Home Diseases Oral cancer: symptoms, therapy, prognosis

Oral cancer: symptoms, therapy, prognosis

by Josephine Andrews
Published: Last Updated on 197 views

Oral cancer, also known as oral cavity carcinoma, is a malignant tumor in the oral cavity that is usually caused by excessive tobacco or alcohol consumption. The tumor can be recognized by white or reddish spots, for example on the tongue or gums. Oral cancer always requires medical treatment. The earlier it is diagnosed, the better the prognosis. Find out more about symptoms, treatment and diagnostics here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

C03 C06 C01 C07 C05 C04 C02 C09 C08 C00

quick overview

  • What is oral cancer? A malignant tumor that affects the lining of the inner cheeks, floor of the mouth, palate and tongue, as well as the jaw , salivary glands and lips, among other things
  • Causes : Pathological transformation or new formation of cells in the skin or mucous membrane, triggered by carcinogenic substances (carcinogens)
  • Risk factors: nicotine (tobacco) and alcohol, human papilloma virus (HPV), possibly genetic factors, consumption of betel nuts
  • Signs (Symptoms): White or reddish spots, pain, difficulty chewing and swallowing, swelling, bleeding, numbness, bad breath, loss of appetite, weight loss, poor performance
  • Treatment: Depending on the tumor stage: surgical removal (resection) if possible with reconstruction, radiotherapy and/or chemotherapy
  • Course and prognosis: Depending on the time of diagnosis and treatment, a cure is possible. The earlier treatment is given, the better the prognosis for oral cancer. Relapses may occur within five years of treatment.
  • Diagnostics: Tissue examination (eg reflection with biopsy ), ultrasound , X – ray , positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRT)
  • Prevention: renunciation of the consumption of tobacco of any kind, drinking little or no alcohol, careful oral and dental care, attending dental check-ups

What is oral cancer (cancer of the oral cavity)?

Oral cancer or oral cavity cancer is technically called oral cavity carcinoma. It is a malignant tumor (malignant carcinoma) in the mouth. The term oral cavity carcinoma is a collective term that includes all malignant cancer variants that occur in connection with structures of the oral cavity.

frequencies

Oral cancer is one of the most commonly diagnosed cancers worldwide. On average, around 10,000 new cases per year occur in Germany. Men between the ages of 55 and 65 are affected more often than women, who are most commonly diagnosed with oral cancer between the ages of 50 and 75. In Western Europe, the number of new cases per 100,000 population is 6.9 for men and 3.2 for women.

causes

Oral cancer is a malignant tumor that is based on a spontaneous degeneration of cells in the oral mucosa, which then multiply uncontrollably. Doctors refer to this process as carcinogenesis. The cause is the influence of carcinogenic substances. In the case of oral cavity cancer, it is primarily the nitrosamines contained in tobacco, for example, that penetrate the skin cells and change the cell’s genetic material.

risk factors

The main risk factors associated with the development of oral cavity cancer are tobacco and alcohol. Excessive or chronic consumption of tobacco or alcohol increases the risk of developing oral cancer sixfold. Those who consume tobacco and alcohol at the same time increase their risk of oral cancer by a factor of 30.

Another risk factor for oral cancer is an unbalanced and very meaty diet. In particular, heavily fried foods pose an increased risk because of the nitrosamines they contain. In Asia, the excessive consumption of the betel nut, which – like caffeine – contains psychoactive substances, plays a role. However, in western countries it has no significant relevance for the development of oral cavity cancer.

Some studies indicate that human papillomavirus (HPV) poses a risk for oral cancer. However, the estimated proportion of people currently suffering from oral cancer, in which the disease can be traced back to an HPV infection, is less than five percent.

It is also suspected that a genetic predisposition (predisposition) also promotes the development of oral cancer.

Where does oral cancer (cancer of the oral cavity) occur?

In more than 90 percent of cases of oral cancer, the oral mucosa is pathologically altered, which is why this type of tumor is usually a so-called squamous cell carcinoma (SCC). But sometimes malignant cells also form in other parts, such as the muscles, glands or lymphatic tissue. Oral cancer occurs in the following areas of the oral cavity:

  • Floor of the mouth (floor of the mouth cancer, medical: floor of the mouth carcinoma)
  • Tongue ( tongue cancer , medical: tongue carcinoma)
  • Inner cheek wall (colloquially: cheek cancer)
  • Hard and soft palate (cancer of the palate, medical: carcinoma of the palate)
  • Jaws (e.g. jawbone cancer, medical: jawbone carcinoma)
  • Gums (gum cancer, medical: gingival carcinoma)
  • Lips (lip cancer, medical: lip carcinoma)
  • Tonsils (tonsil cancer, medical: tonsillar carcinoma)
  • Salivary glands (salivary gland cancer, medical: parotid tumor)

How do you know if you have oral cancer?

Oral cavity carcinoma usually develops over a longer period of time and is often only discovered at a late stage. The first signs of a pathological change in the oral cavity are conspicuous white or reddish spots. Doctors refer to theses as leukoplakia and erythroplakia. These are pathological skin changes that are colored and cannot be wiped away. These are precancerous stages that often develop into malignant tumors.

In addition to color changes, rough, thickened or hardened areas indicate a possible disease, especially if they last longer than two weeks and are painful. Patients with oral cancer often also report numbness in the tongue, teeth or lips, unclear bleeding and difficulty chewing and swallowing. The latter are based, for example, on loose teeth or swelling in the throat.

If the tongue cannot be moved easily, this often leads to difficulties in speaking. It is not uncommon for those affected to suffer from bad breath and loss of appetite, which are often associated with weight loss, poor performance and fatigue.

The symptoms mentioned are sometimes signs of other, less serious illnesses and must therefore be clarified with a doctor.

Is Oral Cancer Curable or Fatal?

In principle, there is the possibility of surgically removing a tumor in the oral cavity or treating it with the help of radiotherapy and/or chemotherapy. Which treatment method is ultimately the most suitable depends on various factors. The age and the general state of health of the person concerned play a decisive role.

However, the severity of the disease is more important. Comprehensive diagnostics are therefore carried out before each intervention. The results provide information about the stage of the tumor and what treatment successes and risks can be expected in each case. An interdisciplinary team of treating physicians puts together the final treatment plan together with the patient.

Classification of tumor stages

Doctors divide cancers such as oral cancer into tumor stages in order to choose the appropriate treatment method. The tumor is categorized in terms of its spread according to the TNM classification. The term TNM refers to the size and extent of the tumor (T), whether and how many lymph nodes (N) are affected and whether the tumor has spread, ie metastases (M) are present. Depending on the stage of the tumor, the doctors determine the therapy that promises the best possible treatment success for oral cancer.

surgery

In most cases of oral cancer, surgical removal of the tumor (resection) is the treatment of choice. The advantage lies in the fact that the damaged tissue can be precisely examined by means of an operation and removal of the tumor – if possible. This makes it possible to define the tumor more clearly and to see whether and to what extent metastases have already formed.

In some cases, the tumor cannot be completely removed. Additional radiation and/or chemotherapy is then given. If the lymph nodes are affected, these are also removed as far as possible.

After a resection, in which a large proportion of the healthy tissue must also be removed, the affected area is rebuilt (reconstructed). Either directly in an operation or in follow-up treatments. As far as possible, the body’s own tissue such as skin, bones or muscles is removed from other parts of the body and reinserted (transplanted) for the reconstruction.

When planning and carrying out a reconstruction, several factors are taken into account that are important for improving the quality of life of the person concerned. On the one hand, there are functional aspects (such as chewing, swallowing, speaking), on the other hand, aesthetics play a special role.

radiation therapy and chemotherapy

Usually, surgery for oral cancer is followed by radiation or chemotherapy to help treat it and prevent it from coming back (recurrence). Both forms of therapy are used in combination or individually. The latter is particularly the case when surgery is not possible or to relieve symptoms.

In radiation therapy, doctors distinguish between two basic procedures:

  • percutaneous radiation therapy (radiation is carried out from the outside through the skin)
  • brachytherapy (radiation is carried out from the inside directly on the tumor)

Brachytherapy is used for oral cancer, especially for smaller tumors that are easily accessible. Larger tumors in later stages are usually irradiated from the outside through the skin. As a rule, the radiation is administered in several small individual doses in order to avoid or reduce further damage to the surrounding healthy tissue.

A method that supplements radiotherapy for the treatment of very aggressive tumors is positron emission tomography (PET). This additional proton radiation minimizes the amount of radiation in the peripheral areas of the tumor and helps to protect the surrounding healthy tissue. If, for example, sensitive tissue such as supplying nerves and blood vessels are in the immediate vicinity of a tumor, a supportive PET treatment is recommended.

Chemotherapy is also a common treatment for oral cancer. However, it is not sufficient as the sole therapy for a cure, ie for curative treatment. It is therefore usually combined with radiotherapy. In chemotherapy, drugs, so-called cytostatics, with active ingredients such as cisplatin, carboplatin, 5-fluorouracil, paclitaxel and docetaxel are administered. They inhibit cell division and growth. This means that both cancer cells and other body cells can no longer multiply.

After successful treatment, the doctors draw up an optimally aligned aftercare plan, which may include further therapies. Part of this plan includes regular check-ups to prevent recurrence and treatment of any comorbidities or side effects. It is equally important that the patient receives psychosocial support throughout the treatment period, for example from a psycho-oncologist (a doctor who specializes in the psychological care of cancer patients).

forecast

As with other cancers, healing from oral cancer depends on several factors. However, the earlier it is diagnosed, the greater the chances of recovery. If left untreated, the disease progressively worsens in most cases. This means that the further the oral cancer progresses, the worse the prognosis.

Various studies show that there is often a relapse within two years of successful treatment. The later the diagnosis was made and the more advanced the cancer was, the greater the likelihood that oral cancer will come back.

Doctors speak of an average five-year survival rate of around 50 percent for oral cavity cancer. This means that half of the patients died within five years of diagnosis. The other half, on the other hand, live longer than five years or are cured.

Can a Dentist Detect Oral Cancer?

Because oral cancer prognosis worsens the later it is detected, early diagnosis is important. Oral cancer first develops in the mouth. It is therefore often discovered by dentists, but also by other specialists who play a role in the treatment of diseases in the mouth. These include, for example, ear, nose and throat doctors, orthodontists and oral surgeons.

In the case of oral cavity cancer, metastases (seeds of the tumor) often form. The lymphatic vessels or lymph nodes as well as blood vessels, nerves and bones may also be affected. It is therefore important for the diagnosis to carry out a comprehensive examination that also includes neighboring tissue.

initial diagnosis

If oral cancer is suspected, the doctor first thoroughly examines the oral cavity. He also asks questions about lifestyle, for example whether the patient smokes or drinks a lot of alcohol. In order to inspect the oral cavity more closely, the doctor often carries out a mirror examination ( endoscopy ). He can take tissue samples from the suspicious area (biopsy), which are then examined for tumor cells.

If the suspicion of oral cavity cancer is confirmed, further diagnostics are necessary. A carcinoma of the oral cavity may affect other areas of the body and form metastases, for example in neighboring or distant regions of the body such as the jaw and skull bones or in the trachea to the lungs . In order to check this as early as possible, the doctor carries out further examinations such as ultrasound and X-rays and, if necessary, computed tomography (CT), magnetic resonance imaging (MRT) or positron emission tomography (PET).

It is important to attend the annual check-ups at the dentist – not only for dental health, but also to detect tumors in the oral cavity at an early stage.

How can you prevent oral cancer?

To prevent oral cancer, doctors recommend avoiding tobacco and excessive alcohol consumption. On the other hand, it is advisable to have regular preventive check-ups at the dentist and to seek advice on careful oral and dental care.

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