About Oral Cancer

Oral cancer is the sixth most common type of cancer globally, with India contributing to almost one-third of the total cases. Approximately 80,000 new cases are reported annually in India. Oral cancer can affect various parts of the oral cavity, including the lips, the front two-thirds of the tongue, the gums, the inner lining of the cheeks and lips (buccal mucosa), the floor of the mouth, the hard palate, and the area behind the wisdom teeth (retromolar trigone).

Common Symptoms of Oral Cancer:

• Non-healing ulcer in the mouth
• Unexplained bleeding
• Lump or swelling in the jaw, face, or mouth
• Loose teeth
• Pain, numbness, or weakness in the face
• Difficulty opening the jaws or chewing
• Difficulty swallowing
• Changes in speech
• Ear pain or hearing loss
• Difficulty breathing
• White or red patches in the mouth
• Unexplained weight loss
• Swelling in the neck

Types of Oral Cancer

Oral cancers can develop in various areas, including:

• Lip Cancer
• Cheek/Buccal Mucosa Cancer
• Lower/Upper Alveolus Cancer
• Retromolar Trigone (RMT) Cancer
• Floor of the Mouth Cancer
• Tongue Cancer
• Hard Palate Cancer

The majority of oral cancers are squamous cell carcinomas.

Screening and Diagnosis

Early detection of oral cancer is crucial. Regular self-examinations and annual dental check-ups are recommended. Report any persistent white or red patches, or non-healing ulcers, to a healthcare provider.

Diagnostic Procedures Include:

• Physical Examination: Visual inspection of the oral and nasal cavities, neck, throat, and tongue, along with palpation for lumps.
• Biopsy: The removal and examination of a small tissue sample under a microscope to confirm the presence of cancer.
• Imaging Tests: These may include X-rays, CT scans, MRI, or PET scans to assess the extent of the cancer.

Myths About Oral Cancer Diagnosis

A common myth is that biopsies or Fine Needle Aspiration Cytology (FNAC) can spread cancer. This is false; a biopsy is the only definitive way to diagnose cancer and does not cause it to spread.

Tumor Board and Multispecialty Clinic Evaluation

Oral cancer patients are typically evaluated by a multidisciplinary team, including surgical oncologists, medical oncologists, radiation oncologists, onco-pathologists, and imaging specialists. The treatment plan is personalized based on the patient’s age, general condition, cancer type, and stage, following international treatment guidelines such as those from the National Comprehensive Cancer Network (NCCN).

Treatment Options

Treatment options offered include:

• Composite Resection/Commando Operation: A surgical procedure to remove oral cancers.
• Maxillectomy: Removal of the upper jawbone (maxilla) if affected by cancer.
• Neck Dissections: Removal of lymph nodes in the neck to prevent cancer spread.
• Plastic Surgery: Reconstruction using various free flaps and local or regional flaps to restore the face, neck, and oral defects.
• Frozen Section Technique: A method to ensure complete cancer removal during surgery by quickly analyzing tissue margins.

Causes and Risk Factors of Oral Cancer

Common risk factors include:

• Tobacco Use: Both smoking and smokeless tobacco.
• Alcohol Consumption: Excessive alcohol use increases the risk.
• Poor Oral Hygiene: Sharp teeth and poor dental care.
• Human Papillomavirus (HPV) Infection: Linked to oral cancers.
• Syphilis: A sexually transmitted infection that can increase the risk.

Post-Surgery Care (Do’s and Don’ts)

Do’s:

• Speak less to promote healing.
• Maintain a liquid diet with adequate salt at regular intervals.
• Ensure proper feeding tube care if applicable.
• Continue prescribed medications and maintain oral hygiene with Betadine and Hydroxyl mouthwash.
• Follow plastic surgeon’s instructions if flap reconstruction was performed.

Don’ts:

• Avoid sudden exertion to the head and neck area.
• Refrain from using room heaters if you have a tracheostomy tube.
• Avoid addictive substances and brushing your teeth unless advised otherwise.

Oral Cancer Prevention and Care Tips

1. Quit Tobacco: Avoid smoking and chewing tobacco to reduce the risk of oral cancer.
2. Limit Alcohol Consumption: Excessive drinking, especially combined with smoking, significantly increases cancer risk.
3. Regular Dental Visits: Regular check-ups can help detect cancer early.
4. HPV Vaccination: Protects against HPV-related oral cancers.

Protect Lips from Sun Exposure: Use lip balm with SPF and limit sun exposure to reduce the risk of lip cancer.