Oral Cancer

Oral cancer refers to cancer that develops within the oral cavity, encompassing areas such as the inner lining of the mouth, tongue, gums, lips, the roof, and floor of the mouth. It typically manifests as an ulcer, growth, or lump in the mouth that doesn’t respond to treatment and fails to heal over time. Early diagnosis and treatment are crucial, as oral cancers can be life-threatening and have the potential to spread throughout the body if left untreated.

Early diagnosis significantly improves the chances of successful treatment. Unfortunately, many cases are diagnosed at an advanced stage due to delayed medical attention or alternative treatment choices. Oral cancer is most commonly associated with tobacco use in any form and excessive alcohol consumption.

While most cases occur in individuals over 50, younger people aged 25-30 are also increasingly affected by oral cancers. Men are at higher risk than women, and a lack of sufficient fruits and vegetables in the diet has been linked to increased risk. It’s important to note that more than 25% of oral cancer cases occur in non-smokers and occasional alcohol drinkers.

Symptoms to watch out for include:

• Painless ulcers or growths in the mouth that bleed upon touch and persist for over a month despite treatment.
• Thickening or swelling, accompanied by velvety white or red patches in the mouth.
• Jaw swelling or pain.
• Unexplained bleeding from the mouth.
• Difficulty wearing dentures.
• Unexpected tooth looseness.
• Chewing or swallowing difficulties, speech problems, or jaw and tongue movement limitations in advanced stages.
• Hoarseness or voice changes if cancer has spread to the vocal apparatus.
• Unexplained weight loss.

Oral cancer risk factors include:

• Tobacco use, including smoking (cigarettes, cigars, pipes) and smokeless tobacco (paan masala, chewing paan).
• Excessive alcohol consumption.
• Certain strains of Human Papillomavirus (HPV), are associated with oral and oropharyngeal cancers.
• Ultraviolet light exposure from the sun or tanning beds primarily causes lip cancer.
• Epstein-Barr Virus infection (infectious mononucleosis).
• Radiation exposure.
• Family history of cancer.

Oral cancer can be detected during routine dental exams or through self-examination. Self-examination is recommended yearly and every three months for smokers or tobacco chewers. A dentist should evaluate any swelling, ulcer, or lesion inside the mouth once a year for the general population. The American Cancer Society suggests oral cancer screening exams every three years for those over 20 and annually for those over 40.

Suspicious lesions should be biopsied for a definitive oral cancer diagnosis. If the biopsy confirms cancer, additional investigations such as a CECT scan of the face and neck and FNAC (needle cytology) of an enlarged neck lymph node may be required. If the biopsy is negative but suspicion remains, a repeat biopsy from deeper areas may be recommended.

Life expectancy after oral cancer diagnosis varies based on factors like cancer stage, location, and spread. The 5-year survival rate is commonly used to estimate outcomes:

• Early-stage oral cancers with no spread have a survival rate of more than 85-90%.
• If cancer has spread to nearby tissues or lymph nodes, the rate drops to 70%.
• When cancer has spread to distant parts of the body, the survival rate is less than 40%.

Preventing oral cancer is possible through:

• Maintaining a healthy lifestyle.
• Consuming a balanced diet rich in vegetables and fruits.
• Strictly avoiding all forms of tobacco.
• Moderating alcohol consumption.
• Using sunscreen on the face to protect against UV rays.
• Reducing the risk of HPV through safe sexual practices.

Oral cancer treatment typically involves surgery to remove cancerous growth, followed by radiation therapy and/or chemotherapy to eliminate remaining cancer cells.

Preparation includes diagnostic CT scans and X-rays, pre-operative photographs, CT angiograms if needed, arranging blood units, and admission the day before surgery. The importance of tracheostomy, ICU care, and post-operative ventilation should be discussed, and consent should be obtained for microvascular surgical exploration if vessel blockage occurs after surgery.

The surgical process involves general anesthesia, tracheostomy if necessary, Ryles’s nasogastric tube insertion, urinary catheter placement, neck lymph node dissection, wide local excision of the tumor, and reconstruction using bone, muscle, or skin transfer with associated blood vessels. The goal is to restore appearance and function as closely as possible to the original state.

• Microvascular reconstruction employs a powerful microscope to reconnect blood vessels and nerves in transferred tissues. Various flap types can be used for reconstruction, depending on the defect’s constituents.
• The harvested tissue (FLAP) is used to reconstruct the area with surgical defects. It helps to heal the defect and helps restore form and function.

Recovery includes ICU stay, monitoring of the flap, antibiotic and analgesic administration, head elevation, Ryles’s tube feeding, regular Betadine mouth gargles, dressing changes, drain removal, and gradual resumption of oral feeds and mouth opening exercises. Complete recovery typically takes about three weeks.

Further treatment, such as radiotherapy and chemotherapy, depends on the final histopathology report. Radiotherapy should commence within 6-8 weeks post-surgery, ensuring complete wound healing.

Dr. Amit Agarwal specializes in microvascular reconstruction for oral cancer, achieving a high success rate of around 95%. The outcome depends on factors like vessel status, patient immunity, and protein levels.

Complications may include risks related to anesthesia, microsurgical reconstruction (e.g., thrombosis, flap failure), skin slough, oro-cutaneous fistula, infection, hematoma, poor wound healing, scars, deep vein thrombosis, pulmonary or cardiac issues, revision surgery, facial asymmetry, and sutural dehiscence.

Understanding oral cancer, early detection, and access to specialized treatment are crucial to improving outcomes for individuals affected by this condition.