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Oral Cancer (Mouth Cancer)

All cancers that occur in the lip, tongue, hard palate, floor of the mouth, retromolar region (20-year-old tooth region) and buccal mucosa (cheek) are referred to as "mouth cancer" (oral cancer ) . While the behavior of each of these cancers is very different, they are all types of aggressive cancer.

What is Oral (mouth) cancer?


Oral cancer (mouth cancer) is the growth of abnormal cells anywhere in the mouth or lips. While catching oral cancers as early as possible is extremely important for the treatment success rate, surgery is at the forefront in the treatment of tumors in this region. Surgery should be performed as wide as possible, safe, with a surgical margin, and the surgical area removed during the operation should be supported with pathology (frozen). In some cases, chemotherapy may be used in addition to surgery. In the treatment of a cancer in the mouth, neck dissection (except for the hard palate) is absolutely necessary.


What are the risk factors for oral cancer?


Long-term and heavy users of tobacco and tobacco products have an increased risk of oral cancer. As a matter of fact, it has been determined that approximately 75 percent of people with oral cancer use tobacco. The risk of oral cancer increases as the amount and duration of tobacco use increases. Excessive alcohol consumption, too much exposure to the sun, being over 40 years old and being obese also increase the risk of oral cancer. People with a history of head and neck cancer have an increased risk of developing mouth cancer, especially if they continue to smoke and drink alcohol. In addition, HPV infection, ultraviolet rays, malnutrition, weakening of the immune system, having certain health problems such as graft-versus-host disease or fanconi anemia, and poor oral hygiene are also factors that increase the risk of oral cancer.


Note: People with oral cancer are more likely to develop cancer of the larynx, esophagus, or lung.


What are the types of oral (mouth) cancer?


Oral cancer is categorized by the type of cell in which the cancer (carcinoma) begins to grow. Squamous cell carcinoma is the most common type of mouth cancer, accounting for 9 out of 10 cases.​


Less common types of oral cancer include:

  • Adenocarcinoma, which are cancers that develop inside the salivary glands

  • Sarcoma growing from abnormalities in bone, cartilage, muscle, or other tissues

  • Oral malignant melanoma, in which cancer begins in the cells that produce skin pigment or color (melanocytes). These appear as very dark, mottled bumps that often bleed.

  • Lymphoma that usually develops from cells found in lymph nodes. (They can also grow in the mouth.) 


On the other hand, oral cancer is a type of cancer that falls under the umbrella of 'head and neck cancers'.  

Other types of head and neck cancer include:

  • Throat cancer

  • Nasopharyngeal cancer (the area behind the nose that forms the upper part of the throat (pharynx)

  • Oropharyngeal cancer

  • Hypopharyngeal cancer

  • Thyroid gland cancer

  • Nose and sinus tumors

  • Esophageal cancer 


What are the symptoms of oral (mouth) cancer?


If any of the symptoms of oral cancer persist for more than 2 weeks, it is important to consult a doctor immediately. 


The symptoms of oral cancer can be listed as follows:

  • Non-healing mouth/lip sore

  • Lump or swelling inside the mouth

  • White or red patches inside the mouth

  • An area inside the mouth that fades and stays that way

  • Lump or thickening of the cheeks

  • Sore throat that does not heal for a long time

  • Losing voice

  • Bad breath

  • Chewing or swallowing problem

  • Problem of inability to move the jaw and tongue

  • Numbness in the tongue or part of the mouth

  • Pain around the teeth and in the jaw

  • Unexplained weight loss

  • Constantly feeling that something is stuck in the throat


How is oral (mouth) cancer diagnosed?


The diagnosis process in mouth cancer begins with a physical examination. With or without symptoms, the dentist notices an abnormal tissue change in the mouth during a routine checkup and may feel any lump or mass. A direct examination of the lesion or a small biopsy can make the diagnosis. Once diagnosed, the doctor will determine the extent of the cancer with various tests, whether the cancer has spread beyond the oral cavity.


Tests to be done may include:


  • MRI scan of the head and neck

  • CT scan of the chest to look for cancer in the lymph nodes

  • Positron Emission Tomography (PET) scan to look for cancer in other parts of the body

  • The doctor may also look at the larynx, esophagus, and lungs by sliding a tube with a small camera at the end down the throat.


How is oral (mouth) cancer diagnosed?


Mouth cancer treatment applications; The general health status of the patient may vary depending on the location and stage of the cancer. The surgical procedure, the most common treatment for mouth cancer, involves removing the tumor and some surrounding healthy tissue. In cases where cancer cells have spread to the lymph nodes, the surgeon will remove them to prevent the cancer from spreading to other parts of the body. One of the most exciting new developments in the treatment of mouth cancer is the widespread use of robotic surgery.​


Radiotherapy is the primary treatment for some small tumors. Radiotherapy uses high-energy x-rays to kill cancer cells. In some cases, patients undergoing surgery are given radiotherapy to remove cancer cells that may have remained at the microscope level in the body after surgery. Even when radiotherapy cannot cure the cancer, it can relieve symptoms such as bleeding and difficulty swallowing.​


Doctors may administer chemotherapy to shrink tumors before the surgical procedure if needed. In cases where the tumor is too large to be operated on, chemotherapy and radiotherapy can relieve the symptoms caused by the cancer.​If the cancer is diagnosed at an earlier stage (Stages I and II), the chances of recovery are much higher. Because the tumors in these stages are smaller than 4 centimeters at the widest point and have not spread to the lymph nodes. Cancer patients in these stages can be treated with a surgical procedure and radiotherapy. Stage III and IV tumors are more advanced. At these stages, tumors are treated with radiotherapy, chemotherapy, or both, in addition to more extensive surgical procedures. Targeted drug therapy can also be used alone or in combination with chemotherapy-radiotherapy. 


Immunotherapy uses drugs that help the immune system fight cancer. Immunotherapy can be administered to people with advanced mouth cancer that does not respond to standard treatments.


FREQUENTLY ASKED QUESTIONS ABOUT ORAL (MOUTH) CANCER

How can the risk of mouth cancer be reduced?


Although there is no proven method of preventing oral cancer, the risk of developing oral cancer can be reduced by considering the following recommendations. ​


Tobacco use should be stopped or not started: Tobacco use increases the risk of oral cancer. Smoking and chewing tobacco exposes cells in the mouth to dangerous chemicals that can cause cancer.

Alcoholics should consume in moderation: Excessive alcohol consumption can irritate the cells in the mouth, making them vulnerable to oral cancer. Indeed, excessive alcohol consumption should be avoided.

Excessive sun exposure should be avoided: Sunscreen cream should be used as a substrate to protect the lips from the harmful rays of the sun by staying in the shade as much as possible. A wide-brimmed hat should be used that effectively covers the entire face, including the brim.


Along with these, eating a well-rounded, healthy diet with a variety of fruits and vegetables can also reduce the risk of oral cancer.


What is supportive care for mouth cancer?


Supportive care helps relieve the physical, practical, emotional and spiritual challenges of oral cancer. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment. Getting rid of oral cancer and getting used to life after treatment is a different process for each individual, depending on the location of the tumor, the stage of the cancer, the organs and tissues taken during the surgery, the type of treatment and many other factors. Even after treatment has ended, there may still be problems with coping with long-term side effects. A person being treated for oral cancer may have the following concerns.


Self-esteem and body image


How a person feels about himself is defined as self-confidence. Body image is how a person sees their own body. Oral cancer and its treatments can affect a person's self-esteem and body image.


This condition is usually caused by the following factors:


  • scars

  • skin changes

  • changes in face shape

  • having to use a prosthesis

  • difficulty speaking or eating

  • weight loss


Some of these changes may be temporary, while others may last for a long time or become permanent.

Some individuals may avoid socializing even if the effects of the treatment are not visible outside the body. Because they may be afraid that others will judge them, they may be afraid of experiencing a sad and angry emotional hit.


Those who are affected by your appearance after oral cancer surgery should give themselves time. Talking to someone who has had a similar experience, family support, socializing with friends can help the individual. There are also tools that can help with facial changes, such as camouflage makeup for scars or wearing scarves and hats.


Dry mouth


Many people will experience dry mouth during and after treatment for mouth cancer. Radiotherapy or a surgical procedure that damages the salivary glands can cause dry mouth. Chemotherapy combined with radiotherapy can often exacerbate dry mouth complaints. Intensity modulated radiotherapy (IMRT) can help reduce this complication in many patients.


Chewing and swallowing difficulties


Mouth surgery can cause difficulty in chewing and swallowing, especially if it involves removing certain structures such as the tongue and jawbone. In some cases, it may be necessary to have reconstruction or dental prosthesis to replace a structure inside the mouth. Ways to improve swallowing include changing your head posture and doing range-of-motion exercises for the jaw and tongue. A feeding device called a glossectomy spoon allows a person with only part of their tongue to place soft food at the back of their mouth. This also aids in swallowing.


Speech problems


Surgery in which large parts of the tongue, jawbones, or palate are removed can cause speech problems. Restructuring helps reduce these complications, but restoring normal function is often difficult. Oral prostheses can make up for tissue lost during surgery and help improve speech.A speech therapist can assess speech problems and help manage them.


Taste changes


Radiotherapy to the head, neck, or mouth can damage the salivary glands and taste buds on the tongue, which can affect the way some foods taste. Chemotherapy drugs can also affect the taste cells in the mouth. Surgery to remove part or all of the tongue may result in decreased or loss of the sense of taste.


Dental problems


Radiotherapy can cause dental problems. Saliva helps clean teeth and gums, so when less saliva is secreted you are at higher risk of developing cavities and gum disease. Radiotherapy can also affect tooth enamel. In this case, the risk of tooth decay also increases.Before starting the treatment, you can go to the dentist for a check-up. Because good oral care is very important to prevent problems. Fluoride treatments can be applied to prevent tooth decay. After the treatment, the dentist should be checked regularly.


Feeding problems


It can cause difficulty in chewing and swallowing and loss of appetite, malnutrition and weight loss. Steps can be taken to increase appetite and help people eat more and continue to eat well. Nutritional supplements may be recommended. A registered dietitian can often help people manage their diet and appetite.


Decreased thyroid function (hypothyroidism)


Between 30 percent and 40 percent of people who receive radiotherapy for head and neck cancers, including mouth cancer, will develop hypothyroidism. Some symptoms of hypothyroidism include extreme fatigue, dry skin and hair, hair loss, weight gain, and intolerance to cold.Those with hypothyroidism after oral cancer treatment may need to take daily medication.

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