Mouth (Oral) Cancer

Oral cancer can present with the following symptoms:

• A sore on the mouth or lip that does not heal
• A reddish or whitish patch, growth, or lump inside the mouth
• Loose teeth
• Jaw and/or ear pain
• Pain or difficulty in swallowing

If the aforementioned symptoms persist for more than two weeks, patients are advised to visit their doctor as soon as possible.

Mouth cancers form due to changes in the DNA of cells in the lips and oral cavity. These changes cause the cells to grow and divide uncontrollably instead of undergoing normal programmed cell death. The abnormal mouth cancer cells accumulate to form a tumour. 

Although the exact causes of these DNA changes are not fully known, the following risk factors increase the risk of developing mouth cancer:

• Frequent use of tobacco products (cigarettes, cigars, pipes, chewing tobacco, and snuff)
• Heavy alcohol consumption
• Exposure of the lips to excessive sunlight
• Human papillomavirus (HPV) infection, which is a sexually transmitted virus
• Weakened immune system

The following tests are commonly used to diagnose oral cancer:

• Physical examination: The dentist checks the mouth and lips to detect abnormalities and/or areas that cause pain/discomfort, such as white patches (leucoplakia) and/or sore.
• Biopsy: A piece of tissue or fluid is excised or aspirated from the suspected area and tested in the laboratory to confirm any presence of cancer cells.
   

The stage and location of the cancer along with the overall health and personal preference of the patients determine the therapeutic modality to be used for mouth cancer treatment. 

A patient may require one or a combination of the following treatments: 

• Surgical resection: The oral surgeon may excise the tumour along with some surrounding healthy tissue to ensure the removal of all the tumour cells. If the cancer has spread to the cervical lymph nodes, they may also be removed. Usually, after surgical resection, reconstructive surgery may be needed to restore eating and speaking functions.
• Radiation therapy: High-energy waves or particles, such as gamma rays, X-rays, electrons, or protons are used to kill cancer cells. Often, radiation therapy is used post-surgery; however, sometimes, for patients with early-stage mouth cancer, it may be used alone.
• Chemotherapy: Cancer cells are killed using chemicals, i.e., chemotherapy drugs. These drugs are often administered alone or in combination with other drugs/therapeutic modalities for cancer treatment. Chemotherapy is often combined with radiation for greater effectiveness due to their synergistic role.
• Targeted drug therapy: Targeted drugs that alter specific growth-related aspects of cancer cells can be used to eliminate these cells. Often, these drugs are used in combination with chemotherapy/radiation therapy or alone. 
• Immunotherapy: Immunotherapy stimulates the patient’s immune system to fight cancer by counteracting “immune evasion” by cancer cells, i.e., escape from the immune system using various techniques. Generally, immunotherapy-based treatments are reserved for patients with advanced-stage mouth cancers for which standard treatments have been ineffective.
   

If symptoms such as persistent sores, lumps, or difficulty swallowing last for more than two weeks, it is important to consult a doctor promptly.

While not all cases of oral cancer can be prevented, several healthy lifestyle choices can help reduce the risk:

• Avoid tobacco in all forms
• Limit alcohol consumption
• Protect lips from excessive sun exposure
• Maintain good oral hygiene
• Consider HPV vaccination (where appropriate)

Patients with suspected or diagnosed oral cancer should consult:

• Oral and maxillofacial surgeons
• Oncologists (medical and radiation)
• ENT specialists (ear, nose, throat doctors)
• Reconstructive surgeons (for post-surgical rehabilitation)