Oral cancer

Symptoms Of Oral Cancer

Oral cancer presents itself with the following symptoms:

• Sore on the lip or in the mouth that doesn't heal
• Pain in the mouth 
• Lump or thickening in the lips, mouth, or cheek
• White or red patch on the gums, tongue, tonsil, or lining of the mouth
• Sore throat 
• Difficulty in chewing or swallowing
• Trouble moving the jaw or tongue
• Numbness of the tongue, lip, or other areas of the mouth
• Swelling or pain in the jaw
• Poor fitting of the dentures 
• Loosening of the teeth 
• Pain around the teeth and gums
• Changes in the voice
• Lump or mass in the neck or back of the throat
• Loss of weight
• Ear pain

Cancer care should never be left to chance. Tata 1mg is dedicated to providing the support, resources, and guidance needed at every stage of the journey.
Explore Cancer Care Platform

Causes Of Oral Cancer

• Oral cancer occurs when abnormal cells begin to grow within the oral cavity. 

• These abnormal cells develop because of changes (mutations) in their DNA. 

• This mutated DNA dictates the cells grow uncontrollably and continue living after normal cells die. 

• These masses of cells can form a tumor and when left untreated, these cells continue to grow out of control and spread to other parts of the body.

• Numerous risk factors or possible causative agents for the development of oral cancer.
  
  

Know more about other cancer-related myths and facts.
Watch Now

Types Of Oral Cancer

There are multiple types of oral cancer and are generally categorized by the kind of cell cancer (carcinoma) starts to grow. They include:

1. Squamous cell carcinoma

• This is the most common type of mouth cancer. 

• The earliest form of squamous cell cancer is called carcinoma in situ. This means the cancer cells are only in the top layer of cells lining cells.

2. Adenocarcinoma

• It is a cancer that develops inside the tissue of the salivary gland, which grows from abnormalities in bone, cartilage, muscle, or other tissue.

3. HPV-related cancers

• Infection with certain high-risk types of the human papillomavirus (HPV) causes most of the squamous cell cancers of the oropharynx (called HPV-positive cancer). 

• HPV is rarely associated with oral cavity cancer. 

4. Verrucous carcinoma

• This is a rare type of squamous cell cancer that is most often found in the gums and cheeks.

• It is a slow-growing cancer that hardly ever spreads to other parts of the body.
  
  

Other types of oral cavity cancers

1. Minor salivary gland cancers: These can start in the glands in the mouth and throat lining. 

2. Lymphomas: The tonsils and base of the tongue contain immune system (lymphoid) tissue, where cancers called lymphomas can start.

3. Leukoplakia and erythroplakia: These are possible precancerous conditions where certain types of tissue changes can be seen in the mouth or throat.

Risk Factors For Oral Cancer

Oral cancer is one of the most common types of cancer and is associated with several risk factors. They include:

1. Modifiable factors

• Tobacco
• Betel quid
• Alcohol
• Diet and nutrition
• Mouthwash
• Maté (it is a tea‑like beverage)
• Poor dental status

Note: Tobacco use, including smoking and chewing, is the leading risk factor for head and neck cancers, linked to 85% of cases.

Want to quit smoking, but are unable to do so? 
Read This Now

2. Non- modifiable factors 

• Family history
• Gender (men are more likely to develop oral and oropharyngeal cancers than women)
• Fair skin
• Age

Note: Oral cancer can develop in people of any age, but is seen more in individuals older than 45 years who have an increased risk for oral cancer.

Want to find out if you are at risk of developing cancer? Well, there is a test for that called geneCORE predict – hereditary cancer risk test. This test predicts your risk of up to 22 major cancers. 

Know More

3. Environmental factors

• Viral infections (HPV, Epstein-Barr Virus and Herpes Simplex Virus Type 1 have been proposed to be involved in oral cancers)
• Fungal infections 
• Prolonged sun exposure
• Syphilis
• Radiation
• Immunosuppression

Diagnosis Of Oral Cancer

Diagnosing oral cancer at an early stage is the key to a better prognosis. TNM stands for tumor, node, and metastases. It is one of the staging systems doctors use for mouth cancer. It includes:

Primary tumor (T)

• TX: Tumor cannot be assessed

• T0: No evidence of primary tumor

• Tis: Carcinoma in situ (CIS)- a group of abnormal cells that are found only in the place where they first formed in the body

• T1: Tumor 2 cm or less in greatest dimension

• T2: Tumor more than 2 cm but not more than 4 cm in greatest dimension

• T3: Tumor more than 4 cm in greatest dimension

• T4a: A moderately advanced local disease. 

• T4b: Very advanced local disease.
  
  

Regional lymph nodes (N)

• NX: Cannot be assessed

• N0: No regional lymph node metastasis ( spread of cancer)

• N1: Metastasis in a single lymph node on one side (ipsilateral), 3 cm or less in greatest dimension

• N2: Metastasis as specified in:

  • N2a: Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension.

  • N2b: Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension

  • N2c: Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.

• N3: Metastasis in a lymph node more than 6 cm in greatest dimension.
  
  

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed

• M0: No distant metastasis.

Early detection is the key to a good outcome for any cancer. Read about 8 common signs of cancer that you should look out for.
Click Now

The diagnosis consists of the following:

1. Physical examination

• Primarily, the external parts such as lymph nodes, salivary glands, lips, etc. are inspected

• An internal examination of the mouth is performed to look for irregularities, swelling, and thickening.
  
  

2. Histopathological examination

• Vital staining techniques: Tolonium chloride (also known as toluidine blue) staining is used to detect mucosal abnormalities in the oral cavity. 
  
  
• Biopsy: A tissue sample is removed surgically from the suspected region and sent to the pathological laboratory for a detailed microscopic examination.
  
  
• Brush biopsy: In brush biopsy, cells from the oral lesion are obtained by scraping the surface mucosa. 
  
  
• Exfoliative cytology: Exfoliative cytology is a simple and noninvasive diagnostic technique for the early detection of oral cancer.
  
  
• Incisional biopsy: In this type of biopsy, a representative tissue sample is carefully chosen for selective diagnosis.
   
  

3. Imaging techniques

Several advanced imaging techniques are used for the diagnosis of oral cancer.

• Magnetic resonance imaging (MRI): MRI provides the details of the oral cavity structures and adjacent parts. Soft-tissue discrimination by MRI aids in assessing the extent of local and regional spread of the tumor, invasion depth, and extent of involvement of lymph nodes.
  
  
• Computed tomography (CT): The CT scan uses X-ray radiation and a computer to create pictures of the body to locate the cancerous lesion and determine its spread to the other parts of the body.
  
  
• Positron emission tomography (PET): The PET scan determines the spread of tumor cells to the lymph nodes or other parts of the body.
  
  
• Radiological techniques: X-ray is used to determine the spread of cancer to the other organs outside the mouth and oropharynx. The x-ray done for oral cancer is known as an orthopantomogram (OPG).
  
  
• Optical imaging techniques: These include optical coherence tomography and tissue fluorescence imaging that can effectively differentiate between cancerous and non-cancerous lesions. 
  

Get all your labs in the safety and comfort of your homes with the best professionals. 
Book Your Tests Now

4. Biomarker detection 

• Biomarkers are used for the early detection of oral cancer. Biomarkers 

• are components of the cells present in body fluid or tumor cells that are overexpressed during the onset of the disease. 
  
  

5. Other methods

In recent years, significant advancements have been reported in diagnostic techniques that are rapid and specific for the detection of cancer biomarkers. They include:

• Raman spectroscopy: It is a safe method used to study materials without damaging them. It gives detailed information about their chemical makeup and structure.
  
  
• Confocal microscopy: This is another light-based technique that provides images of many important cellular and architectural features of squamous cell carcinoma (SCC).
  
  

Diagnosed with cancer?
Read about things you need to know if you are planning on taking a second opinion.
Click Now

Prevention Of Oral Cancer

The exact cause of oral cancer is unknown and there can be multifactorial causes. The best way of preventing any kind of cancer is to lead a healthy lifestyle. Other things to keep in mind include:

1. Get cancer screening for early detection

Early detection of cancer enables more effective and affordable treatment, reducing cancer-related morbidity and mortality

People generally think cancers are fatal. Whereas, cancers are treatable and even curable, especially with early detection and proper treatment. Know more about other cancer-related myths and facts.

Watch This Video now

2. Always self-examine yourself

• Look at the inside of both of your cheeks with your flashlight
• Feel those areas with your fingers
• Check the floor of your mouth (beneath your tongue) with your flashlight
• Examine the floor of your mouth with your finger
• Stick out your tongue, examine the top, both sides and under the surface using your flashlight.
  
  

3. Visit your dentist regularly

As part of your examination, your dentist can look and feel in and around your mouth and any unusual lumps or sores can be detected early. 

4. Stay away from all forms of tobacco

Smokeless tobacco, like chewing or snuff tobacco, can cause leukoplakia—gray-white ulcers in the mouth that may turn cancerous and contain chemicals that harm cancer-protective genes.

Want to quit smoking? Try our smoking cessation range. 
Shop Now

5. Limit your alcohol intake

Moderate to heavy alcohol consumption is associated with higher risks of certain head and neck cancers, and reducing the intake can be very beneficial.

6. Get vaccinated for HPV

Human papillomavirus (HPV), particularly HPV16, is strongly associated with oropharyngeal cancers, especially those at the back of the mouth. The best way to prevent HPV is to get vaccinated before you become sexually active, and also practice safe sex. 

Know more about HPV vaccinations, and their types.
Click Here

7. Protect your lips from the sun 

• Limit sun exposure during the peak hours 
• Wear a protective lip balm with SPF when stepping out
• Reapply lip balms after you eat or drink
• Use hats that shield your face from the sun.
  
  

Protect your lips and skin from all the sun's harmful rays using our extensive range of sunscreens.
Fill Your Carts Now

8. Understand chemoprevention 

Chemoprevention is the use of certain drugs or other substances to help lower a person's risk of developing cancer or keep it from coming back.

9. Add probiotics to the diet

• Probiotics are live microorganisms that provide a health benefit to the host. 
• Recent data on probiotic products show a protective effect against cancer cell activity.
  
  Buy Probiotics Here

10. Take supplements

• Some supplements can prevent oral cancer such as Vitamin C, Vitamin E, Vitamin A, Omega-3 fatty acids, and Carotenoids.

Fill the gap in your diet with our range of vitamin and mineral supplements.
Explore Now

Specialist To Visit

Cancer is not a single disease but a group of related diseases. Hence, it requires comprehensive care. Doctors who take care of patients with oral cancer and help in diagnosing and formulating a treatment plan are:

• Dentists
• Otolaryngologists
• Oncologists
• Radiation oncologists
• Medical oncologists
  
  

A dentist can detect early signs of oral cancer during routine check-ups, improving chances of successful treatment.

An otolaryngologist specializes in diagnosing and treating conditions of the ears, nose, throat, and can also play a vital role in detecting and managing oral cancer.

An oncologist is a doctor who treats cancer and provides medical care for a person diagnosed with cancer. 

A radiation oncologist is a doctor who uses radiation to treat cancer whereas a medical oncologist uses chemotherapy and other medicines to treat cancer.

A medical oncologist can develop a personalized treatment plan for oral cancer, including chemotherapy, immunotherapy, or targeted therapies.

Speak to an expert doctor to find out how you can reduce these risks of developing oral cancer.
Book Consultation Here

Treatment Of Oral Cancer

Any kind of cancer requires multidisciplinary treatment that includes surgery, chemotherapy, and radiation, alone or in combination. Oral cancer treatment includes:

1. Surgical management 

• Surgery for primary tumors: Surgery is advised for early-stage tumors, while advanced stages require surgery or chemoradiotherapy. Tumor removal methods depend on its location and extent.

• Surgery for neck dissection: Neck dissection detects any spread of cancer in the early stage and removes the majority of affected lymph nodes. 

• Other surgeries:

  • Glossectomy (partial or total removal of your tongue)

  • Mandibulectomy (surgery for oral cancer in your jawbone)

  • Maxillectomy (removal of a part or all of the bony roof of your mouth).
    
    

2. Surgery in case of recurrence

• Recurrence rates in the oral cavity are 30%, and Salvage (or 'rescue') surgery is used to refer to surgical treatment after failure of initial treatment. 
  
  

3. Reconstruction

• The oral cavity is a complex site made up of several structures critical for speech, swallowing, and appearance. 

• To be deemed successful, reconstruction should attempt to address all three, and it must be tailored to the site of the defect. 
  
  

4. Radiation

Radiation therapy uses X-rays to destroy or damage cancer cells, making them unable to proliferate. Radiotherapy is mainly used in patients with locally advanced oral cancer.

Types of radiation therapy include:

• External-beam radiation therapy: The most common type of radiation in which the radiation is given from a machine outside the body. 
  
  
• Internal-beam radiation therapy: When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Brachytherapy involves the application of a radioactive source close to the tumor. 
  
  

5. Chemotherapy

Chemotherapy (chemo) is treatment with anti-cancer drugs that are injected into a vein or taken by mouth, which allows them to enter the blood and reach most parts of the body. Drugs used for chemotherapy include:

• Cisplatin

• Carboplatin

• 5-fluorouracil (5-FU)

• Paclitaxel (Taxol)

• Docetaxel (Taxotere)

• Hydroxyurea

Other less often-used drugs include:

• Methotrexate

• Capecitabine

Types of chemotherapy include:

• Adjuvant chemotherapy: It is given after surgery and is sometimes combined with radiation therapy. The goal is to kill cancer cells that might have been left behind at surgery because of the smaller size and also prevent recurrence.
  
  
• Neoadjuvant or induction chemotherapy: This is given before surgery with or without radiation to shrink some larger cancers to make surgery easier and remove less tissue..
  
  

6. Chemoradiation

• Chemoradiation is chemotherapy given at the same time as radiation.

• It has been shown to shrink oral cavity and oropharyngeal tumors that are not widespread but are too advanced for surgery. 
  
  

7. Targeted therapy

• It is the use of medicines that target or are directed at proteins in cancer cells by destroying cancer cells or slowing their growth. 

• Cetuximab is the most commonly used drug for this therapy.
  
  

8. Immunotherapy

• This therapy uses medicines to help boost a person’s immune system to find and destroy cancer cells more effectively. 

• It typically works on specific proteins involved in the immune system to enhance the immune response.

Looking to gain expert insights on cancer treatment options?
Watch This Video

Home-care For Oral Cancer

There are certain plant-based products used as traditional and domestic medicines and food additives. Some of the herbs with anti-cancer effects include:

• Curcumin or Turmeric (Haldi): It suppresses the tumor activity and consequently reduces tumor growth and metastasis. 
  
  
• Ginger (Adrak): It can be used as a therapeutic agent in UV-induced skin diseases, including cancer of lips.
  
  
• Saffron (Kesar): Studies have reported the antioxidant, anti-cancer, anti-inflammatory, antidepressant, antihistamine, and memory-enhancer effects of saffron in animal models.
  
  
• Cinnamon (Dalchini): It has numerous biological functions such as antioxidant, antibacterial, anti-inflammation, anti-diabetes, and anti-tumor activity. 
  
  

Complications Of Oral Cancer

Complications occur either due to untreated disease and subsequent spread of the tumor or commonly due to side effects of treatment. These include:

1. Complications from surgery

• Failure of the flap
• Damage to local motor and sensory nerves
• Paralysis of the vocal cords
• Restriction of the range of motion of the jaws
• Difficulty in speaking
• Improper wound healing
• Potential long-term requirement of feeding tubes
• Patients may require an extended stay in intensive care.
  
  

2. Complications from chemo or radiotherapy 

• Pain
• Bleeding
• Osteoradionecrosis
• Inflammation of the mucosa
• Dry mouth is also known as xerostomia
• Difficulty in swallowing and speaking
• Reduced oral intake and malnutrition
• Increased infections due to decreased immunity.
  
  

Alternative Therapies For Oral Cancer

When considering alternative and complementary treatments for any kind of cancer, it is very important to communicate with your medical teams as some of the alternative therapies may be contraindicated from the treatment plan. An alternative therapy, that has proven beneficial in managing oral cancer is:

Photodynamic therapy (PDT) 

• Photodynamic therapy uses a drug that is activated by light, called a photosensitizer or photosensitizing agent, to kill cancer cells. 
  
  
• Studies suggest PDT, for superficial tumors (2mm)and for tumors with a depth of more than 10 mm, interstitial PDT (iPDT) can be an alternative. 

Note: This is just an adjunct to the treatment and does not replace medical treatment.

Living With Oral Cancer

Living with oral cancer may seem very difficult, but a good support system along with a positive attitude can help the patients cope with the diagnosis and treatment. Some of the things that can prove to be beneficial include:

1. Get all the emotional support

• It is normal to feel depressed, anxious, or worried when you get to know that cancer is a part of your life. 

• Everyone benefits from support, whether from friends, family, religious groups, support groups, or professional counselors.
  
  

2. Take post-treatment follow-up very seriously

• Patients with oral cancer are at risk for recurrences and cancer in the other parts of the body. Regular dental visits and endoscopies can help detect any early signs. 

• Endoscopy and other tests are generally done:

  - Every 1 to 3 months during the first year
  - Every 2 to 6 months during the second year
  - Every 4 to 8 months during the 3rd to 5th years
  - Every year after the 5th year
  
  

3. Give importance to palliative care

• Oral cancer causes severe physical, psychosocial, and spiritual pain to patients and their families. 

• Palliative care focuses on improving how you feel during treatment by managing symptoms. 

• Palliative treatments include symptom-relief medication, nutrition, relaxation, emotional and spiritual support, and activities that bring joy.
  
  

4. Quit smoking

• Smoking is the leading cause of death due to oral cancer.

• It is very important to quit smoking because even people with early-stage oral cavity or oropharyngeal cancer are at risk of a new smoking-related cancer if they continue to smoke. 

Why Should You Say Yes To No Smoking?
Find Out Now

5. Get proper rehabilitation

Radiation, surgery, and certain chemo drugs can lead to problems with speech, swallowing, and hearing. Speech, hearing, and swallowing rehabilitation are required to maintain the quality of life. Therapists that can help you include:

• Speech therapists: Who are knowledgeable about speech and swallowing problems and can help you learn to manage them. 

• Audiologist (a specialist in hearing): Who can help you with devices to improve your hearing if the treatment has affected your hearing capacity.
  
  

6. Keep health insurance and copies of your medical records

• Keeping health insurance after treatment is essential to cover the costs of tests and doctor visits. 

• While no one wants to consider cancer returning, it’s important to stay prepared.
  
  

7. Manage cancer care expenses

• Cancer treatment can be costly, and unexpected expenses may arise, adding financial stress for patients and families.

• Seek financial assistance from social workers who can guide you on available benefits or grants and assist with the claiming process to ease the financial burden.

Tips for caregivers

• Encourage and provide mental support to the patient
• Understand the course of treatment
• Talk with empathy and a positive attitude to the patient
• Help the patients with household chores
• Handle insurance and billing issues for them
• Help the patient manage their symptoms and side effects
• Coordinate their medical appointments and give medications on time
• Assist the patient in maintaining personal care and hygiene
• Take care of patients' needs.
  

Access expert-guided cancer care and support. 
Explore Now