Oral Cancer

Oral cancer (also called mouth cancer) develops in the tissues of the oral cavity, including the lips, tongue, cheeks, gums, floor of the mouth, hard palate, and oropharynx (back of the throat/tonsils). Early detection is critical for survival. Here’s a focused overview:

1. Types & Locations

• Squamous Cell Carcinoma (SCC)

1. • >90% of cases. Arises from the mucosal lining.

Other Types:

• Verrucous carcinoma (less aggressive), minor salivary gland tumors, lymphoma, and melanoma.

Key Sites:

• Tongue(most common), floor of mouth, lips, gums, tonsils/oropharynx (often HPV-related).

2. Symptoms

• Early Signs:
  • Non-healing ulcer/sores(persisting >2 weeks), red/white patches (leukoplakia/erythroplakia).
• Advanced Signs:
  • Persistent mouth pain, dysphagia(trouble swallowing), hoarseness, loose teeth.
  • Lumpin neck (lymph node metastasis), numbness, unexplained bleeding.

🚨 Red Flags: Any mouth sore that doesn’t heal in 2–3 weeks warrants evaluation.

3. Risk Factors

• Tobacco Use:
  • Smoking (cigarettes, cigars, pipes), smokeless tobacco (chew, snuff).
• Alcohol:Heavy drinking (synergistic with tobacco: ↑ risk 15–30×).
• HPV Infection:
  • HPV-16causes 60–70% of oropharyngeal cancers (tonsil/base of tongue).
• Sun Exposure:Lip cancer (outdoor workers).
• Other:
  • Poor oral hygiene, ill-fitting dentures, chronic irritation, betel quid chewing (Asia), and immunosuppression.

4. Diagnosis

• Clinical Exam:
  • Visual/tactile inspection of oral cavity, neck nodes.
• Biopsy:
  • Incisional or brush biopsy of suspicious lesions (definitive diagnosis).
• Imaging:
  • CT/MRI:Assess tumor size, depth, and nodal spread.
  • PET-CT:For staging distant metastasis.
• Endoscopy:
  • Pan endoscopy (oral cavity, pharynx, larynx) for large tumors.

5. Treatment

            Depends on stage, location, and HPV status (for oropharyngeal tumors).

• Early Stage (I–II):
  • Surgery:Primary tumor excision ± neck dissection.
  • Radiation:Alternative for inoperable cases or post-op if high-risk features.
• Advanced Stage (III–IV):
  • Surgery + Reconstruction:
    1. Wide excision + neck dissection.
    2. Flap reconstruction (e.g., radial forearm, fibula).
  • Chemoradiation:
    1. Cisplatin-based chemo + radiation (for unresectable tumors or organ preservation).
  • HPV+ Oropharyngeal Cancer:
    • De-escalation trials (reduced chemo/radiation to lessen side effects).
  • Metastatic/Recurrent:
    • Immunotherapy:Pembrolizumab/nivolumab (PD-1 inhibitors).
    • Targeted Therapy:Cetuximab (EGFR inhibitor) with radiation.

6. Prognosis & Key Factors

• Early Detection:5-year survival >80% for Stage I vs. <40% for Stage IV.
• HPV+ Tumors:Better response to treatment (5-year survival ~80% vs. 40% for HPV-).
• Poor Prognosis Factors:
  • Perineural invasion, lymphovascular invasion, positive margins, extracapsular nodal spread.

7. Prevention & Early Detection

• Avoid Tobacco/Alcohol:Most preventable cause.
• HPV Vaccination:Prevents HPV-related oropharyngeal cancer (recommended for ages 9–45).
• Sun Protection:Lip balm with SPF.
• Regular Dental Exams:
  • Dentists screen for oral lesions every 6–12 months.
• Self-Exams:
  • Check for ulcers, color changes, or lumps monthly.

• • Focus on immunotherapy, targeted agents, and minimally invasive techniques.

Multidisciplinary care (ENT, oncology, dentistry, nutrition) is crucial.

Consult an oral surgeon or head/neck oncologist