet rich in fruits and vegetables and staying physically active can support your overall health and reduce the risk of recurrence.

7. Monitoring for Recurrence

       Early Detection: If any new symptoms or unusual changes in your mouth or throat occur, you should report them to your healthcare provider immediately. Early detection of recurrence can significantly improve the chances of successful treatment.

8. Long-term Monitoring

       Ongoing Care: Even after five years, when the risk of recurrence typically decreases, continued monitoring remains important. Some late effects of treatment, such as secondary cancers or osteoradionecrosis (bone damage from radiation), may occur years after the initial treatment.

Follow-up care is an ongoing process that plays a vital role in ensuring the best possible outcome after oral cancer treatment. It helps manage any long-term side effects and provides an opportunity to detect and treat any recurrence of cancer early.

How can people who have had oral cancers reduce their risk of developing a second primary (new) cancer?

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