Oral cancer

Oral cancer . General term in Medicine for any malignant growth located in the mouth. It may appear as a primary lesion of the same tissue of the oral cavity , or by metastasis from a site of distant origin, or by extension of neighboring anatomical structures, such as the nasal cavity or maxillary sinus .

Summary

[ disguise ]

• 1 History
• 2 Causes
• 3 Symptoms
• 4 Risk factors
• 5 Self-exploration
• 6 Causative agents of oral cancer
  • 1 Exogenous or Extrinsic
  • 2 Endogenous or Intrinsic
• 7 Diseases or damage to health
  • 1 Illnesses or damage to health are
    • 1.1 Premalignant States
    • 1.2 Premalignant Lesions
  • 8 Diagnosis
  • 9 PDCB Exam
    • 1 Physical examination
      • 1.1 Lip
      • 1.2 Cheek mucosa
      • 1.3 Palate
      • 1.4 Mobile language
      • 1.5 Floor of the mouth
      • 1.6 Root or base of the tongue and oropharynx
      • 1.7 Neck
    • 10 Prevention
      • 1 Other tips
    • 11 Expectations
    • 12 Bibliography
    • 13 Sources

History

Oral cancer is a health problem that affects a significant group of people around the world, capable of producing notable anatomical and physiological consequences in those who suffer from it. The incidence, prevalence and severity of this disease vary from country to country.

Numerous studies have shown that cancerization is a relatively complex phenomenon in which several factors act or participate and where probably none of them alone is capable of causing a neoplasia . This justifies the universal criterion that cancer is a disease with multifactorial causes, which depends on the simultaneous action of social or behavioral, hereditary and environmental factors.

Cancer that appears in the oral cavity can have various histological varieties: teratoma , adenocarcinoma derived from one of the salivary glands , lymphoma of the tonsils or some other lymphatic tissue, or pigmented cell melanoma of the oral mucosa . The most common form of oral cancer is squamous cell carcinoma , originating in the tissues that delimit the mouth and lips .

Oral cancer is usually located in the tissue of the lips or tongue , although it can appear on the floor of the mouth, the lining of the cheeks , the gums , or the palate or roof of the mouth. Under a microscope , most cancers that develop in the mouth have similar characteristics and are collectively called squamous cell carcinoma. They are evil in nature and tend to spread very quickly.

The histological variety of the oral complex allows various types of benign and malignant neoplasms to develop there , but it has been shown that more than 95% of malignant tumors of the oral cavity are of epithelial origin. This justifies that oral squamous cell or squamous cell carcinoma (EBC) is the most common malignant neoplasm in the stomatological system and all etiological and analytical studies of the epidemiological profile have been directed towards its origins. These investigations have established that the oral complex has two well-defined and delimited anatomical regions, with the capacity to suffer from the same type of cancer, but subject to the action of very different risk factors; These locations are: the lips and the oral cavity.

Causes

Most oral cancers look very similar under the microscope , they are called squamous cell carcinomas , they are malignant and tend to spread quickly. Smoking and other tobacco uses are associated with 70-80% of oral cancer cases. The smoke and heat from cigarettes , cigars and pipes irritate the mucous membranes of the Mouth . The use of chewing tobacco or snuff causes irritation due to direct contact with the mucous membranes. Excessive alcohol consumption is another activity associated with increased risk of oral cancer.

Other factors that increase the risk of oral cancer include poor oral and dental hygiene and chronic irritation (from, for example, rough teeth, dentures, or fillings). Some cases of oral cancer begin as a white plaque ( leukoplakia ) or as a mouth ulcer . An infection with human papillomavirus has recently been shown to be a risk factor.

Oral cancer accounts for approximately 8% of all malignancies. Men acquire this type of cancer twice as often as women, particularly those over 40 years of age.

Symptoms

Symptoms of oral cancer include:

• White or red spots inside the mouth
• A mouth sore that won’t heal
• Bleeding in the mouth
• Tooth loss
• Trouble or pain swallowing
• A lump in the neck
• Earache​

Additional symptoms that may be associated with this disease are:

• Abnormal taste in the mouth
• Mouth ulcer
• Difficulty swallowing
• Lingual problems

Risk factor’s

Tobacco and alcohol consumption are habits that increase the possibility of oral cancer. If these are consumed together, the possibility is much greater than if they are consumed independently. Excessive exposure to sunlight is a risk factor for lip cancer. People who work in the sun (farmers, sailors) should take special care, especially if they are light-skinned people.

Poor or no dental hygiene, factors that erode the mucosa such as broken, poorly positioned teeth or poorly adjusted prostheses, are also factors that favor the formation of lesions that can become malignant.

Keeping your mouth in good condition is essential to prevent oral cancer, hence the importance of practicing good dental hygiene and visiting the dentist periodically .

It usually appears in elderly people. For this reason, the elderly should go to the dentist more frequently for check-ups. However, this does not happen because in many cases they no longer have teeth and do not go to the dentist, unless their dentures become loose.

It is also more common in black people than in white people.

Self-exploration

The patient must know what the normal structures of the mouth are like. When these change, you must go to the dental office so that the dentist can carry out a review. To do this, the dentist must perform an examination explaining everything to the patient. He or she must learn what the mouth is like under normal conditions and what alterations are not pathological.

To do this, the patient must follow a self-examination method in which they will observe the face, neck, lips, the inside of the cheek, the palate, the gum, the tongue and the floor of the mouth. The dentist could be asked to give us in writing the steps we must follow so that we do not forget.

The patient should perform this self-examination at home every 5-6 months at least and if any findings occur, go to their dentist. Sometimes the dentist finds it difficult to motivate the patient to perform self-examination, but taking into account that the benefit is life, it is worth doing it.

Causative agents of oral cancer

Classically, the causative agents of oral cancer have been divided according to their mechanism of action on the human body into two large groups:

Exogenous or Extrinsic

They act by extracorporeal routes, generally known and caused by physical, chemical or biological damage at the tissue level.

Endogenous or Intrinsic

They act through intracorporeal routes, which are poorly understood and justified by genetic bases, endocrine changes, immunological deficit and nutritional disorders that affect tissues.

Diseases or damage to health

Premalignant states and/or lesions of the oral complex are the first sign that the oral tissues are responding to the risk factors and, while still being a damage to oral health, they become non-modifiable risk factors that require a greater control and clinical follow-up.

Diseases or damage to health are

Premalignant States

• Lichen planus of the oral mucosa .
• Florid oral papillomatosis
• Oral submucosal fibrosis
• Actinic cheilitis
• Atrophic mucosa of the mouth
• Smoker’s palate.
• Immune deficiencies
• Human papillomavirus infection
• Herpes simplex virus infection
• Naevus of the oral mucosa .

Premalignant Lesions

• Leukoplakia of the oral mucosa
• Erythroplakia of the oral mucosa
• Inverted smoker’s palate.

Diagnosis

An examination of the mouth by a trained health professional or dentist will show visible and in some cases palpable lesions on one of the lips, tongue, and other areas in the mouth. As the tumor grows, it may become ulcerative and may begin to bleed. If the cancer advances on the tongue, the individual may experience difficulties speaking, chewing, or swallowing. The only method to determine if a lesion is cancerous is through a biopsy and microscopic evaluation of cells removed from the lesion.

PDCB Exam

The PDCB examination of a subject who comes to the consultation of a dentistry service in search of dental care should begin from the moment he settles into the dentistry chair .

We interview patients and relatives. Specifying the type of symptoms, emphasizing the sequence and time of their appearance.

Physical exam

To identify any morphological alteration and as stated in the Oral Cancer Detection Program. The exam has been simplified into seven steps, taking full advantage of the examiner’s skill. In them, the examination is directed to topographic areas that have anatomical continuity:

• Have the patient sit facing the examiner and ask him or her to remove any prostheses before beginning the exam.
• Perform a general inspection of the patient’s face, detailing any alteration in their physiognomy .

Lip

The exploration of the lip begins from the skin to the mucosa, from one commissure to the other and the height to the vestibular sulcus , which is explored together with the vestibular or labial gingiva to the canine area.

Bimanual palpation will reveal any sign of alteration in the accessory salivary glands , the insertion of the frenums and the normal consistency of the gum and lip .

cheek mucosa

It begins on the right side, from the commissure to the retromolar space, which is thoroughly explored; also the rest of the vestibular sulcus and the labial gingiva.

Normal structures such as the termination of the parotid duct , the linea alba , ectopic sebaceous glands , occasional dark spots of ethnic origin, and other common structures in the area should be remembered; The maneuver is repeated on the left side. When xerostomia or increased volume of some of the salivary glands is noted, it should be extracted and the quality, quantity and consistency of the saliva evaluated . To milk the parotid gland, place a finger in the preauricular area and move the finger forward following the path of the duct.

Palate

In this case we include in an exploration block the hard palate, the soft palate with the uvula and the anterior pillars, as well as the palatal gingiva . One should remember the palatine papilla , the median raphe, the palatine rugae, the mouth of the ducts of the accessory mucous glands, and occasionally the torus palatine .

mobile language

Explore the dorsal surface, edges and vertex of the tongue. Check lingual mobility by instructing the patient to project the tongue and move it in all directions. Perform bidigital palpation of the dorsal aspect and edges, looking for nodules or indurations. To do this, you can take the lingual vertex with a piece of gauze. In this region, filiform, fungiform, vallate and foliaceous papillae can normally be identified; Medial rhomboid glossitis and lingual fissure and grooves.

floor of the mouth

With the help of a depressor or mouth mirror, examine the floor of the mouth, the ventral surface of the tongue and the lingual gum. To inspect these sites, instruct the patient to place the apex of the tongue on the hard palate.

For bidigital palpation of the floor of the mouth, the index finger of one hand is placed under the chin and the finger of the other hand palpates the anterior floor of the mouth on each side.

The anatomical formations of these sites include: the exit of the ducts of the sublingual and submandibular salivary glands, lingual frenum , prominent sublingual glands, mandibular torus , internal oblique line and apophysis genis (line of insertion of the muscles of the floor of the mouth) . The accessory salivary glands can be found on the ventral surface of the tongue.

The submandibular gland is milked by placing a finger on the submandibular triangle of the neck with a movement toward the chin. Saliva from the submandibular glands is drained through Wharton’s duct located behind the lower incisors. Normally functioning salivary glands will produce at least one drop of clear, watery saliva.

Root or base of the tongue and oropharynx

Inspect the root or base of the tongue and the rest of the oropharynx, using the oral or laryngeal mirror, previously heated above body temperature , while pulling the lingual vertex forward and down with gauze. With your index finger, palpate the base of the tongue and the rest of the oropharynx with a U-shaped movement. The following structures should be identified here: palatine, lingual and pharyngeal tonsils, lymphoid vegetations of the base of the tongue and the valleculae .

Neck

Inspection of the face and neck will detect pigmentation changes or increases in volume, asymmetries or other alterations. For palpation, starting on the left side, tilt the patient’s head toward that side with the help of your left hand, while palpation is performed with the right, repeat the maneuver on the right side, inverting your hands. Carefully palpate the areas of the submandibular, internal jugular, transverse cervical and accessory spinal lymph node chains and the submental, parotid, preauricular, retroauricular and occipital groups. Palpate the parotid, submandibular, and sublingual salivary glands and the temporomandibular joint.

To complete the neck examination, stand behind the patient and, using both hands, palpate the entire neck, detecting possible differences between the contralateral structures. Even in the absence of symptoms, a unilateral cervical nodule in a middle-aged patient is suspicious for malignancy.

Prevention

Many oral cancers are discovered through routine dental exams.

Other tips

• Have dental problems corrected.
• Minimize or avoid alcohol consumption.
• Minimize or avoid smoking or other tobacco use.
• Practice good oral hygiene.

Expectations

About half of people with oral cancer will live more than five years after diagnosis and treatment. If cancer is detected early, before it has spread to other tissues, the cure rate is almost 75%. Unfortunately, more than half of oral cancer cases are in an advanced stage when they are detected and most have spread to the throat or neck. Approximately 25% of people with oral cancer die from delayed diagnosis. and treatment.