Oral Cancer

What is oral cavity?

Oral Cavity [1]

Different parts in your oral cavity
Tongue
Lips
Gums and Teeth
Lining of cheeks
Salivary glands
Floor of the mouth
Roof of the mouth (hard palate)
Tonsils
Uvula

What is Oral Cancer?

Cancer occurring in the tissues of oral cavity (begins at the lips and extends backwards to the front part of the tonsils) or oropharynx (part of the throat) is termed as oral cancer.

Burden of the disease 

India has one third of oral cancer cases in the world [2].
Oral cancer accounts for around 30% of all cancers in India [3].
Oral cancers in India estimated (Globocan, 2018) [4]:
New cases: 1,19,992
Deaths: 72,616
In general, more men suffer and die from oral cancer than women [5].

Are you at risk?

  • Tobacco & Arecanut consumption
    1. All forms of tobacco, including cigarettes, beedi, pipes, cigars, and chewing (smokeless) tobacco[6,7].
    2. Keeping tobacco quid inside mouth
    3. Paan and Areca nut are also causal agents [8].
  • Alcohol consumption: Alcohol increases the risk of oral cancer [9]. The risk is about twice as high in people who have 3 to 4 alcoholic drinks per day compared to those who don’t drink alcohol [10,11].
    The risk of oral cancer is even higher in people who use both alcohol and tobacco [12].
  • Sharp teeth or ill fitting dentures: Chronic irritation of gums and cheek by ill fitting dentures or sharp teeth [13].
  • Diet : Lack of proper nutrition and diet low in fruits and vegetables are linked with an increased risk of cancers of the oral cavity and oropharynx [14].
  • Human Papillomavirus (HPV):  HPV infection increases the risk of certain types of oral cancer, especially in younger people [15,16].
  • Weak immune system: people with weakened immunity are more prone to suffer from oral cancers. Certain immune deficiency diseases at birth, radiotherapy and chemotherapy, medicines given to organ transplant recipients and the Acquired immunodeficiency syndrome (AIDS) may be responsible for weakened immune system [17,18].
  • Exposure to sun’s ultra violet rays: may cause lip cancer [17].

Precancerous conditions

The following oral disorders have a risk of converting into oral cancer

  • Leukoplakia
  • Erythroplakia
  • Oral Submucous Fibrosis (OSMF)
  • Oral Lichen Planus (OLP)
  • Oral lichenoid lesion (OLL)
  • Smoker’s palate

Read More>>

When should you consult a doctor? [19]

  • A persistent sore in the mouth or  face which does not heal
  • Difficulty or decrease in opening the mouth
  • Development of white, red or mixed patches on tongue, gums or inner linings of mouth
  • A lump or hard mass in the neck
  • Chronic pain in mouth, tongue/jaw pain
  • Difficulty in chewing or swallowing
  • Swelling, thickening, lumps or bumps on lips, gums or inner cavity of mouth
  • Unexplained bleeding in mouth
  • Hoarseness or change in voice
  • Loose teeth and ill-fitting dentures
  • Unexplained weight loss

If the above signs/ symptoms persist for more than 2 weeks, one should consult a doctor for further evaluation.

Are there test for early detection?[20]

Many cancers of the oral cavity have a long early pre-cancer period which provide during which they may have same symptoms. Early detection of these lesions is possible during routine general health check-ups/screening by doctors/dentists/health workers (oral visual examination) or by oral self-examination.

Oral Self Examination
You can examine your mouth yourself by looking at your mouth with the help of mirror in bright light, for early detection of oral cancers.
Procedure for oral self- examination [19]

  • Wash your hands thoroughly
  • Explore your mouth with your finger
  • Tilt your head back; examine the roof of your mouth for any abnormal thickening.
  • Pull the cheeks on one side at a time, inspect the inner surface and back of the gums.
  • Pull out your tongue and hold it with finger upwards, inspect and feel the floor of the mouth and look carefully at the tongue.
  • Feel on both sides of the neck for any lump or enlarged lymph nodes.
  • If you detect any abnormality, bring it to the notice of your doctor for further evaluation.

References

  • [1] Oral anatomy. http://screening.iarc.fr/atlasoral_list.php?cat=H4&lang=1. Accessed on 3rd September, 2014
  • [2] Coelho KR. Challenges of the Oral Cancer Burden in India. J Cancer Epidemiol. 2012; Volume 2012, Article ID 701932. doi:10.1155/2012/701932
  • [3] Sankaranarayanan R, Ramadas K, Thomas G et al. Effect of screening on oral cancer mortality in Kerala, India: a cluster-randomised controlled trial. Lancet 2005;365:1927–33
  • [4] Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11[Internet]Lyon, France: International Agency for Research on Cancer; 2013.  Available from: http://globocan.iarc.fr, accessed on 6th August 2014
  • [5] Global oral cancer fact sheets. http://www.who.int/oral_health/publications/fact_sheet_tobacco/en/index1.html. Accessed on 10th September 2014
  • [6] Global Tobacco Adults Survey. Available at www.mohfw.nic.in/WriteReadData/l892s/1455618937GATS%20India.pdf;2009
  • [7] Pednekar MS, Gupta PC, Yeole BB, et al. Association of tobacco habits, including bidi smoking, with overall and site-specific cancer incidence: results from the Mumbai cohort study. Cancer Causes Control. 2011; 22(6): 859-68
  • [8] Lin WJ, Jiang RS, Wu SH, et al. Smoking, Alcohol, and Betel Quid and Oral Cancer: A prospective Cohort Study. J Oncol 2011;2011:525976
  • [9] IARC Monographs on the Evaluation of Carcinogenic Risks to Humans VOLUME 96 Alcohol Consumption and Ethyl Carbamate IARC 2010. Lyon, France. http://monographs.iarc.fr/ENG/Monographs/vol96/mono96.pdf. Accessed on 5th September 2014
  • [10] Turati F, Garavello W, Tramacere I, et al. A meta-analysis of alcohol drinking and oral and pharyngeal cancers: results from subgroup analyses. Alcohol Alcohol 2013;48:107-18
  • [11] Hashibe M, Brennan P, Benhamou S, et al. Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. J Natl Cancer Inst 2007;99:777-89
  • [12] Znaor A, Brennan P, Gajalakshmi V, et al. Independent and combined effects of tobacco smoking, chewing and alcohol drinking on the risk of oral, pharyngeal and esophageal cancers in Indian men. Int J Cancer 2003;105:681-6
  • [13] Oral cavity and oropharyngeal cancer. http://www.cancer.org/acs/groups/cid/documents/webcontent/003128-pdf. Accessed on 7th September 2014
  • [14] World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer-a Global Perspective. Washington DC:AICR;2007
  • [15] International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from http://monographs.iarc.fr/ENG/Classification/index.php. Accessed on 6th August 2014.
  • [16] Chocolatewala NM and Chaturvedi PJ. Role of human papilloma virus in the oral carcinogenesis: an Indian perspective. Cancer Res Ther. 2009; 5(2):71-7. HPV Infection in Young Australians. PLOS One 2014;6:1691-704.
  • [17] International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 100D (2012). A Review of Human Carcinogens: Radiation. Geneva:WHO;2012
  • [18] Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 2007; 370:59-67.
  • [19] American Association of Oral and Maxillofacial Surgeons. https://www.aaoms.org/docs/media/oralcancerselfexam.pdf. Accessed on 22nd January 2015
  • [20] Early Detection, Diagnosis, and Staging. http://www.cancer.org/cancer/oralcavityandoropharyngealcancer/detailedguide/oral-cavity-and-oropharyngeal-cancer-diagnosis
  • [20] Warnakulasuriya SJohnson NWvan der Waal I. Nomenclature and classification of potentially malignant disorders of the oral mucosa. J Oral Pathol Med 2007; 36 :575-580.
  • [21] Rangnathan K and Gauri Mishra. An overview of classification schemes for oral submucous fibrosis. J Oral MaxillofacPathol2006; 10: 55-58.
  • [22] Greenberg MS, Glick M, Ship JA. 11th ed. Hamilton: B.C. Decker; 2008. Red and white lesions of the oral mucosa. Burket’s Oral Medicine; pp. 90–91.
  • [23]Kamath VV, Setlur K, Yerlagudda Oral Lichenoid Lesions – A Review and Update. Indian J Dermatol2015; 60: 102.