Oral Cancer

Oral cancer or mouth cancer, a type of head and neck cancer, is any cancerous tissue growth located in the oral cavity. It may arise as a primary lesion originating in any of the tissues in the mouth, by metastasis from a distant site of origin, or by extension from a neighboring anatomic structure, such as the nasal cavity.

Alternatively, the oral cancers may originate in any of the tissues of the mouth, and may be of varied histologic types: Teratoma, adenocarcinoma derived from a major or minor salivary gland, lymphoma from tonsillar or other lymphoid tissue, or melanoma from the pigment-producing cells of the oral mucosa.

There are several types of oral cancers, but around 90% are squamous cell carcinomas, originating in the tissues that line the mouth and lips.

Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth).

Most oral cancers look very similar under the microscope and are called squamous cell carcinoma, but less common other types of oral cancer occur, such as Kaposi’s sarcoma.

Types of Oral Cancer


Squamous cell carcinoma: More than 90% of cancers that occur in the oral cavity and oropharynx are squamous cell carcinoma. Normally, the throat and mouth are lined with so-called squamous cells, which are flat and arranged in a scale-like way. Squamous cell carcinoma means that some squamous cells are abnormal.

Verrucous carcinoma: About 5% of all oral cavity tumors are verrucous carcinoma, which is a type of very slow-growing cancer made up of squamous cells. This type of oral cancer rarely spreads to other parts of the body, but can invade the tissue surrounding the site of origin.

Minor salivary gland carcinomas: This category includes several kinds of oral cancer that can develop in the minor salivary glands, which are found throughout the lining of the mouth and throat. These types include adenoid cystic carcinoma, mucoepidermoid carcinoma, and polymorphous low-grade adenocarcinoma.

Lymphomas:Oral cancers that develop in lymph tissue, which is part of the immune system, are known as lymphomas. The tonsils and base of the tongue both contain lymphoid tissue. See our pages on Hodgkin lymphoma and non-Hodgkin lymphoma for cancer information related to lymphomas in the oral cavity.

Leukoplakia and erythroplakia: These non-cancerous conditions mean that there are certain types of abnormal cells in the mouth or throat. With leukoplakia, a white area can be seen, and with erythroplakia, there is a red area, flat or slightly raised, that often bleeds when scraped. Both conditions may be precancerous; that is, they can develop into different types of cancer. When these conditions occur, a biopsy or other test is done to determine whether the cells are cancerous.

Stages of Oral Cancer


The stage of a cancer describes its size and whether it has spread. Knowing the stage helps doctors decide on the best treatment for you. The two most commonly used staging systems are the TNM and the number system.
TNM staging system
T describesthe size of the tumor in the mouth and whether it has grown into areas around the mouth. For example, a T1 tumor is small and hasn’t spread, while a T4 tumor has spread into nearby muscles, bones or skin.
N describes whether the cancer has spread to the lymph nodes. N0 means that no lymph nodes are affected, while N1, N2 or N3 means there are cancer cells in the neck lymph nodes.
M describes if the cancer has spread to another part of the body. This is called metastatic cancer. M0 means the cancer hasn’t spread and M1 means the cancer has spread to distant organs, such as the liver or lungs.
Number staging system
Mouth cancers can also be given a number stage from 1 to 4.

Stage 1 the tumor is 2cm or smaller and only in the mouth. This would be called T1, N0 M0 in the TNM system.

Stage 2 the tumor is 2 to 4cm and only in the mouth.

Stage 3 the tumor is bigger than 4cm and only in the mouth or the tumor is any size in the mouth and has also started to spread into the neck lymph nodes.

Stage 4 the tumor has spread to other areas around the mouth
And/or has spread into the neck lymph nodes
And/or has spread to distant organs.

Prevention of Oral Cancer

The treatment plan for oral cancer varies from patient to patient and is established according to the following five main factors:

  1. The patient’s age, general health and past medical history,
  2. The cancer type, size, and location,
  3. The treatment tolerance,
  4. The risk for hidden disease
  5. The need to save certain functions.

A better treatment outcome is achieved in patients diagnosed with oral cancer at an early stage.

The main treatment approach in patients with oral cancer treatment noida is: surgery and radiotherapy with or without Chemotherapy.

SURGERY

Surgery is a procedure aimed to completely remove the tumor tissue together with adjacent healthy tissue in order to prevent relapse of cancer.

THE COMMONLY PERFORMED SURGERIES FOR ORAL CANCER ARE:

Conservative Resections for oral cavity (mouth) Cancer

Conservative resections are done for early cancers of the oral cavity. The main objective is to preserve organs and attain good quality of life for the patient For early tongue cancers only wide excision with reconstruction can be done. For lesions of buccal mucosa (Inner lining of the cheek) only resection and preservation of part of the mandible (marginal mandibulectomy) can be done. This can be achieved with good results using CO2 laser for surgical Resection. For cancers of upper gum only removal of part of maxillary bone can be done with Prosthodontic rehabilitation.

Composite Resections

These extensive surgeries are done for locally advanced tumors of the oral cavity (mouth) which are caused by tobacco chewing and are very common in south Asia (India). This involves removal of part of the jaw / whole jaw with adjoining buccal mucosa (Inner lining of the cheek) with or without removal of skin of the cheek. Removal depends on adequate margin of resection.

For cancer of the tongue, removal of tongue is done with or without removal of the jaw and along with this neck dissection (removal of lymph glands in the neck) is done. The gap appearing after the resection is repaired with plastic surgery (local / regional / free flaps). After that patient is rehabilitated by a physiotherapist, Prosthodontic surgeon, speech and swallowing therapist.

Maxillectomy

For cancers of cheek bone (maxilla), radical maxillectomy is done, which involves removal of cheek bone (maxilla) with or without preservation of eye depending on involvement of the eye or not. If, cheek skin is involved, that is also removed. These tumors may extend to the skull base, i.e. near the brain, Resection involves removal of the tumor with preservation of vital nerves, which is technically demanding and involves a team of experienced Head And Neck Cancer Surgeons. Neuro-Surgeons, Plastic and Reconstructive Surgeons to achieve a better cancer control and good functional and cosmetic outcome.

Mandibular Arch and Floor of the Mouth Resections

These challenging surgeries for advanced loco-regional tumors of the jaw, involve removing the entire tumor, including jaw, neck dissection for removal of lymph nodes, removing fibula (leg bone) of the patient and reconstructing the jaw with fibula. This is done to ensure that the patient’s original facial appearance is maintained and functions of chewing, swallowing and speech are preserved. In this fibular reconstructed Jaw, teeth can be put at a later date, so that the patient can chew.

Free Flap Reconstructions

Free Flap Reconstruction is a novel plastic reconstruction technique. After cancer resection (removal), large gaps appear in the resected part of the body, which have to be reconstructed by using the skin / muscle / bone of the patient. Before the surgery, the part of the body of the patient is chosen as a donor area, ensuring that it aptly matches the area being resected. After taking the graft from the donor area, it is harvested and used for replacing the gap caused by resection. Bone is replaced by a bone from area, where it has minimal function.

This also involves anastomoses (rejoining) of very small blood vessels to restore blood supply and joining of nerves to restore sensory and motor functions of the body. High magnification microscope and very fine sutures (thinner than hair) are used for anastomoses. This procedure is very technically demanding and takes 4 – 10 hours. Dharamshila Hospital is the only hospital in North India performing these surgeries regularly with very good results.

CO2 Laser surgeries for organ and function preservation.

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