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Oral Cancer - Prevention, causes and treatment

Oral cancer is a type of malignant tumor that can affect different parts of the mouth. We talk about the types of oral cancers that exist and about the prevention, cause and treatment of this disease in this post.

A) What is an oral tumor?

The first thing to know is that the body normally controls the division and growth of cells. However, this balance of cell division and death can be broken on some occasions, forming a tumor. We speak of an oral tumor when it develops in any part of the mouth.

A1) Are all tumors cancerous?

It is essential to know that NOT all tumors are cancerous. The difference between a benign and a malignant one is that the latter can grow and spread to other parts of the body, while the benign one can increase in size, but it will not spread. Metastasis is the process by which a cancerous focus spreads to another organ through the blood or lymphatic system.


A2) Types of oral tumors - Where can they appear?

Oral tumors can affect various structures of the mouth, such as the mucosa, palate, floor of the mouth, tongue, lips, gums, salivary glands, and bones.


B) All about cancer in the mouth

Therefore, oral cancer is a malignant tumor that develops in any of the previously mentioned parts of the mouth.

B1) Oral cancer - A very common disease

Cancer in the oral cavity is not rare. More than 400,000 annual cases of this disease are diagnosed globally of which, 130,000 people a year die. The average age of diagnosis is 62 years, most of them men with a history of regular consumption of alcohol and tobacco.

B1.a) Oral squamous cell carcinoma - The most common oral cancer

Malignant tumors in the oral cavity account for about 4% of all those that can occur in the body. Of these, 90% are oral squamous cell carcinoma, the most common in the oral region.


B2) Causes of cancer in the mouth

Cancer occurs when carcinogenic agents act on cells, alter their genetic material and produce a mutation. Alcohol and tobacco are the most common carcinogenic agents, being responsible for up to 90% of cases. Human papillomavirus has also emerged as a potential risk factor for the development of this type of cancer in recent years. Other causes may be radiation, excessive sun exposure, poor hygiene, or poor eating habits.


B3) How to prevent oral cancer

The best way to prevent oral cancer is to avoid or minimize exposure to the carcinogens described above. For this reason, it is recommended to drink as little alcohol as possible and not to smoke or quit. For its part, the human papillomavirus (HPV) is a sexually transmitted infection, another reason to put all possible protection measures during sexual practice. To avoid the consequences of the sun, it is recommended to reduce exposure in the central hours of the day and always do so with sunscreen. Finally, regular check-ups of our oral health at the dentist are essential to detect early signs of the development of this disease.

B4) Symptoms of cancer in the mouth

The appearance of white or red spots in the oral cavity or symptoms such as unexplained bleeding, pain, or numbness in the mouth require immediate evaluation by an oral surgeon. White or red spots that do not disappear within 3 weeks always require specialist consultation, as they may be an early manifestation of cancer. Another common manifestation is the appearance of ulcerated tumors or painful ulcers, lesions whose size usually varies from a few millimeters to several centimeters. The most frequent location in 75-80% of cases is the tongue, the floor of the mouth and the area of the soft palate.


B5) The diagnosis of this type of cancer

Oral cancers have quite evident clinical characteristics in advanced stages, so they do not usually pose any diagnostic problem. However, they can present various clinical forms in early stages, which can lead to diagnostic error and even go unnoticed, since they normally do not present symptoms. Only oral examination by a specialist, and more specifically a biopsy, will allow us to make a definitive diagnosis. Early diagnosis of oral cancer increases the survival rate of those affected by up to 90%.


C) Oral cancer treatment

A multidisciplinary team made up of oncologists, head and neck surgeons, radiation therapists, and radiologists will decide the best treatment option for each patient.

C1) Oral surgery

Treatment of cancer in the mouth requires surgery in most cases. The extent of the surgery will depend on the size of the tumor, the involvement of the neck lymph nodes and the presence of metastases. In fact, if oral cancer is detected at very early stages, it may require only minimally invasive surgery.


C2) Radiotherapy, another oral cancer treatment

Radiation therapy is a treatment modality that uses radiation to kill cancer cells. This is usually done in association with surgery to maximize the effectiveness of treatment in curable cases.


C3) Chemotherapy

Chemotherapy is a drug treatment in which different drugs can be used. The role of chemotherapy in the treatment of oral cavity cancer is evaluated on a case-by-case basis.


C4) Side effects of oral cancer treatment

The side effects of oral cancer treatment depend on the extent of the surgery and the need for radiation therapy or chemotherapy. Common side effects include dry mouth, sores, salivary gland involvement, taste change, difficulty swallowing or opening the mouth, etc. The duration of each effect is variable, ranging from a few weeks to a lifetime.


D) Other lesions in the mouth that can turn malignant

Potentially malignant disorders of the oral cavity are a rather heterogeneous group of mucosal lesions associated with an increased risk of malignant transformation to cancer. These lesions are related to numerous etiological factors, which may be genetic and/or environmental.

D1) Leukoplakia

It is the most common potentially malignant lesion. It is a generally white lesion on the mucosa of the mouth that does not come off when scraped. The most common cause is tobacco use, although there are also some that could be related to a virus. If the lesion is still present one month after eliminating the possible etiological factors, a biopsy is recommended to obtain a definitive diagnosis. It is estimated that the rate of malignancy of these lesions is 9,5%.

D2) Proliferative verrucous leukoplakia

It is an aggressive form of leukoplakia with slow growth that can form warty lesions. Tobacco does not seem to be related to these lesions, but the exact causes of their appearance are not known. These lesions usually arise in older people and more frequently in the gums and buccal mucosa area. They are usually extensive on presentation and almost 50% malignant. Its treatment is complicated due to the difficulty of obtaining a removal with good clinical margins and the high recurrence rates.


D3) Lichen planus

It is a disease of unknown origin that can affect the skin and mucous membranes of all parts of the body. It can appear and disappear in outbreaks and is usually associated with psychosomatic disorders and situations of stress and anxiety. It usually manifests as whitish stretch marks that normally appear on the mucosa of the cheeks, although they can also appear on the tongue and gums. It has a low risk of malignancy, around 1.4%, but follow-up of the lesions twice a year is recommended to detect possible changes. There is no fully effective treatment and the goal is to control existing flare-ups, usually by applying topical corticosteroid gels or rinses.


D4) Erythroplakia

They are reddish lesions with a smooth or mottled appearance that appear in the oral cavity. Tobacco and alcohol are its main etiological factors, although it is also related to diets low in vegetables and HPV. Its degree of malignancy is very high, 33.1%. In fact, most red lesions of the oral mucosa already present carcinoma in situ or invasive disease at the time of diagnosis. Therefore, it is recommended that any red lesion be biopsied. Treatment must be surgical, removing the lesion and eliminating the patient's smoking and alcohol consumption habits.


E) Dentists and their importance in the treatment of mouth cancer

The role of dentists is also extremely important before, during and after treatment. For example, treating gum disease or cavities before major surgery or radiation therapy or chemotherapy reduces the risk of infection or complications. Periodic visits are recommended during treatment, since the possible side effects mentioned above may require local and/or symptomatic treatment, in addition to being able to detect possible cavities or gum problems early. Maintaining optimal oral health may help reduce common symptoms such as soreness and dry mouth after cancer treatment. The dentist can better advise the patient on how to achieve optimal oral and dental care. Follow-up by the dentist is also extremely important to detect possible complications of treatment or recurrence of the cancer.

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