Besides the random defects occurring in the cell, genetic errors can be inherited or can be caused due to virus, or develop as a result of exposure to chemicals or radiation. Most of the time our complex immune system tries to control these defects, which are formed in cells, but when it gets weaker or due to some another reason is not able to repair the defect tumor cells that are formed.
Mouth cancer causes much more lethal effect and death than any other cancer cases. The death rate of this cancer is extremely high due to the cancer being diagnosed late in its formation. Sometimes it is only diagnosed when the cancer has metastasized to other parts of the body, mostly the lymph nodes of the neck. Further treatment at late stage of diagnosis is quite poor than when it is found in a localized area.
Oral cancer is lethal because it has the ability of producing secondary tumors, which means that including the primary tumor in oral cavity there are also secondary tumors in other parts of body which have originated from the primary tumor and through the lymphatic routes have infected other organ systems. There are many types of oral cancers, but the big part of it consists of squamous cell carcinomas, other different forms of mouth cancers are Oral Malignant Melanoma, Mucoepidermoid Carcinoma, Adenoid Cystic Carcinoma.
Doctors and scientists at hospitals and medical centers after a tiresome job of research and experiments have established that two major causes of oral cancer are tobacco and alcohol intake. Tobacco use: smoking cigarettes, cigars, or pipes, chewing tobacco, accounts for 80-90 per cent of oral cancers. Studies have shown that smokeless tobacco users or the people who chew tobacco are at particular risk of developing oral cancer. Chronic use of alcohol increases the risk of oral cancer, even for people who do not use tobacco. However, people who use both alcohol and tobacco have high risk of oral cancer. Oral cancer usually occurs in people over the age of 40 but can develop at any age.
Signs and symptoms of oral cancer:
Oral cancer usually goes unnoticed in its earlier stages because its usually painless and minor physical changes which occur most of the people don't pay any attention to. Symptoms, which are symptoms or signs of mouth cancer, can have following changes in oral cavity: a) sore in the mouth that does not heal b) a lump in the mouth c) whitish or red patches on the inner surface of the mouth d) difficulty while chewing or swallowing e) difficulty in movement of jaw or tongue f) feeling of numbness of the tongue or other parts of mouth g) swelling of the jaw which causes tooth to fit poorly. Any of these symptoms may be caused by cancer or by other, less serious problems. Mouth cancer can only be diagnosed after fully completing medical tests.
Any changes, which have occurred in oral cavity and which can be termed as signs for mouth cancer, can only be proven after biopsy. Usually the doctors remove a part of the changed tissues of the oral cavity and the pathologist examines the tissue under a microscope to check for cancer cells. If the cancer cells are diagnosed then doctors due further tests to confirm the stage and extent to which cancer cell has effected the oral cavity. Cancer is classified on TNM basis, T stands for tumor, N for node, and M for metastasis.
The most common method of biopsy is incision biopsy. During biopsy the doctor removes the part of the lesion and sends it to pathologist. The sample of tissue is examined under a microscope to see whether there are any mutated cells in the tissue. If in case the changes have occurred in lymph node, fine needle aspiration cytology (FNB) is the best method of diagnosis. The technique is comparatively reliable and cheap. A small needle syringe is inserted into the lymph node mass, and cells are sucked out, or pulled out into the syringe. Usually doctor takes the material from different parts of lymph node to get the full picture of the mutation of the cells.
Another form of incision is the "punch" biopsy. In this case, with a scalpel or a pair of small tissue scissors doctor snips the tissue and removes a group of cells from the sampled area. And the material is sent to the pathologist for examination.
Another new method which is emerging quite regarding the test of oral cancer is called Oral CDx. In this case the doctor rubs the suspicious area with a brush and then the cells, which are colleted on the brush, are sent to a lab for computer analysis. This technique is quite simple and painless, which doesn't require any local anesthetic for this procedure.
If the results of the test are positive the pathologist examines the cells once again under microscope to confirm the result of the computer.
Other methods for the confirmation of the mouth cancer signs are radiographs. For example, x-rays can detect in case if there is growth of tumor cells in the bone. While in case of mouth cancer most of the changes occur on the surface but in case of metastasis different scanning technologies are used to confirm the diagnosis.
For example, CT scan or computer tomography is a very good tool for correct diagnosis of cancer cells. In case of x-ray only bones can be seen in the radiograph but with the help of CT scan soft tissues of the body are seen in much greater detail than simple x-ray. But CT scan only shows the presence of changed mass or the tissue it can't differentiate whether the cancer cells are benign or malignant .And to determine it; biopsy is the only method which can confirm it.
Another method is Magnetic Resonance Imaging (MRI), which is good in providing accurate image of the affected area. MRI is a procedure in which image is created using electromagnetic waves linked to a computer imaging system. Again, this procedure can only show the actual presence of masses, biopsy has to be done for confirmation.
A new technique which has developed is PET, or Positron Emission Tomography, which instead of taking picture like x-ray and MRT analysis of the metabolism of the cancer cells, because all cells use glucose, as a source of energy, can analyze how much glucose is being metabolized in different areas of the body. Because cancer cells proliferate and divide at an extremely high rate they use much more energy than neighboring healthy cells. This increased use of energy and high rate of metabolism is used as the main technique in PET to detect cancer cells and tumors
Radionuclide scanning is the earliest method of scanning tumor cells. It can detect cancer cells in other parts of the body. In this technique the patient receives radioactive substance per dose or in the form of injection. The radioactive material then gets accumulated in the cancer tissues and then the patient is scanned. The tumor area is then called hot or cold zones depending on the type of radioactive material used.
These screening methods are for confirmation and assessing the condition of the patient. The best method, which confirms mouth cancer, is clinical study, direct examination of the area as well as biopsy. The ability of earlier detection, as well as its exact location in the body, can greatly increase the survival rate of this disease.
When the pathologist examines the tissue material from the patient and confirms the existence of mouth cancer, the patient's doctor needs to know the stage of the disease so that he can choose the best treatment for the patient. Staging of mouth cancer means being aware and confirm the spread of cancer, and to what extent it has affected other parts of the mouth or has given secondary tumor cells to other parts of the body.
After establishing how much the cancer has spread, doctor also uses his point of diagnosis to grade a cancer, which elaborates how fast the cancer is spreading, whether it is differentiated or not. A fully-differentiated cancer is not so aggressive, a moderately differentiated cancer is quite aggressive and a poorly differentiated is extremely aggressive in the speed with which it is progressing.
The staging phase or the diagnostic stage of mouth cancer plays a great role in further treatment and everything else which will follow later, therefore great caution is taken while correctly and effectively determining the malignancy and stage of the cancer. Thus, detailed diagnosis gives the pathway for specific treatment for the specific form of mouth cancer.
Oral cancer treatment variation depends on the multitude of sites where mouth cancer has occurred. In general, early lesions in most locations are suitable for treatment by surgery or irradiation and the therapeutic choice is usually made after considering the complications, which can arise for each treatment. Patients with mouth cancer are treated by a group of specialists. The medical team can include an oral surgeon; an E.N.T surgeon; a medical oncologist; a radiation oncologist; a plastic surgeon, etc.
Surgical treatment to remove a tumor in the mouth is basically the most common method of treatment for patients with mouth cancer. In case if there is a secondary tumor in other parts of the patient the operative procedure will be more extensive.
Radiation therapy can be used selectively before operation or post operation after microscopic assessment of the regional nodes provides the opportunity for post surgical pathologic staging. The use of radiation-energy is used to damage cancer cells and stop them from growing. Like surgery, radiation therapy is a local therapy; it affects only the cells in the treated area.
The cancer cells can be exposed to the radioactive energy externally with the help of an external beaming machine or internal by directly placing radioactive materials into or near the tumor (internal radiation). Radiation therapy is sometimes used instead of surgery for small tumors in the mouth. Patients with large tumors of lymph nodes and other organs need a combined method both surgery and radiation therapy.
Radiation therapy can be given before or after surgery. Before surgery, radiation can shrink the tumor so that it can be removed. Radiation after surgery is used to destroy cancer cells that may remain.
Many studies now report of improved local and regional node control after such multimodality approaches for mouth cancer. Combined chemotherapy is used together with surgical and radiotherapy. The combined chemotherapy is basically used to reduce in tumor bulk and allow more effective radiotherapy or to improve respectability of advanced lesions. Bleomycin, methotrexate and cytostatic drugs have been administered synchronously with radiation therapy in attempt to demonstrate synergistic effect.
No methods of mouth cancer treatment can be complete without mention of effective efforts in cancer prevention. Alcohol and tobacco abuse makes the etiologic factor in the development of mouth cancer and all patients should be encouraged in behavior modification so that to cease the use of etiological factors which causes mouth cancer