Oral cancer , also known as oral cancer , is a type of head and neck cancer and is a growth of cancerous tissue located in the oral cavity.
It may appear as a primary lesion originating from tissue in the mouth, by metastasis from a place away from origin, or by extension of adjacent anatomical structures, such as nasal cavities. Alternatively, oral cancers may originate from any tissue of the mouth, and possibly histologic types vary: teratomas, adenocarcinomas derived from major or minor salivary glands, lymphomas from tonsils or other lymphoid tissue, or melanoma of the pigment - producing oral mucosal cells. There are several types of oral cancers, but about 90% are squamous cell carcinomas, derived from tissues that line the mouth and lips. Oral or mouth cancer most often involves the tongue. Can also occur in the floor of the mouth, the lining of the cheek, gingiva (gums), lips, or the palate (roof of the mouth). Most oral cancers look very similar under a microscope and are called squamous cell carcinomas, but fewer other types of cancers occur, such as Kaposi's sarcoma.
In 2013 mouth cancer resulted in 135,000 deaths rising from 84,000 deaths in 1990. The five-year survival rate in the United States was 63%.
Video Oral cancer
Signs and symptoms
In the early stages, it can escape the attention. It can be painless with little physical changes. But changes in precursor tissue, can be noticed by doctors.
Early stage symptoms may be persistent red or white patches, non-healing ulcers, swelling or progressive enlargement, unusual surface changes, sudden tooth mobility without obvious cause, unusual oral bleeding or epitaxis and prolonged hoarseness.
End-stage symptoms may include non-induration areas, paresthesias or tongue or lips disesthesia, airway obstruction, chronic serous otitis media, otalgia, trismus, dysphagia, cervical lymphadenopathy, persistent pain or referred pain and altered vision.
Maps Oral cancer
Cause
Oncogenes are activated as a result of DNA mutations. Risk factors that affect a person for oral cancer have been identified in epidemiological studies (epidemiology).
About 75 percent of oral cancers are associated with modifiable behaviors such as tobacco use and excessive alcohol consumption. Other factors include poor oral hygiene, irritation caused by false teeth that do not fit and other rough surfaces of teeth, poor nutrition, and some chronic infections caused by fungi, bacteria or viruses. If oral cancer is diagnosed at an early stage, treatment is generally very effective.
Chewing betel nut, paan and areca nut known as 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 only 4% in the UK.
Oral cancer often appears as a non-healing ulcer (does not show signs of healing after 2 weeks). In the US, oral cancer accounts for about 8 percent of all malignant growth. Men are affected twice as often as women, especially men older than 40/60.
Praligned lesions
Premalignant (or precancerous) lesions are defined as "benign, morphologically altered tissues that have a greater risk of malignant transformation than normal." There are several types of premalignant lesions occurring in the mouth. Some oral cancers begin as white patches (leukoplakia), red spots (erythroplakia) or red and white patches (erythroleukoplakia or "spotted leukoplakia"). Other premalignant lesions include oral lichen planus (especially erosive type), oral submucosal fibrosis and actinic cheilitis. In India subcontinent oral fibrosis submucosa is very common. This condition is characterized by a limited mouth opening and burning sensation in eating spicy foods. This is a progressive lesion where the mouth opening becomes more limited, and then even normal eating becomes difficult. This happens almost exclusively in India and Indian communities living abroad. The overall prevalence of potentially malignant oral disorders in the Middle East is 2.8%. Lichen planus/lichenoid lesions were the most common lesions (1.8%) followed by leukoplakias (0.48%), chronic hyperplastic candidiosis (0.38%), and erythroplakia (0.096%). Smoking, alcohol, and age (& gt; 40 years) are key identifiable risk factors.
Tobacco
In a study of Europeans, smoking and other tobacco use were associated with about 75 percent of cases of oral cancer, caused by irritation of the mucous membranes of the smoke and smoke of cigarettes, cigars and pipes. Tobacco contains more than 60 known carcinogens, and its combustion, and the by-products of this process, is the main mode of engagement. The use of tobacco chewing or tobacco causes irritation due to direct contact with mucous membranes.
The use of tobacco in any form by itself, and even more in combination with heavy alcohol consumption, continues to be an important risk factor for oral cancer. However, due to the current trend in the spread of HPV16, in early 2011 the virus is now considered a major contributing factor in 63% of newly diagnosed patients.
Alcohol
Several studies in Australia, Brazil, and Germany show that mouthwash containing alcohol is also a potential cause. The claim is that constant exposure to alcoholic rinses, even in the absence of smoking and drinking, leads to a significant increase in the development of oral cancers. However, studies conducted in 1985, 1995, and 2003 summarize that alcohol-based mouth rinses are not associated with oral cancers. In a March 2009 summary, the American Dental Association said "available evidence does not support the link between mouth cancer and mouthwash containing alcohol". A 2008 study showed that acetaldehyde (alcohol breakdown product) is involved in oral cancer, but this study focuses specifically on alcohol abusers and does not refer to mouthwash. Any association between mouth cancer and mouthwash is weak without further investigation.
Human papillomavirus
Infections with human papillomavirus (HPV), particularly type 16 (more than 180 species), are known risk factors and independent factors for oral cancer. The fast-growing segment of those diagnosed did not present with historic stereotypical demographics. Historically, people aged over 50 years, white blacks 2 to 1, men over women 3 to 1, and 75% of people who have ever used tobacco products or heavy alcohol users. This rapidly growing new sub population between 30 and 50 years is dominated by non-smokers, white, and slightly more men than females. Recent research from several peer-reviewed journal articles suggests that HPV16 is a major risk factor in the new population of oral cancer victims. HPV16 (along with HPV18) is the same virus that is responsible for most of all cervical cancers and is the most common sexually transmitted infection in the US. Oral cancer in this group tends to support the pillars of tonsils and tonsils, tongue base, and oropharynx. Recent data indicate that individuals who come to the disease from this particular cause have significant survival advantages, as the disease responds better to radiation treatments than tobacco-related diseases.
Stem cell transplant
Patients after hematopoietic stem cell transplantation (HSCT) are at a higher risk for oral squamous cell carcinoma. Post-HSCT oral cancer may have more aggressive behavior with a worse prognosis, when compared with oral cancer in non-HSCT patients. This effect should be due to continuous lifetime immune suppression and chronic graft-versus-host disease.
Diagnosis
Early diagnosis of oral cancer patients will reduce mortality and help improve care. Oral surgeons and dentists can diagnose these patients at an early stage. Healthcare providers, dentists, and oral surgeons should have high knowledge and awareness that will help them to provide better diagnoses for oral cancer patients. Oral examinations by health care providers, dentists, oral surgeons show visible and/or palpable (perceived) lesions of the lips, tongue, or other mouth areas. The lateral/ventral side of the tongue is the most common site for intraoral SCC. When the tumor grows, it can become an ulcer and bleed. Difficulty speaking, difficulty chewing, or difficulty swallowing can develop. Filler tubes are often needed to maintain adequate nutrition. This sometimes becomes permanent because feeding difficulties can include the inability to swallow even a sip of water. Doctors may order some special tests that may include chest X-ray, CT or MRI, and tissue biopsy.
While a dentist, physician or other health professional may suspect a malignant lesion, there is no way of knowing by sight - since benign and malignant lesions may look identical to the eye. Non-invasive brushing biopsy (BrushTest) can be performed to rule out the presence of dysplasia (pre-cancer) and cancers of the mouth area suggesting unexplained color or lesions. The only definitive method for determining whether cancer or precancerous cells is present through the biopsy and microscopic evaluation of cells in the discarded sample. A tissue biopsy, whether from the tongue or other oral tissues and microscopic examination of the lesions confirms the diagnosis of oral or precancerous cancer.
Screening
The US Preventive Services Task Force (USPSTF) in 2013 states that evidence is insufficient to determine the balance of benefits and screening hazards for oral cancer in asymptomatic adults by primary care providers. The American Family Physician Academy has the same conclusion while the American Cancer Society recommends that adults over 20 years old who undergo periodic medical examinations should have oral cavities checked for cancer. The American Dental Association recommends that providers remain alert to signs of cancer during routine screening.
There are a variety of screening devices, however, there is no evidence that regular use of these devices in the practice of general dentists is helpful. However, there are compelling reasons to worry about the risk of harm caused by this device if used routinely in common practice. Such damage includes false positives, unnecessary surgical biopsies and financial burden on the patient.
Management
Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough, and if surgery tends to produce satisfactory results functionally. Radiation therapy with or without chemotherapy is often used in conjunction with surgery, or as a definitive radical treatment, especially if the tumor is inoperable. Surgery for oral cancer includes:
- Maxillectomy (can be done with or without orbital exenteration)
- Mandibulektomi (removal of the lower jaw or lower jaw)
- Glossectomy (removal of the tongue, can be total, hemi or partial). When glossectomy is performed for smaller tumors (& lt; 4cm), the adequacy of resection (the margin status) is best assessed from the resected specimen itself. Margin status (positive/clear cutting through versus negative/clear margin) obtained from glossectomy specimens appears to be a prognostic value, while the sample margin status of post-glossectomy defects is not. The margin sampling method seems to be correlated with local recurrence: preference for bed margins/tumor defects may be associated with worse local controls.
- Radical neck dissection
- Operation Mohs or CCPDMA
- Combinations, e.g. glossectomy and laryngectomy done together
- Food tubes to maintain nutrients
Due to the vital nature of the structures in the head and neck regions, surgery for larger cancers is technically demanding. Reconstructive surgery may be needed to provide acceptable cosmetic and functional results. Bone transplants and surgical flaps such as radial forearm flaps are used to help rebuild the raised structure during cancer excision. Oral prosthesis may also be needed. Most oral cancer patients rely on filler tubes for their hydration and nutrients. Some will also get ports for chemotherapy to be delivered. Many oral cancer patients are disabled and suffer many long-term after effects. Side effects often include fatigue, speech problems, difficulty maintaining weight, thyroid problems, difficulty swallowing, inability to swallow, memory loss, weakness, dizziness, high frequency hearing loss and sinus damage.
The survival rate for oral cancer depends on the exact site and stage of the cancer at diagnosis. Overall, 2011 data from the SEER database showed that survival was about 57% at five years when all the early diagnosis stages, all sex, all ethnicity, all age groups, and all treatment modalities were considered. The survival rate for stage 1 cancer is about 90%, then the emphasis on early detection to improve survival outcomes for patients. Similar survival rates are reported from other countries such as Germany.
After treatment, rehabilitation may be needed to improve movement, chew, swallow, and talk. Speech and language pathologists may be involved at this stage.
Chemotherapy is useful in oral cancer when used in combination with other treatment modalities such as radiation therapy. It is not used alone as monotherapy. When the drug is not possible, it can also be used to prolong life and can be considered palliative but not curative treatment. Biological agents such as Cetuximab have recently been shown to be effective in the treatment of head and neck cell carcinomas, and are likely to have an increased role in future management of this condition when used in conjunction with other treatment modalities.
Oral cancer treatment will usually be done by a multidisciplinary team, with radiation, surgery, chemotherapy, nutrition, dentistry and even psychology experts all likely to be involved with the diagnosis, treatment, rehabilitation, and patient care.
Prognosis
- Fouling face, head and neck post operation
- Complications of radiation therapy, including dry mouth and difficulty in swallowing
- Other metastases (spread) cancer
- Significant weight loss
The prognosis depends on the stage and overall health. The grading of the invasive front of the tumor is a very important prognostic parameter.
Epidemiology
In 2013 mouth cancer resulted in 135,000 deaths, up from 84,000 deaths in 1990. Oral cancer is more common in people from the lower end of the socioeconomic scale.
Europe
Europe ranks second highest after Southeast Asia among all continents for a standard age level (ASR) specifically for oral and oropharyngeal cancers. There are an estimated 61,400 cases of lip and mouth cancer in Europe in 2012. Hungary recorded the highest mortality and morbidity due to oral and pharyngeal cancer in all European countries while Cyprus reported the lowest
United Kingdom
The British Cancer Research found 2386 deaths from oral cancer in 2014, other studies have shown this mainly in the category of elderly population; only 6% of people under 45 are affected by oral cancer. UK is the lowest th lowest for men and the highest 11 th for women for the incidence of oral cancer in Europe. In addition, there is regional variability in the UK, with Scotland and northern England having higher rates than southern England. The same analysis applies to lifetime risks of developing oral cancer, as in Scotland it was 1.84% in males and 0.74% in females, higher than the rest of the UK, to 1.06% and 0.48%, respectively -something.
Oral cancer is the sixth most common cancer in the UK (about 6,800 people diagnosed with oral cancer in the UK in 2011), and it is the most common cause of nineteenth cancer deaths (about 2,100 people died of disease in 2012).
Northern Europe
The highest incidence of oral and pharyngeal cancers was recorded in Denmark, with the standard age level per 100,000 from 13.0, followed by Lithuania (9.9) and the UK (9.8). Ã, Lithuania reported the highest incidence in men while Denmark reported the highest in women. The highest rates for mortality in 2012 are reported in Lithuania (7.5), Estonia (6.0) and Latvia (5.4). High incidence rates of cancers of the mouth and pharynx in Denmark can be attributed to their higher alcohol intake than other Scandinavian citizens and low intake of fruits and vegetables in general.
Eastern Europe
Hungary (23.3), Slovakia (16.4) and Romania (15.5) reported the highest incidence of oral and pharyngeal cancers. Hungary also recorded the highest incidence in both sexes as well as the highest mortality rate in Europe. It ranks third globally for cancer death rates. Cigarette smoking, excessive alcohol consumption, inequalities in care received by cancer patients and gender-specific systemic risk factors have been determined as a major cause of high rates of morbidity and mortality in Hungary.
Southern Europe
The incidence rate of oral cancer in Western Europe found France, Germany and Belgium to be the highest. ASR (per 100,000) are 15.0, 14.6 and 14.1, respectively. When filtered by gender category, the same country ranked the top 3 for men, however, in different Belgium sequences (21.9), Germany (23.1), France (23.1). France, Belgium and the Netherlands ranks highest for women, with ASR 7.6, 7.0, 7.0, respectively.
Western Europe
Incidence of oral and oropharyngeal cancers was noted, finding Portugal, Croatia and Serbia having the highest rates (ASR per 100,000). These values ​​are 15.4, 12 and 11.7, respectively.
United States
In 2011, nearly 37,000 Americans were projected to be diagnosed with oral or pharyngeal cancers. 66% of the time, this will be found as the final stage of three and four diseases. This will cause more than 8,000 deaths. Of those newly diagnosed, only slightly more than half will live within five years. Similar survival estimates are reported from other countries. For example, the relative survival of five years for oral cancer in Germany is about 55%.
Overall oral cancer is at higher risk for black men opposed to white men, but certain cancers - like lips, are at higher risk for white males opposed to black men. Overall, the rates of oral cancer between the gender groups (male and female) appear to be declining, according to data from 3 studies
Of all cancers, the attributes of oral cancer to 3% in men, compared with 2% in women. New cases of oral cancer in the US in 2013, estimated at nearly 66,000 with nearly 14,000 are associated with tongue cancer, and nearly 12,000 from the mouth, and the rest of the oral and pharyngeal cavities. In the previous year, 1.6% of lips and cancers of the oral cavity were diagnosed, in which the age-standard incidence rate (ASIR) in all geographical regions of the United States was estimated at 5.2 per 100,000 population. It is the 11th most common cancer in the US among men, while in Canada and Mexico it is the 12th and 13th most common cancers. ASIR for lips and oral cancer among men in Canada and Mexico are 4,2 and 3,1, respectively.
South America
ASIR in all geographical regions of South America in 2012 sits at 3.8 per 100,000 inhabitants where about 6,046 deaths have occurred due to lips and oral cavity cancer, where the age-standard mortality rate remains at 1.4.
In Brazil, however, lips and oral cancer are the 7th most common cancer, with an estimated 6,930 new cases diagnosed in 2012. These numbers are increasing and have overall ASIR higher at 7.2 per 100,000 inhabitants where about 3000 death has occurred
Prices are rising in both men and women. By 2017, nearly 50000 new cases of oropharyngeal cancer will be diagnosed, with rates twice as high in men as women.
Asia
Oral cancer is one of the most common types of cancer in Asia because of its association with smoking (tobacco, bidi), the consumption of betel and alcohol. Regional events vary with the highest rates in South Asia, particularly India, Bangladesh, Sri Lanka, Pakistan and Afghanistan. In the countries of Southeast Asia and Arabia, although the prevalence is not that high, the estimated incidence of oral cancer ranged from 1.6 to 8.6/100,000 and 1.8 to 2.13/100,000 respectively. According to GLOBOCAN 2012, estimates of standard age of cancer incidence and mortality are higher in males than females. However, in some areas, particularly Southeast Asia, similar rates are noted for both sexes. The median age of those diagnosed with oral sarcoma cell carcinoma is about 51-55. In 2012, there were 97,400 deaths recorded for oral cancer
India
Oral cancer is the most common form of cancer in India. 130,000 people succumb to oral cancer in India every year. The reason for the high prevalence of oral cancer in India is the tobacco consumed in the form of gutka, quid, snuff or misri.
Africa
There is limited data for the prevalence of oral cancer in Africa. The following levels illustrate the number of new cases (for the incidence rate) or death (for death rate) per 100 000 individuals per year.
The incidence rate of oral cancer was 2.6 for both sexes. This figure is higher in men at 3.3 and lower in women in 2.0.
The mortality rate is lower than the incidence rate of 1.6 for both sexes. This figure is higher for men at 2.1 and lower for women at 1.3.
Australia
The following levels illustrate the number of new cases or deaths per 100 000 individuals per year. The incidence rate of oral cancer was 6.3 for both sexes; this was higher in men in 6.8-8.8 and lower in women at 3.7-3.9. The mortality rate was significantly lower than the incidence rate at 1.0 for both sexes. This figure is higher in men at 1.4 and lower in women at 0.6.
Table 1 provides the standard incidence of age and mortality rates for oral cancer based on location in the mouth. The location of 'other mouth' refers to the buccal mucosa, vestibule and non-specific mouth portions. Data show lip cancer has the highest incidence rate while gingival cancer has the lowest overall rate. In terms of mortality rates, oropharyngeal cancer has the highest rates in men and tongue cancer has the highest rate in women. Lips, palatal and gingival cancers have the lowest overall mortality rate.
See also
- Head and neck cancer
- Oral mucosal tissue techniques
References
External links
- Digital guide for early diagnosis of oral neoplasia (IARC Screening Group)
- Information about oral cancer from Stanford Hospital
- Graphical information on oral cancer and HPV links from Mount Sinai Hospital, New York
- The Oral Cancer Foundation
Source of the article : Wikipedia
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