What do we mean by ‘Mouth Cancer’?
Oral cancer, often referred to colloquially as mouth cancer, encompasses cancers affecting various parts of the mouth, including the tongue, gums, cheek, jaw bone…..
Typically, oral cancers originate from the cells lining the mouth, known as mucosa, commonly identified as squamous cell carcinomas, akin to prevalent skin cancer types.
In addition to mucosal cells, mouth cancers may also arise from minor salivary glands, bone tissues, blood vessels, nerves, and other structures, albeit less frequently, collectively constituting less than 5% of all cases.
Cancer manifests when cells undergo abnormal changes, proliferating uncontrollably and potentially spreading to other bodily regions. These abnormal cells accumulate, forming a mass or lump, indicative of malignant growth.
What is the Oral Cavity?
The oral cavity, encompassing the region between the lips and the top of the throat, is susceptible to various forms of cancer affecting distinct areas, such as:
- Anterior portion of the tongue
- Sublingual area (located beneath the tongue and above the lower jaw)
- Jawbones
- Upper and lower gum tissues (gingiva)
- Inner lining of the lips and cheeks (buccal mucosa)
- Frontal region of the upper mouth (hard palate)
- Area behind the wisdom teeth, known as the retromolar trigone
It’s noteworthy that while the lips are anatomically part of the mouth, cancers affecting them exhibit similarities to skin cancer rather than typical oral cancers.
What does the oral cavity do?
The oral cavity plays a vital role in daily functions like tasting, chewing, swallowing food, and speech. The tongue is primarily responsible for facilitating eating by softening food and aiding in the swallowing process, as well as assisting in speech.
Impairments in tongue movement, whether due to surgical muscle loss or scarring that restricts mobility, can significantly impact both speech and eating abilities.
Jawbones contribute to maintaining facial structure and provide essential support for chewing functions.
Signs and Symptoms of Mouth Cancer
The symptoms of mouth cancer vary depending on its location, size, and extent of spread in the body. Common indications include:
- Persistent sore or lump resembling an ulcer in the mouth
- Pain in the mouth or ear
- Presence of white or red patches on the gums, tongue, or inside the mouth
- Unusual bleeding or numbness in the mouth
- Difficulty in chewing, swallowing food, or moving the tongue
- Trouble opening the mouth
- Noticeable lump in the neck
- Loose teeth or ill-fitting dentures
While these symptoms are often not indicative of mouth cancer, experiencing them for an extended period, typically more than a few weeks, warrants consultation with a healthcare professional promptly. Early diagnosis and intervention are crucial, and your doctor can assist in evaluating and addressing any concerns you may have.
Treatment Options for Mouth Cancer
Upon receiving a mouth cancer diagnosis, your healthcare team will discuss suitable treatment options and may suggest seeking a second opinion. Surgery form the preferred first treatment option in mouth cancer. The 3 broad treatment in mouth cancer are surgery, radiation and chemotherapy. Early cancers are treated with surgery alone, while advanced cancers will need adjuvant therapy with radiation / chemotherapy based on a detailed pathology report received 1–2 weeks post-surgery.
Some factors taken into consideration during treatment decision:
- Cancer size and location
- Spread of the cancer
- Personal factors such as age, overall health, and medical history
- Available treatment modalities and any relevant clinical trials
- Patient preferences
Reconstruction:
After removal of cancer along with adjacent normal tissues to cure cancers, it is important to rebuild the lost part. As oral cavity is required for regular functions of eating, drinking, speaking, swallowing… In reconstruction, we harvest a suitable tissue which is lost because of cancer surgery and rebuild it to gain these important functions. This will help us to achieve good quality of life once they get back to their normal life after completion of treatment.
Below are pictures of a cheek cancer which was reconstructed with tissue from thigh and the second picture is of a tongue cancer patient reconstructed with a tissue from forearm. These patients are cured of cancer and back doing their normal activities and living a new happy transformed happy lives .
Adjuvant therapy
The adjuvant therapy, may involve radiation therapy alone or combined with chemotherapy (chemoradiation). Typically, this treatment begins around 6 weeks post-surgery, allowing time for recovery and planning. The entire treatment duration usually spans approximately 6 weeks. During this treatment along with the treating surgical team and entire group of allied specialist will handhold and guide the patients in the rehabilitaitve journey. This includes Dental surgeon, Speech and Swallow specialist, Dietician, Physiotherapist, Psychologist….
Follow up
After completion of treatment, patient is advised to follow up every 2 monthly for 1 year, 3 monthly next 2 year and 6 monthly there after. Clinical, endoscopic and imaging test will be done on follow up as indicated.