Oral cancer is cancer which originates in any part of the oral cavity, (the lips, tongue, pharynx etc). It may arise as a primary lesion originating in any of the oral tissues, by metastasis from a distant site of origin, or by extension from a neighboring anatomic structure, such as the nasal cavity or the maxillary sinus. 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.
All cancers are diseases in the cancer cells. Oncogenes are activated as a result of mutation of the DNA, the exact cause is often unknown. Risk factors that predispose a person to oral cancer have been identified in epidemiological studies. India being a member of International Cancer Genome Consortium is leading efforts to map oral cancer’s complete genome.
In many Asian cultures chewing betel, paan and Areca is known to be a strong risk factor for developing oral cancer. In India where such practices are common, oral cancer represents up to 40% of all cancers, compared to just 4% in the UK.
Smoking and other tobacco use are associated with about 75 percent of oral cancer cases, caused by irritation of themucous membranes of the mouth from smoke and heat of cigarettes, cigars, and pipes. Tobacco contains over 60 known carcinogens, and the combustion of it, and by products from this process, is the primary mode of involvement. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes.
Alcohol use is another high-risk activity associated with oral cancer. There is known to be a strong synergistic effect on oral cancer risk when a person is both a heavy smoker and drinker. Their risk is greatly increased compared to a heavy smoker, or a heavy drinker alone. Recent studies in Australia, Brazil and Germany point to alcohol-containing mouthwashes as also being etiologic agents in the oral cancer risk family. Constant exposure to these alcohol containing rinses, even in the absence of smoking and drinking, lead to significant increases in the development of oral cancer. A 2008 study suggests that acetaldehyde (a break-down product of alcohol) is implicated in oral cancer.
Infection with human papillomavirus (HPV), particularly type 16 (there are over 120 types), is a known risk factor and independent causative factor for oral cancer. (Gilsion et al. Johns Hopkins) A fast growing segment of those diagnosed does not present with the historic stereotypical demographics. Historically that has been people over 50, blacks over whites 2 to 1, males over females 3 to 1, and 75% of the time people who have used tobacco products or are heavy users of alcohol. This new and rapidly growing sub population between 20 and 50 years old is predominantly non smoking, white, and males slightly outnumber females. Recent research from Johns Hopkins indicates that HPV is the primary risk factor in this new population of oral cancer victims. HPV16 (along with HPV18) is the same virus responsible for the vast majority of all cervical cancers and is the most common sexually transmitted infection in the US. Oral cancer in this group tends to favor the tonsil and tonsillar pillars, base of the tongue, and the oropharnyx. Recent data suggest that individuals that come to the disease from this particular etiology have some slight survival advantage.
Oral cancer can be identified by lumps or lesions on the tongue, lip or other areas of the mouth. They are usually small and discoloured and usually painless although may develop a burning sensation or pain once the tumour is advanced. Other symptoms include difficulty swallowing, ulcers or other mouth sores that do not go away after two weeks and, in later stages, pain and paraesthesia.
Often the surgical removal of the tumor is recommended, due to the nature of the structures of the neck and head area surgery is often demanded. Reconstructive surgery may be required to give an acceptable cosmetic and functional result. Most oral cancer patients depend on a feeding tube for their hydration and nutrition. Some will also get a port for the chemo to be delivered. Many oral cancer patients are disfigured and suffer from many long term after effects. The after effects often include fatigue, speach problems, trouble maintaining weight, throid issues, swallowing difficulties, inability to swallow, memory loss, weakness, dizziness, high frequency hearing loss and sinus damage.
Chemotherapy is useful in oral cancers when used in combination with other treatment modalities such as radiation therapy. It is not used alone as a monotherapy. When cure is unlikely it can also be used to extend life and can be considered palliative but not curative care. Biological agents, such as Cetuximab have recently been shown to be effective in the treatment of squamous cell head and neck cancers, and are likely to have an increasing role in the future management of this condition when used in conjunction with other treatments.
Treatment of oral cancer will usually be by a multidisciplinary team, with treatment professionals from the realms of radiation, surgery, chemotherapy, nutrition, dental professionals, and even psychology all possibly involved with diagnosis, treatment, rehabilitation, and patient care.
Complete avoidance of tobacco based products is vital to avoid oral cancer. If you have had previous types of cancer or have a deficient immune system, regular check ups are important to recognise the early signs of oral cancer if they occur.
Treatment of the causes should subside the symptoms of halitosis, there fore if it is caused by bacteria in the mouth then good oral hygiene is required through regular brushing and flossing and visits to the dentist. An anti-bacterial mouthwash would also aid the problem. Prohibiting from tobacco use is also eesential in prvention of bad breath and drinking plenty of water will help keep the mouth moist and stop the effects of xerostomia (dry mouth). If the problem is caused by other health issues then they will need to be addressed i.e. treatment of a respiratory infection would subside the symptom of halitosis.
Regular brushing, flossing and the use of an anti-bacterial mouth wash will prevent halitosis. Also a smoker would notice a marked improvement of halitosis if they were to quit smoking.