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Introduction
 Cancers of the mouth and oral cavity, like all cancers, are irregular
and abnormal growths of cells that can build up into masses of tissue,
or tumors, Cells of different shapes and functions make up various parts
of the body: the skin, heart, lungs, bones, and so forth. All cells
reproduce themselves by dividing. Normal growth and repair of body
tissue take place in this orderly manner.
When cell division is not orderly,
abnormal growth takes place. Masses of tissue called tumors build up.
Tumors may be benign or malignant.
Benign tumors remain localized and
usually do not spread or threaten one's life. They may be removed
completely by surgery and are not likely to recur.
Malignant tumors are cancers. They can
invade and destroy nearby tissues and organs and spread to other parts
of the body. The new growths they form are called metastases. Even if
the original cancer is removed by surgery or radiation therapy, the
disease sometimes recurs because it may have spread.
Oral cancer is the term used to refer
to tumors on the lips, in the mouth (also called oral cavity or buccal
cavity), and in the pharynx, the upper part of the throat just behind
the mouth. These tumors often are easily visible.
The most common sites of cancers of the
mouth and oral cavity are the floor of the mouth, the pharynx including
the soft palate, the lips and the tongue. Other sites may include the
salivary glands, the gums or gingivae, the hard palate or roof of the
mouth, and the buccal mucosa or soft tissues inside the cheeks.
Symptoms
Tissue changes in the mouth which might be the earliest beginnings of
oral cancer can be easily seen or felt. If you should find any abnormal
areas in your mouth which persist more than 10 days, see your dentist
without delay.
Particular warning signals for oral
cancer are a raised growth; swelling or lump anywhere in the mouth;
changes in color, particularly the presence of red, brown or black
spots, redness with white patches, or white rough patches; continuous
bleeding or a sore that does not heal in 10 days; tingling, burning or
numbness in the tongue or lip or pain anywhere in the mouth; painful,
sensitive or loose teeth; or difficulty in swallowing or talking.
Any of these symptoms may be caused by
something other than cancer. A thorough examination of your mouth and
throat by a dentist or physician will reveal a cancerous condition if
there is one.
Diagnosis
Your dentist may recognize signs of possible early cancer during your
dental examination and may biopsy suspicious areas to determine if the
changes are malignant or benign. A small sample of tissue from the
suspected area will be removed for close examination under a microscope.
The doctor who examines the tissue is a pathologist, a physician who
interprets and diagnoses the changes caused by disease in body tissues.
The biopsy is used to confirm or rule out a diagnosis of cancer.
When a diagnosis of cancer is
confirmed, it is best for you to begin treatment in a hospital that has
an expert staff and resources to apply all forms of effective treatment
right from the beginning. Before treatment you may, if you wish, request
a second opinion from another physician to confirm the diagnosis and
recommendations for therapy.
Treatment
Your doctor will consider a number of factors in determining the best
treatment for you. Among these are your medical history, your general
health, and the type and location of the cancer or cancers you have.
Your treatment must be tailored to your individual needs.
Immediate treatment should follow the
diagnosis of cancer. Surgery is used in many cases to remove the tumor.
Often the surgeon also removes nearby lymph glands to find whether the
disease has moved that far. Sometimes the disease has spread to the neck
even though no lump may be detected there.
When the cancer has spread, the surgeon
will perform surgery. This consists of removal of tissue from the area
of the neck to which the cancerous cells have spread.
Radiation therapy is an alternative to
surgery and is used particularly to destroy a tumor that may be too
large for surgical removal.
Radiation therapy involves exposure to
X-rays or gamma rays emitted from radioactive isotopes such as cobalt
60. X-ray over several weeks can cure most lip cancers with the least
effect on facial appearance. Radiation therapy may involve super-voltage
equipment such as a linear accelrator or betatron.
Another form of radiation therapy used
by some radiologists in localized cases and cancer of the tongue, lip or
floor of the mouth, is called interstital irradiation. Here, needles
containing radioactive elements are implanted to destroy the cancer.
Sometimes external irradiation is used
before an operation to shrink a large tumor to a more operable size. At
other times, it may be used after an operation to attack cancer cells
that the surgery cannot reach or to treat a tumor that recurs after
surgery.
There may be some after effects from
radiation therapy, such as pain in swallowing or chewing or loss of the
sense of taste and smell. To avoid or reduce such difficulties, some
radiologists favor split dose radiation therapy applying a first
treatment and then waiting for a period of time before the second dose.
The basic principle of radiation
therapy is to focus the radiation on the cancer at doses that will
destroy the malignant cells with minimal damage to surrounding normal
tissue.
Treatment by anticancer drugs, or
chemotherapy, is used along with surgery or radiation treatment in some
case to slow down or control growth of the tumor cells. Bemuse the drugs
can act on normal cells as well as cancerous ones, your physician must
maintain a delicate balance of enough drugs to kill cancer cells without
destroying too many healthy ones.
Some anticancer drugs make you feel
sick for a while, but your doctor tries to work out a treatment schedule
that disrupts your daily routine as little as possible. The length and
frequency of drug treatments depend on a number of factors. These
include your type of cancer, the kind of anticancer drugs prescribed,
and how long it takes you to respond to the treatment and how well you
tolerate any side effects.
After surgical treatment of cancers in
and around the mouth, there is sometimes facial deformity or
disfigurement because of the amount of tissue that has to be taken out
to remove all of the diseased cells. Today's new methods of
reconstructive surgery minimize these problems by skin and bone grafts,
such as using a flap of the upper lip to fill in part of the lower lip,
silicone rubber implants to fill out facial hollows, or plastics and
other synthetics to rebuild the jaw structure or facial features.
Modern day diagnosis and treatment of
cancers in the mouth require a team of medical, surgical dental and
paramedical specialists. Your care may include the ear, nose, and throat
surgeon, orthodontist, radiotherapist, chemotherapist, plastic surgeon,
pathologist, and newer specialist such as the prosthetist and
prosthodontist (who make and fit artificial body and dental parts), the
speech therapist to help with speaking difficulties, and even
cosmeticians to minimize facial scars. All these play a role in the
diagnosis, surgery, reconstruction and rehabilitation of the patient
with cancer of the mouth.
Strong chemicals in
Kattha, Chuna and tobacco burn into soft mouth tissues… risking
eventual cancer of the mouth or throat. It begins as an innocent white
patch you don't even feel. See your doctor or dentist immediately. Mouth
cancer can also be caused by jagged tooth edges, ill-fitting bridgework
and false teeth. There's nothing to get worried about... yet. Oral
cancer is completely curable if detected early. If you eat paan, be sure
to rinse your mouth thoroughly before sleep. Regularly visit your
dentist. And make the effort to stop chewing now.
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Patient Education
