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Oral Cancer Treatment in India

Oral Cancer

Oral cancer is a cancer that develops in the tissues of the mouth or throat. Most develop in the squamous cells found in your mouth, tongue, and lips. Oral cancers are most often discovered after they have spread to the lymph nodes of the neck. Early detection is key to surviving this cancer. Oral cancer appears as a growth or sore in the mouth that does not go away. Oral cancer, which includes cancers of the lips, tongue, cheeks, floor of the mouth, hard and soft palate,sinuses, and pharynx (throat)

Types of Oral Cancer

In the head and neck region, two of the most common types of cancer are cancer of the oral cavity (mouth and tongue) and cancer of the oropharynx (the middle of the throat from the tonsils to the tip of the voice box). The oral cavity and oropharynx, along with other parts of the head and neck, contribute to the ability to chew, swallow, breathe, and talk.

A cancer that develops on the inside or outside layer of the body is called a carcinoma and these types of cancer are categorised by the type of cells the cancer starts in.
Squamous cell carcinoma is the most common type of mouth cancer, accounting for nine out of 10 cases. Squamous cells are found in many places around the body, including the inside of the mouth and under the skin.
Less common types of mouth cancer include:

  • oral malignant melanoma – where the cancer starts in cells called melanocytes, which help give skin its colour
  • adenocarcinomas – cancers that develop inside the salivary glands

Causes of Oral Cancer

Risk factors for the development of oral cancer include:

  • Smoking . Cigarette, cigar, or pipe smokers are six times more likely than nonsmokers to develop oral cancers.
  • Smokeless tobacco users. Users of dip, snuff, or chewing tobacco products are 50 times more likely to develop cancers of the cheek, gums, and lining of the lips.
  • Excessive consumption of alcohol. Oral cancers are about six times more common in drinkers than in nondrinkers.
  • Family history of cancer.
  • Excessive sun exposure, especially at a young age.
  • HPV infection (a sexually transmitted virus)

Symptoms of Oral Cancer

The most common symptoms of oral cancer include:

  • Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums, or other areas inside the mouth
  • The development of velvety white, red, or speckled (white and red) patches in the mouth
  • Unexplained bleeding in the mouth
  • Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck
  • Persistent sores on the face, neck, or mouth that bleed easily and do not heal within 2 weeks
  • A soreness or feeling that something is caught in the back of the throat
  • Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
  • Hoarseness, chronic sore throat, or change in voice
  • Ear pain
  • A change in the way your teeth or dentures fit together
  • Dramatic weight loss

Stages of Oral Cancer

There are four main stages in this system – stages 1 to 4. Some doctors also refer to stage 0.

Stage 0 or carcinoma in situ (CIS)

If you have CIS or stage 0 cancer of the mouth or oropharynx, you have a very early stage cancer. Some doctors prefer to call this pre cancer. There are cancer cells but they are all contained within the lining of the mouth or oropharynx. So they have not spread. As the cells have not spread, this is not yet a true cancer. If the pre cancer is not treated, there is a high chance of this condition going on to develop into an invasive cancer.

Stage 1

This is the earliest stage of invasive cancer. It means that cancer has begun to grow through the tissues lining the mouth or oropharynx and into the deeper tissues underneath. The cancer is no more than 2 cm across and has not spread to nearby tissues, lymph nodes or other organs.

Stage 2

If you have stage 2 cancer, the tumour is larger than 2cm across, but less than 4cm. The cancer has not spread to lymph nodes or any other organs.

Stage 3

Having stage 3 mouth or oropharynx cancer can mean one of two things. Either the cancer is bigger than 4cm but has not spread to any lymph nodes or other parts of the body. Or the tumour is any size but has spread to one lymph node on the same side of the neck as the cancer. In this case the lymph node involved is no more than 3cm across.

Stage 4

Stage 4 means the cancer is advanced. It is divided into 3 stages

  • Stage 4a means the cancer has grown through the tissues around the lips and mouth – lymph nodes in the area may or may not contain cancer cells
  • Stage 4b means the cancer is any size and has spread to more than 1 lymph node on the same side of the neck as the cancer, or to lymph nodes on both sides of the neck, or any lymph node is bigger than 6cm
  • Stage 4c means the cancer has spread to other parts of the body such as the lungs or bones

Diagnosis of Oral Cancer

Biopsy

To make a definite diagnosis of any mouth or oropharyngeal cancer your doctor needs to take a sample of tissue from the affected area (a biopsy) and look at it under a microscope for signs of cancer. If the area is easy to get at (for example, in your mouth) your doctor will be able to remove a very small amount of tissue and send it to the laboratory. There are different ways of taking a biopsy to diagnose mouth and oropharyngeal cancers. They include scalpel biopsy andpanendoscopy. If you have a lump in your neck, your doctor may take a sample of cells using fine needle aspiration.

Scalpel biopsy

A scalpel biopsy means cutting out a small piece of tissue from the affected area. Your doctor will inject some local anaesthetic into the area to numb it. Then the doctor cuts round the biopsy area, gently lifts the piece of tissue using a pair of tweezers and cuts it off. This is uncomfortable but only lasts a short time. For many people, the most uncomfortable part is the local anaesthetic injection

Nasoendoscopy

A nasoendoscopy (sometimes spelt nasendoscopy) or laryngoscopy allows your specialist to look at all your upper air passages. This includes the back of your throat (the pharynx).

The specialist passes a narrow, flexible telescope (a nasoendoscope) up your nose and down your throat. It can be a bit uncomfortable, so your doctor may use an anaesthetic spray to numb your throat first. But if you have the anaesthetic spray you can’t eat or drink until it wears off so you may choose not to have it. If the specialist sees any abnormal area in your throat, they will need to take a biopsy from that area.

Fine needle aspiration

Fine needle aspiration is also called FNA. If your doctor can feel a lump in your neck, you may need to have a fine needle aspiration. This means putting a thin needle into the lump. The specialist will first feel the lump, so that they know where to put the needle. Once the needle is in the lump, the doctor draws out cells and fluid. The doctor sends the cells to the laboratory, where a specialist called a pathologist examines them to see if they are cancerous.

Your doctor may also use a fine needle biopsy to see if the cancer has spread to the lymph nodes in your neck. The doctor puts the needle into one of the large lymph nodes and draws out fluid and cells for testing.

Panendoscopy

Your doctor may ask you to go into hospital to have a panendoscopy. This is usually if they can’t get a good view using the mirror or nasoendoscope, or if they see something abnormal and need to take a biopsy. The nasoendoscope is too fine to use for a biopsy. But a panendoscope is thicker so your specialist can use it to remove a sample of the affected tissue. A panendoscope is a series of connected tubes that a head and neck surgeon uses to look at your upper airways. There is a camera and light at one end, and an eyepiece at the other.

You have this test while you are under general anaesthetic. The doctor gently puts the panendoscope up your nose and down into your throat. They will look at all parts of your pharynx, as well as the larynx (voice box), food pipe (oesophagus), windpipe (trachea) and breathing tubes (bronchi). This is because people with mouth and oropharyngeal cancers are at a greater risk of developing cancers in other areas of the head and neck.

Chest X-ray

You need to have a routine chest X-ray if you are going to have surgery under general anaesthetic

CT scan

MRI scan

Orthopantomogram (OPG or OPT)

This type of X-ray takes pictures of the area around the upper jawbone (maxilla) and lower jawbone (mandible) and the surrounding area. It can pick up any signs of cancer in and around these bones. It is also a useful way of seeing if you need any dental work done before treatment starts. Your doctor may call this test a Panorex scan

PET-CT Scan

Barium swallow

A barium swallow is a type of X-ray investigation. This is not a very common test but you may have it if you are having difficulty swallowing solid food.
You swallow a liquid that contains barium. Barium shows up the outline of the inside of the digestive system very clearly on X-ray

Treatment of Oral Cancer

Oral cancer treatment may include surgery, radiation therapy, or chemotherapy. Some patients have a combination of treatments.
At any stage of disease, people with oral cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care

Surgery

Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be removed as well. Patients may have surgery alone or in combination with radiation therapy.

Non-surgical Treatments

Radiation therapy

Radiation therapy (also called radiotherapy) is a type of local therapy. It affects cells only in the treated area. Radiation therapy is used alone for small tumors or for patients who cannot have surgery. It may be used before surgery to kill cancer cells and shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because it enters the bloodstream and can affect cancer cells throughout the body. A new targeted therapy called cetuximab, which blocks a growth factor upon which cancer cells may depend, is being used today, either alone or in combination with radiation and older chemotherapy drugs.
Chemotherapy is usually given by injection

Biological Therapy:

Biological therapy is treatment designed to stimulate or restore the ability of the body’s immune (natural internal defense) system to fight infection and disease. Biological therapy is also called biotherapy or immunotherapy. Biological therapies are treatments that act on processes in cells. They may

  • Stop cancer cells from dividing and growing
  • Seek out cancer cells and kill them
  • Encourage the immune system to attack cancer cells

There are many different types of biological therapy and they may be called

  • Biological Response Modifiers (BRMs)
  • Biologic agents or biologics
  • Targeted therapies
  • Immunotherapy