Cancer is a term for diseases which abnormal body cells divide without control. A cancerous cell invades nearby tissues; it can spread through the body either through the blood stream and lymphatic system.
Cancer can occur in any body cell of the body. That is cancer can occur in any part of the body. The oral cavity is not exempted from this situation. Cancer of the mouth can occur both in the hard and soft tissue. The bone, the oral mucosa, the tongue, flow of the mouth, bone of the mouth- upper and lower jaws.
The body cells normally grow and divide to form new cells ? a process called replication when these cells grow, they die and this replication/ reproduction is necessary so that new cells can take the place of the old ones.
The process of reproduction or replication is an ordered process, it follows several intricate processes, should the orderly process go wrong for example and cells are formed when the body does not need them, the extra cells could form a mass therefore referred to as a tumor (a growth).
Tumors can be either benign or malignant. The benign tumors are not cancer; on the other hand literarily speaking malignant tumors are cancer.
Generally benign tumor rarely threaten the life of the host individual, they can also be removed and do not recur, one of the features of cancerous cells is the ability to spread from one part of the body to another. Benign tumors therefore do not spread.
The malignant tumors on the other hand are opposite of the characteristics of the benign tumor.
Whilst oral cancer can occur in any part of the mouth, they usually develop mostly in the tongue and in the flour of the mouth.
Most oral cancers begin in the flat cells called squarnous cells that cover the surface of the mouth.
When oral cancer spreads, it travels through the lymphatic system which contains watery liquid called lymph; this lymph carries the cancerous cells to organs in the body located at various bites (lymph nodes).
These lymph nodes sometimes become swollen in infections as can be observed for example when there is a slight injury to the toes, or feet, there often is a concomitant swelling in the inguinal region. The inguinal swelling is often caused by lymph nodes present in the area.
In cancers of the oral cavity when there is a spread, evidence appears in the lymph nodes of the lead and neck region.
When there is evidence of spread of the tumor cells, scientists and doctors refer to these as ?metastases?. The result of metastases is that a similar tumor (same kind of abnormal cells) as the source/ primary tumor appears at the new site.
Therefore, a metastatic tumor of the oral cavity can spread to the neck, lungs and other parts of the body. The canverse is likewise same, a tumor from other part of the body or other organs spread to the oral cavity.
Whilst some factors can be attributed to the development of oral cancers and any other cancers, the explicit facts are it is difficult to doctors to explain why one individual develops cancer. Whilst the other does not whilst both individuals are exposed to the same factors associated with tumor occurrence.
Research work has attributed development of most cancers to various factors. The presence of risk factors actually increases the probability of developing oral cancer or diseased state.
A few of the risk factors in relation to development of oral cancer are enumerated below:
? Chief risk factor is Tobacco, used in various forms, smoking, topical, snuff, chewing especially amongst people in the Indian subcontinent ? (Bidis, betal chewing and kreteks). Heavy smokers who use tobacco for long periods and more often have a higher likelihood of developing oral cancers, indeed head and neck cancers.
The risk increases in users of tobacco products who consume alcohol. Majority of oral cancers develop in people who use alcohol, tobacco, or both tobacco and alcohol.
? Alcohol consumption is another risk factor; there is a direct correlation with the quantity of alcohol consumed. In order words the more alcohol consume the greater the risk of developing oral cancer. Vis ? a vis concomitant use of tobacco with alcohol even increases the risk.
? Sun Cultraa violet rays:
Cancer of the lip, face, neck can be caused by prolonged exposure to certain spectrum off light found in sunlight, hence are as with a lot of sunlight exposure may have increased incidence of oral (head and neck cancers). The agricultural workers who have increased exposure to sunlight may have increased preponderance to skin cancers. This risk can be reduced with the use of hats, screen for the skin ? suncream with various SPF ? Sun Protection factor. The higher the SPF value, the greater the sun protection, the risk of developing of the lip cancer increases. Concomitantly in people who similarly smoke in addition to prolonged exposure to the rays of sun.
? A personal history of head and neck cancer: A history of head and neck cancer are at increased risk of developing another primary head and neck cancer. Additional in such individuals, smoking increases the risk.
? Various studies though not conclusive suggest that reduced infake of anti-oxidant substance like found in fruits and vegetables can contribute (indeed) associated with the development of oral/ head, neck cancers and several other cancers of the body.
? There are correlations and association between certain oral carcinomas (cancers) and human papillomvirus, such as burkitls lymphoma, Epstain Barr.
Quitting habits of tobacco chewing, smoking, use of snuff, and tobacco substances reduces the chances of an individual developing cancer of the oral, head and neck region. Likewise such people can reduce the risk of cancer of the lungs larynx, mouth, pancrease, bladder, ocsophagus and several other body viscera.
? Regular checkup is a good time for the dentists to check your entire mouth and early signs, symptoms could be detected. You could ask the doctor/ dentist for a check for signs should you suspect you are at risk of developing oral cancer.
There are a few symptoms worth considering; these serve just as a guide:
o Patches inside the mouth, lips, which are white in colour or a mixture of red and white or even red.
The white patches referred to medically as leakoplakia are most common. These white patches sometimes have the tendency to become malignant.
o Red patches mixed with white patches referred to as erythroplakia. The erythro signifying the redress like red blood cells are even more likely than develop into malignant lesions than the white patches alone.
o A sore that does not lead over should make one seek medical/ Dentist attention
o Bleeding into the mouth especially spontaneously.
o Loose teeth
o Difficulty in swallowing or pain when swallowing
o In denture (artificial tooth) wearers (loose denture) or difficulty in the fitting of denture or a growth under the denture
o A swelling or lump in the neck
o An earache
Should any of these symptoms occur, a dentist or doctor should be contacted.
AS these above are just symptoms, more often not. The symptoms do not necessarily mean cancer; infections and certain other diseases can cause likers, swellings and the above symptoms.
The visit to the doctor is to rule out and eliminate any likelihood of a serious disease when detected early most cancers can be treated, successfully and where not definitely cured. The quality of life could greatly be improved with early (palliative) treatment.
The above symptoms may be diagnosed to be cancer by a medical personnel or dentist who will examine the mouth taking into consideration, the roof of the mouth, back of the throat, the whole inside of the mouth cheeks and lips, under the tongue looking for tell tale signs of malignancy.
Finally the lymph nodes arranged around the head and neck.
Should the dentist notice an abnormal feature of the oral cavity or lesion a small bit of the tissue/ liker/ growth is removed or sometimes the whole bit is removed. The process of removal of tissue for examination in the laboratory is called a biopsy.
The biopsy removes tissue to look for possibility of the cells removed of normally or abnormality. It can be done under a local anaesthetic agent to reduce the discomfort or pain locally means the anaesthetic agent is placed directly at the point of the excision, removal of tissue.
The biopsy could sometimes be carried out under general anaesthesia in which case, the person is sedated and put to sleep to reduce the discomfort anticipated.
The spe...t who analyses the tissue cells in the laboratory is referred to as a pathologist. Should you need a biopsy the dentists should be able to inform you as to the reason for the biopsy, the amount of tissue he will remove, whether biopsy will be under local anaesthesia or general anaesthesia?, the sequelae of biopsy?, where to get counseling should the result of the biopsy be not favorable, the various treatments available for such cancer.
There are instances where the kind of biopsy may be an aspirate ? removal of fliud should there be a diagnoses of cancer, it is essential that more tests, often laboratory (involving blood) are taken to plan the best treatment and extent of cancer, this is called staging, the earlier the stage of the cancer or the earlier it is detected, the better the prognosis
Staging may require the examination of the throat by a spe...t. This is called endoscopy, which can be direct or indirect. The doctor uses a thin, lighted tube (endoscope) to check the throat windpipe and lungs.
The endoscope can be inserted through the nose or the mouth local anaesthesia to avoid gaggling or discomfort is used sometimes a mild sedative may be incorporated. General anaesthesia may also be used to put the person to sleep.
Radiographs (X-rays) can be used to image and check if the tumors have spread to the mouth ? dental X-rays clest X-rays to check if tumor has spread to the visiera lungs, etc.
There are X-rays machines called (CT Scan) ? computer tomography seans linked to the computer which takes service of very detailed pictures of the body with or without the injection of dye/ contrast media. Should there be tumors in the mouth, throat, reck or clse where in the body. There show up on the CT sean
Additional imaging using a powerful magret linked to the computer ? there is called magnetic resonance imaging. The doctor views the images on the monitor or television screen, there can then be printed on filin for analysis and for the individual to likewise visualise, it is also essential for record purposes.
Treating oral cancer when chagnosed necessitates the active involvement of the patient in the decision making process, it is note worthy to mention that the individual may like to know the treatment options, prognosis and possible management.
The shock and stress of being diagnosed with oral cancer or any cancer for that matter does not make it easier for the full participation of the patient at the initial stages. The necessary myriad of searching questions that needs be asked the health professional may be hard to think of at initial point in time.
An approach of listing questions prior do appointment may be easier to adopt. The necessity to take notes at the dentist appointment could help with the understanding (remembering) what the dentist says. A tape recorder may not be out of place. A family friend/ family member or confident would likewise suffice. Whilst speaking do the doctor ? They may take part in the discussion or take notes or just listen. There may be need to be referred to spe...t to treat oral head and neck cancer.
These spe...ts include oral and maxillofacial surgeons. Otolaryngologists (ear, nose, and throat surgeons ENT), medical oncologists radiation oncologist, plastic surgeons.
The list of other health professionals that may work in the team may include your general dental practitioner, speech pathologist, nutritionist, mental health counsellor and physiotherapist. Most of these health professionals and spe...ts are mostly found in tertiary institutions ? Teaching hospitals, federal medical centre, some general hospitals and indeed a few private health care institutions.
The treatment of oral cancer when diagnosed needs to be structured; currently the Nation health insurance scheme does not cover radiotherapy, chemotherapy whilst in several countries worldwide there is a cap on cancer treatment services covered. The treatment is relatively expensive, where possible a second opinion may be sought only to compare treatment modalities. This may not be practically possible in the country at the moment due to the paucity and scarcity of spe...t facilities and professionals.
The treatment plan is carefully discussed with the individual and often determined by location of the cancer, initial lesion (mouth) or oropharynx (further down the throat) the size of the tumor, whether tumor had spread. All these will help determine mode of treatment, prognosis complications and best expected results of treatment.
Whilst discussing with the doctors naturally all the questions may not need be asked or answered at once as each treatment mode is often adapted and personalised to suit individual needs and values. The risks, side effects, expected end results, complications, realistic benefits, duration of treatment costs, alternative treatment cessation of habits etc, would often be discussed at the treatment planning stages.
There may be added benefit of taking part in new treatment as part of a clinical trial or research, this sometimes lesions the cost and avails individuals the possibility of participating new treatment regimen.
The options of treatment include surgery ? where the tumor is removed alone or in addition with lymph nodes (glands in the neck to which cancer cells can spread).
Surgery may be combined with radiation therapy ? Radiotherapy. This is often used for small tumors or whilst patient is too ill to have surgery. It could also be used before surgery to kill local cancer cells or even shrink the size of cancer growth.
Radiation involves high energy rays. Isotopes of some elements to kill cancer cells these radiation is dangerous to normal cells too hence other parts of the body including the gonads are protected during the procedure.
There are two types of radiation therapy mainly used:
v External Radiation: - This is produced from a machine. The individual attends the hospital once or twice a day, five days a week for several weeks at a time until remission is achieved.
v Implant ? (Internal) Radiation: - The radioactive material is implanted like seeds/ needles or thin plastic tubes out directly in the cancerous growth/ tissue. The patient is admitted in hospitals several days, whilst the implant is in place. The implants are later removed before the patient is discharged there are instances where both methods of delivering radiation are combined.
v Another method of treating oral/ head and neck cancers is through chemotherapy in this instance anticancer drugs are used to kill the cancer cells via systemic therapy that is the drugs are delivered into the blood stream directly usually given by injection.
The anticancer drugs given can affect all the cells of the body. The advantage is that it could be given out patient. That is hospital stay may not be required, cost are cut. It can be given at home
Cancer treatment damages health cells and tissue as well. For this reason they produce ride effects that are not desirable. The side effects produced depends on the location of the tumor and the type and extent of treatment.
If is worth noting that side effects may not be the same for each person, could even change from one treatment session to the next.
Surgery may result in slow wound lealing, the time it takes to heal varies from one individual to the other. Pain is an uncomfortable side effect, most people undergoing cancer treatment are given strong pain killers and sedatives. Weakness and firedness as common with most trauma and surgery occurs. Should surgery involve the removal of lymph nodes swelling and infections result which may take longer than usual to resolve.
Side effects of surgical treatment will depend on the amount of tissue removed, the extent, it other structures like bone, tongue, glands are removed.
It may affect the ability to speak, chew, and smile. The puthooh may change hence subsequent reconstructive surgery to build the bones or tissue of the mouth may be needed.
Almost all patients who have radiation therapy to the head and neck area develop oral side effects.
It is important to get the mouth in good condition before radiation therapy or any other cancer treatment.
The side effect developed from radiation treatment for oral cancer is does - dependent meaning the side effects developed depends on the amount of radiation given the effects of radiation therapy may end after the end of the radiotherapy treatment or some of the side effects may linger much longer after treatment and may indeed never go away.
Some of the effects of radiation therapy include, Dry mouth (Xerostornia) which makes it difficult to speak or talk or swallow.
Dry mouth can increase the incidence of tooth decay (dental caries). To counteract the effects it may become necessary to drink copious amounts of water. There are saliva substitutes, (sprays) which act to moisten and lubricate the mouth. These are artificial saliva should there be increased dental caries (tooth decay) use of fluoride gels or fluoride rinse.
There are other side effects like sore throat, alcers, inflamed tissues ? special rinsed and pain relief to numb the tissues become necessary.
The gums may become sore and readily bleed use of soft toothbrushes and avoiding using toothpicks. Infections readily develop as a result of dry mouth which damages the lining of the mouth. Sequel to radiation therapy tissues of the mouth may heal poorly after dental treatment; it is advisable all dental treatment be done before radiation therapy begins.
Radiation therapy affects the muscles of the mouth, head and neck. The jaws become stiff, physiotherapy can reduce this jaw stiffness. Exercising the mouth ? opening and closing as far as possible without causing pain ? roughly dtiut 2-wenty (20) to thirty (30) times in a sequence about three (3) times a day.
Situation where previous denture (artificial tooth) wearers may need to avoid the use of dentures due to discomfort caused by the dryness of mouth soreness after radiation therapy, denture use may be avoided for up to a year, the denture may also be refit or made.
Loss of sense of smaller taste may also result as food may taste different or smell different voice change from radiation directed at the larynx or voice ? box, the larynx swells up and there is a teching of a lump in the throat.
There is an organ in the neck called thyroid gland. This gland makes hormones called thyroid hormones. Smells sometimes in people with iodine defivency called GOITRE.
Radiation treatment can affect the thyroid. The hormones made by the thyroid may be affected by radiotherapy to the gland. Insufficiency of this thyroid hormone may make the individual tired, feel cold have dry skin and hair. The levels of the thyroid hormone can be checked with blood tests and assay should the level below, doctors may recommend hormonal pills to maintain levels compatible with normal function Dry shin and General body fatigue occur amongst the other side effects.
Chemotherapy and radiation therapy can cause more or less similar side effects viz painful mouth/ gum, dry mouth, infection, loss or change of faste sensation, bleeding mouth, pain. Just like radiotherapy side effects are dependent on the dose and amount of radiation, side effects from chemotherapy depends on the amount of anticancer (chemotherapy) drugs the body receives.
Anti cancer drugs also affect cells of the body that divide rapidly that is have a high flurn over... in addition they affect the blood cells (red blood cells, white blood cells etc.) these are cells that carry nutrients and oxygen round other tissues in the body they fight infections. Chemotherapy therefore, can result in increased infections in the body.
Chemotherapy affects the cells in the hair root which invariably leads to loss of hair Alopecia. The hair grows back after chemotherapy though the colour and consistency of the hair will not be the same.
Chemotherapy causes a loss of apetite nausea and vomiting, dianhea, mouth and lip sores because they affect cells of the gastro intestinal tracts.
It is imperative that nutrition is adequate during cancer treatment to forestall many of the side effects and prevent weight loss, regain strength and rebuild health tissues. This may be difficult due to the discomfort from oral cancer treatment.
Use of thick soups, milkshalies, puddings and a high protein, semi ? liquid diet may suffice. Tissues and dieticians often provide a good guide. Use of a feeding tube may sometimes be required or even by direct incision a flexible tube is passed into the stomach. This tube is temporary and removed once health is regained.
Avoiding sharp crunchy foods like cheps, hot spicy foods, high acid foods, juices like citrus, sugary foods that can cause dental decays (caries) Alcohol drinks are some of the precautions that are advised during cancer treatment.
The treatment of oral cancer in individuals may necessitate reconstructive/ plastic surgery. Dental implants bone grafts etc. Due to advances in oral cancer treatment, Reconstruction surgery may actually be done concurrently with treatment.
Rehabilitation using physiotherapy supportive groups, counseling helps people who have undergone oral cancer treatment return to narmal activities as son as possible, regular checking up, follow, up speech therapy etc.
This piece has been written as a compact guide, better and comprehensive advice available from your dentist.
With promises of improved care through research and clinical trial, cancer needs no longer needs to be the hushed word or disease of misery or som.