Oral Cancer

What is Oral Cancer?

Oral Cancer, also known as head and neck cancer, is a cancer that develops in the tissues of the Mouth, Teeth, Gums, Lips and the Buccal Mucosa (known as the oral cavity).

Over 90% of Oral Cancers begin in the flat cells (squamous cells) that cover the surface of the mouth, the tongue and the lips.

What are the various risk factors for Oral Cancer?

Heavy tobacco and alcohol use are the biggest risk factors. Other risk factors include:

• Human Papillomavirus (HPV)
• Oral Pre-cancerous Lesion
• Betel Quid (Tobacco Paan) use
• Ultraviolet light and excessive sun exposure
• Consumption of drugs to prevent Organ Transplant rejection or to treat Autoimmune diseases
• Certain Genetic Syndromes
• Poor Oro-dental Hygiene
• Sharp Dentition and Dentures

Is Oral Cancer preventable?

Oral Cancer is preventable to a large extent as risk factors like consumption of tobacco and excessive intake of alcohol are within a person’s control.

People who don’t smoke or use tobacco have a lower risk of Oral Cancer, or cancers in other parts of the body, as compared to people who do.

Smokers also have a higher risk of developing cancer in other organs like:

• Lungs
• Larynx
• Pharynx
• Oesophagus
• Bladder
• Kidneys
• Pancreas
• Stomach.

What are the signs and symptoms of Oral Cancer?

Some of the most common Oral Cancer symptoms include:

• A mouth sore that doesn't heal
• A lump or thickening that can be felt inside the mouth
• A white or red patch on the gums, tongue, tonsil or lining of the mouth
• Bleeding in the mouth
• Unexplained loosening of the teeth
• Persistent bad breath
• Pain or difficulty in swallowing or chewing
• Difficulty in moving the jaw or tongue
• Numbness in the tongue, lower lip or chin
• Difficulty in wearing dentures (poor fit)
• A lump in the neck
• Chronic hoarseness
• Chronic unexplained earache
• Unexplained weight loss

How is Oral Cancer diagnosed?

Diagnosis of Oral Cancer involves a medical examination of the mouth and neck, biopsy of oral tissues, imaging such as X-rays, MRI, CT Scan or Ultrasound, and also an assessment of the risk factors.

Who is prone to Oral Cancer?

Oral Cancer is twice as common in men than in women. This may be due to the higher tendency of men to use tobacco and alcohol, in large doses, over a long period of time

Age is also a major risk factor. Two-thirds of all the cases diagnosed are of people who are 55 years or older.

In addition, people whose diets contain small amounts of fruits and vegetables tend to be at greater risk, as well as those with outdoor jobs.

Finally, the Human Papillomavirus (HPV) puts people at a greater risk. Statistically, approximately one-quarter of all patients with Oropharyngeal Cancer also suffer from HPV.

Is pain an early sign of Oral Cancer?

Pain is not always an early sign of Oral Cancer. This is because you typically experience the pain associated with Oral Cancer once the cancer has progressed to an advanced stage. If you are in pain, don’t ignore it. Have your doctor or dentist assess it immediately to determine the cause.

What is the standard treatment for Oral Cancer?

Oral Cancer treatment almost always involves surgery. But that surgery can never be classified as “standard” since each cancer is different and thus requires a personalized approach to treatment. The severity or spread of the cancer will determine whether surgery is minor or if it requires an extensive removal of the surrounding tissue. Post-surgery treatments may include:

• Radiation Therapy or Chemotherapy
• Targeted Drug Therapy
• Physical and Occupational Therapies
• Focussed Pain Management

Do you have doctors who specialize in all types of Cancer?

Indeed. Our Cancer Specialists have an extensive expertise in all forms of Head and Neck Cancers, ranging from the most common Oral Cancers to the very rare ones. Our physicians are at the forefront of cancer care. They specialize in the most advanced surgical techniques which make the procedure minimally invasive, thereby enabling faster recovery. Our team of experts are closely involved in the breakthrough cancer research on finding new methods for the treatment and prevention of Oral Cancer.

My friend has been diagnosed with Oral Cancer, but he doesn't believe it - what should I do?

In the early stages, Cancer can be properly treated with minimal complications. So if a doctor has said that your friend has cancer then it shouldn't be taken lightly. If he doesn't believe that he has Oral Cancer, he can always get it checked from a qualified medical practitioner

Remember, time is of an essence here. Even if there is a slight delay, the situation can dramatically go from bad to worse.

I have Oral Cancer, will Ayurvedic medicines help me?

It has been observed that Ayurvedic medicines do not work once you develop Oral Cancer and patients are strongly advised to undergo surgery. Once the cancer has been diagnosed please do not wait. If the lesion has not progressed, then there are chances that you will have an excellent prognosis.

My friend was diagnosed with cancer after a tooth extraction. Was the doctor negligent?

Definitely not! You can never get oral cancer from any dental procedure performed by your Dentist. The predominant sign of alveolar and gingival carcinoma is mobile tooth / teeth, and only after the extraction, when the socket doesn't heal, and there is some growth, do you realize that the tooth / teeth were mobile because of the cancer. This is a case of misdiagnosis and not of wrong treatment. This type of diagnosis can be missed even by the best Dentists. Usually, such cases have a long history of tobacco consumption.

Does the Leukoplakia patch disappear after discontinuing tobacco abuse?

Leukoplakia will usually disappear on its own if the use of tobacco is stopped. In only 4% of the cases will it progress to Oral Cancer. However, Speckled Leukoplakia has a cancer potential of at least 25%, and in some cases it's as high as 41%.

In case of an Oral Submucous Fibrosis (OSMF), how long does it take for problems related to consumption of spicy food and difficulty in opening of the mouth to disappear (Trismus)?

In Oral Submucous Fibrosis cases, after the patient has completely stopped the consumption of tobacco, it might take a few months for the problems arising from eating spicy food to disappear completely. On the other hand, Trismus might never go away, as it is an irreversible process. A malignant transformation rate of 7-8% has been estimated in OSMF cases, over a period of 7-10 years.

Which treatments are available for the problem of mouth opening in OSMF cases?

For Trismus, many treatments like injecting special medicines into the lesion and performing surgery can be done but are seldom successful. However, for the ‘burning mouth syndrome’ there is no treatment, but you may apply a comforting anaesthetic gel before food consumption.

We cannot emphasize enough how important it is to strictly avoid gutka or tobacco in any form. Stiffening of the mouth is due to OSMF which is pre-cancerous, caused by the consumption of areca nut or supari.

But in 50% of the cases, Oral Cancer is caused primarily by tobacco. Oral Cancer erupts from the mucosa or the lining inside the mouth, and stiffening of the mouth results from the formation of collagen fibres in the connective tissue. The changes in the mucosa may reverse when tobacco consumption is completely stopped, but only if it has not progressed to cancer.

Since Head and Neck Cancers are being frequently treated via surgery, is there a risk of disfigurement?

It's true that surgery is often the recommended treatment for cancers of the head and neck, and that’s why reconstruction is always a part of the treatment plan. The physician discusses the treatment options with the patient, including reconstruction, before any surgery takes place.

In the last 15 years, advances and innovations in reconstructive microvascular surgery have had a major positive impact on the quality of life, post-treatment. At BLK, our surgeons are internationally renowned for their reconstruction innovations involving loss of bone, tissue and muscle, to achieve best possible aesthetic and functional results.

What are the side effects of Radiation Therapy?

1. Dry mouth
2. Loss of taste
3. Sore mouth and gums

Dry mouth is the most common problem associated with radiation therapy. It can be tackled by use of artificial saliva, by drinking plenty of water, and sucking on ice chips. Get yourself regularly checked by your dentist to prevent cavities, which is one of the effects of dry mouth.

Are swallowing problems associated with Head and Neck Cancer?

People who have been treated for Head and Neck Cancer, such as Laryngeal or Oral Cancer, often experience swallowing problems (dysphagia). The seriousness of the swallowing problem depends on the type and nature of the treatment, the size and location of the tumour and the nature of reconstruction, if any.

What causes swallowing problems after Head and Neck Cancer treatment?

Swallowing problems can occur after resections of lesions in the mouth, throat or larynx (voice box) and also after radiation therapy. Some of the surgeries and treatment related therapies that affect swallowing are:

• Oral (mouth) Surgery may result in drooling of liquid or food from the corner of the mouth, and loss of control on chewing and swallowing
• Pharynx (throat) Surgery may cause difficulty in swallowing foods and liquids from the mouth into the oesophagus, which may lead to aspiration of food into the lungs
• Laryngectomy may cause difficulty in moving foods and liquids from the mouth to the oesophagus
• Radiation Therapy leads to soreness in the mouth and throat, reduces salivary secretion, produces dry mouth and causes stiffness in the swallowing related structures. This leads to difficulty in chewing and swallowing of food

What treatments are available for people with swallowing problems after Head and Neck Cancer?

If the individual experiences swallowing problems, the SLP can work with the patient to relieve any discomfort. The treatment may include:

• Muscle exercises
• Compensatory strategies
• Head posture corrections
• Designing a safe diet
• Safe swallowing techniques