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Head & Neck Cancer

Introduction

Any uncontrolled growth of cells that invade and cause the adjacent tissue impairment is known as cancer. Oral cancer ensues with a small, unfamiliar, unexplained growth or sore in the mouthparts that include lips, cheeks, alveolus, gingivobuccal sulcus, tongue, hard and soft palate, floor of mouth extended to the oropharynx. Globally, oral cancer ranks sixth among all types of cancer. India has the largest number of oral cancer cases and one-third of the total burden of oral cancer globally. In India, around 77,000 new cases and approximately one-fourth of global incidences.

Oral squamous cell carcinoma (OSCC) contributes 84-97% to oral cancer. OSCC commonly results from potentially malignant lesions or normal epithelium linings. Potentially malignant disorders (PMDs) such as inflammatory oral submucosa, fibrosis, erythroplakia (slightly raised or flat red patches), leukoplakia (These are flat white or gray patches in mouth), candidal leukoplakia, dyskeratosis congenital, and lichen planus are indicators of the preclinical phase of oral cancer. Tobacco consumption including smokeless tobacco (SLT), betel-quid chewing, excessive alcohol consumption, poor oral hygiene, nutrient-deficient diet, and sustained viral infections, human papillomavirus (HPV) are some of the risks associated with the occurrence of oral cancer. Tobacco consumption (in any form) is a prime cause of cancer, prominently in developing nations. Apart from tobacco, chewing paan containing leaves of piper betel with areca nut, lime, catechu, cinnamon, etc., is a leading source of oral malignancy, especially in the north-eastern parts of India that contributes the highest incidence of cancer in India.

Tobacco consumption has been the predominant factor causing oral cancer. The continual use of tobacco in various forms such as gutka, zarda, mawa, kharra, khaini, cigarettes, bidi, hookah, etc. is a major cause of tumor development in the oral cavity in both young as well as the adult Indian population. Males show a high incidence of tobacco-related cancer.

Oral cavity includes:

• lips.
• Gums (alveolus)
• The lining of the inside of cheeks (buccal mucosa)
• The anterior two-thirds of tongue
• The floor of your mouth (the part under your tongue)
• The first part of the roof of mouth (palate)
• The area right behind wisdom teeth (Retromolar trigone).

SYMPTOMS AND CAUSES

Causes:

Oral cancer starts in the squamous cells in your oral cavity. Squamous cells are flat and, when viewed under a microscope, look like a fish scale.
Normal squamous cells become cancerous when their DNA changes and cells begin growing and multiplying. Over time, these cancerous cells can spread to other areas inside of your mouth and then to other areas of your head and neck or other areas of your body.

About 75% of people who develop oral cancer have the following habits:

• Smoke cigarettes, cigars or pipes.
• Use smokeless tobacco products such as chewing tobacco, dip, snuff or water pipes (hookah or shush).
• Regularly drink excessive amounts of alcohol.
• Spend a lot of time in the sun without protecting their lips with sunblock.
• Have human papillomavirus (HPV).
• Have a family history of oral cancer.

It’s important to note that 25% of people who develop oral cancer don’t smoke or have other known risk factors.

Common signs and symptoms include:

• Sores on lip or inside mouth that bleed easily and don’t heal within two weeks.
• Rough spots or crusty areas on lips, gums or inside of mouth.
• Areas in mouth that bleed for no obvious reason.
• Numbness, pain or tenderness on face and neck or in mouth that occur without apparent cause.
• Difficulty chewing or swallowing, speaking or moving jaw or tongue.
• Unintentional weight loss.
• Earache.
• Chronic bad breath.

DIAGNOSIS AND TESTS

Oral cancer tests include:

• Physical examination: Your healthcare provider will look at the entire inside of mouth and might feel around your mouth. They’ll also examine head, face and neck for potential signs of pre-cancer or cancer.
• Incisional biopsy or punch biopsy: Your healthcare provider will remove small pieces of tissue to get cells to be examined for cancer.
• Direct (flexible) pharyngoscopy and laryngoscopy: They may use an endoscope to look at areas of throat and mouth that can’t be seen. An endoscope is a thin, flexible tube with an attached light and viewing lens.
• Imaging: Contrast CT face and Neck, MRI Face, or PET scan.

The three main treatment options for oral (mouth) are surgery, radiation therapy and chemotherapy.
Several factors before recommending treatment. Those factors include:

• The type of oral cancer
• If the oral cancer you have has spread from the original site to other parts of mouth and throat or other parts of body.
• General health.
• Age

The most common surgeries for oral cancer are:

• Primary tumor surgery: Healthcare providers remove tumors through mouth or an incision in your neck.
• Glossectomy: This is the partial or total removal of tongue.
• Mandibulectomy: This is surgery for oral cancer in lower jawbone.
• Maxillectomy: This surgery removes part or all of the hard palate, which is the bony roof of mouth.
• Neck dissection: This surgery is done to remove lymph nodes from neck.
• Reconstruction: Surgery that removes large areas of tissue might be followed by reconstructive surgery to fill gaps left by the tumor or replace part of your lips, tongue, palate or jaw. In some cases, reconstructive surgery is done by taking healthy bone and tissue from other areas of body.

Healthcare providers may combine surgery with other treatments, including:

• Radiation therapy: Radiation therapy uses strong beams of energy to kill cancer cells or keep them from growing. Healthcare provider may combine radiation therapy with other treatments.
• Targeted therapy: This cancer treatment uses drugs or other substances to precisely identify and attack certain types of cancer cells without hurting normal cells. Monoclonal antibodies are immune system proteins that are created in the lab and used to treat cancer.
• Chemotherapy: Healthcare provider may use anti-cancer drugs that kill cancer cells, including treatments that affect most parts of body.
• Immunotherapy: Immunotherapy is a cancer treatment that engages immune system to fight the disease. The treatment is sometimes called biological therapy.

 

 

PREVENTION

Oral cancer can be prevented, and you can play an active role in preventing it. You can help prevent oral cancer with the following tips:

• If you’re someone who smokes tobacco, chews tobacco or uses a water pipe, try stopping or cutting back. Talk to your doctor about smoking cessation programs.
• If you’re someone who drinks alcohol, drink in moderation.
• Remember your sunscreen. Use UV-AB-blocking sunscreen on your face and sunblock.
• Get vaccinated for human papillomavirus.
• Eat a well-balanced diet.
• Have regular dental check-ups. People between ages 20 and 40 should have an oral cancer screening every three years and annual exams after age 40.