Author: Victoria Lun
Editors: Simran Grewal and Jarshini Nanthakumar
Overview
Mouth cancer (also known as oral cancer) arises in oral regions and is characterized as a form of head and neck cancer (Minić and Pejčić, 2018; Rivera, 2015). The most prevalent form of mouth cancer is squamous cell carcinoma (Rivera, 2015). Patients in the advanced stages have a high mortality rate however, research suggests this type of cancer is preventable (Rivera, 2015).
Mouth cancer occurs worldwide, and is twice as prevalent in males than females (Rivera, 2015). Regions with a high incidence of mouth cancer include Southeast Asia, Western and Eastern Europe, South America, the Caribbean, and the Pacific (Rivera, 2015; Sankaranarayanan et al., 2015). From the above areas, research has demonstrated a higher mortality rate in less developed areas (Rivera, 2015).
Etiology
The use of tobacco and alcohol are the most common causes of mutagenic mechanisms due to the formation of carcinogens (free radicals) and epithelial atrophy, respectively (Minić and Pejčić, 2018; Rivera, 2015). Additionally, it can be caused by increased permeability of epithelial cells lining the oral mucosa (Rivera, 2015).
Symptoms
Symptoms of mouth cancer include:
- Bleeding from the mouth
- Burning sensation of the lips
- Difficulty swallowing and speaking
- Ear discomfort
- Mouth ulcers that persists for over 14 days
- Red or red and white coloured patches
- Swollen lymph nodes
- Toothache (Minić and Pejčić, 2018).
Symptoms of oral squamous cell carcinoma include (Bagan, Sarrion & Jimenez, 2010):
- Pain associated with mouth lesions
- Ear pain
- Bleeding
- Teeth mobility
- Breathing related problems
- Speech difficulty
- Dysphagia
- Cervical lymphadenopathy
Risk Factors
Common risk factors corresponding to the development of mouth cancer include the use of tobacco (smoked and chewed), alcohol, unhealthy diet, ultraviolet radiation, human papillomavirus (HPV), poor hygiene, chronic trauma, and genetic polymorphisms (Sankaranarayanan et al., 2015).
Diagnosis
Clinical Features
Although mouth cancer is difficult to detect during early stages, dentists should perform regular oral mucosa examinations for all patients, especially for males over 40 years of age who smoke and consume alcohol regularly (Minić and Pejčić, 2018). During early stages, red or white coloured lesions can develop into ulcers with raised edges around the tongue, retromolar region and the mouth cavity (Minić and Pejčić, 2018). Additionally, patients may present with texture changes of the mucous membrane (i.e a granular surface), however, these clinical features should not be painful during the early stages (Minić and Pejčić, 2018).
This form of cancer can also develop as masses in the oral cavity and patients are susceptible to ulcerations that do not resolve themselves for more than 14 days (Minić and Pejčić, 2018). The most prevalent symptom patients primarily notice are burning sensations in the mouth however this will be experienced in the later stages of the disease (Minić and Pejčić, 2018). If the aforementioned symptoms are detected, a patient should be referred to a specialist for further examination (Minić and Pejčić, 2018).
Pathological Features
A biopsy conducted by a specialist can confirm the diagnosis of mouth cancer, and an appropriate treatment can then be administered (Minić and Pejčić, 2018). Common imaging techniques used to visualize local spread of cancer if suspected include, X-rays, CT scans, MRIs and PET imaging (Sankaranarayanan et al., 2015).
Treatment
A combination of therapies are used to treat mouth cancer which is dependent on a variety of factors such as size and location of the tumor, outcome of aesthetics, age and socioeconomic background of the patient (Sankaranarayanan et al., 2015).
Non-pharmacological Treatment
Surgery and radiotherapy ( individually or combination therapy) are the most common treatment regimes for both early and advanced stages of mouth cancer (Sankaranarayanan et al., 2015). Additionally, chemotherapy may or may not be included in the treatment plan (Sankaranarayanan et al., 2015).
Pharmacological Treatment
Common chemotherapeutic medications prescribed include cisplatin, carboplatin, 5-fluorouracil, paclitaxel and docetaxel (Rivera, 2015).
References
Bagan, J., Sarrion, G., & Jimenez, Y. (2010). Oral cancer: Clinical features. Oral Oncology, 46(6), 414–417. https://doi.org/10.1016/j.oraloncology.2010.03.009
Minić, I., Pejčić, A., & Minić, I. (2018). Oral Cancer: Incidence and Management. Journal of Oral Cancer and Research, 2(1), Article 1. https://scholars.direct/Articles/oral-cancer/jocr-2-005.php?jid=oral-cancer
Rivera, C. (2015). Essentials of oral cancer. International Journal of Clinical and Experimental Pathology, 8(9), 11884–11894.
Sankaranarayanan, R., Ramadas, K., Amarasinghe, H., Subramanian, S., & Johnson, N. (2015). Oral Cancer: Prevention, Early Detection, and Treatment. In H. Gelband, P. Jha, R. Sankaranarayanan, & S. Horton (Eds.), Cancer: Disease Control Priorities, Third Edition (Volume 3). The International Bank for Reconstruction and Development / The World Bank. http://www.ncbi.nlm.nih.gov/books/NBK343649/
