Non Healing Ulcer, It Could Be Oral Cancer: Schedule an Appointment Today

What is oral cancer?

Cancer can be defined as “an uncontrollable growth of cells that invade and cause damage to surrounding tissue.” Oral cancer can appear as a growth or an ulcer in mouth that does not heal or resolve on its own.  

Incidence of oral cancer

Oral cancer is the sixth most common cancer worldwide, affecting large number of people in India too. The WHO data shows, incidence of oral cancer  1-10 cases per 100 000 population globally. Despite advances in medical world, majority of people succumb to it owing to late diagnosis & treatment. 

Causes: 

Cancer occur due to mutations (alteration) in DNA.  There are several reasons causing genetic alterations. The commonly associated risk factors being:

·       Tobacco: It is the leading cause of oral cancer. Tobacco in any form like chewing, pipes, cigars, snuff releases nicotine & other carcinogens with potential cellular damage

·       Areca nut: Popularly known as supari frequently consumed in Indian subcontinent, Sub-Sahara Africa & Pacific Island. Supari can cause premalignant changes in oral cavity leading to increased chances of cancer in future.

·       Alcohol: Alcohol consumption in association with smoking is strongly associated with carcinomatous changes. High content of alcohol in mouthwash is associated with increased chances of oral cancer

·       Virus: Human Papilloma Virus (HPV), sexually transmitted virus is known to cause cancers of mouth. Herpes simplex, Human Immunodeficiency virus have also been linked with cancers of mouth

·       Genetic Predisposition: individuals with positive family history of oral cancer have higher chances of oral cancer.

·       Sun exposure: Lip cancers are associated with sun exposure especially in fair skin individual. 

·       Miscellaneous: weakened immune system, previous history of radiation exposure, poor nutritional status predispose to cancer risk. AIDS is associated with Kaposi’s sarcoma. 
 

What are the signs/symptoms of oral cancer? 

Oral cancer can be asymptomatic for long. The common signs & symptoms include;

·       A lump/ non healing ulcer: The first sign of oral cancer can be a painless mass or a chronic (long standing) ulcer which does not heal.  Bleeding: Spontaneous or bleeding on provocation can be frequently observed from the area of growth.

·       Loosening of teeth: Bone destruction & loss of supporting tissue leads to loss of teeth. Recent history of multiple tooth loss & loosening can be an early hint for malignancy

·       Pain: Malignant growths are generally painless but can be painful due to bone exposure and damage to adjacent tissues.

·       Paraesthesia: Numbness owing to nerve involvement may be present. Sensory loss & altered facial expression due to involvement of nerves supplying face may be seen in advanced cases. Nerve involvement is frequently associated with poor treatment outcome.

·       Nodal involvement: The cancer cell can metastasize (distant spread) to regional lymph nodes of neck causing pain, swelling & fixing of nodes.

·       Extra oral symptoms: Extra-oral symptoms like altered voice, referred pain, facial asymmetry, skin lesions, facial paralysis, nasal bleeding may be observed.

·       Others: Anorexia, loss of appetite along with fatigue & weight loss may be the first sign of malignancy. History of fever can also be present.

·       Metastasis: Metastasis usually indicate later stage of disease & oral carcinomas frequently metastasis to lungs, liver, distant bone, brain. 

 Types of oral cancer:

It includes cancer of the tongue, cheek, lips, hard and soft palate, floor of the mouth, the paranasal sinuses, and pharynx (throat). It also includes malignancy of salivary glands, various odontogenic (associated with dental tissue) tumors, metastasis from distant sites,  leukemia, lymphoma, sarcomas etc. 

Diagnosis: 

Cancer screening includes:

·       Check-up: A thorough check-up by your oral physician

·       Lab tests:  Blood, urine & salivary examinations are performed to assess the disease & presence of cancer cells

o   Diagnostic aids: 

o   Use of superficial stains & dyes to detect cancer at suspicious areas

o   Fine needle aspiration cytology (study of tumor cells) and studying them under microscope 

o   An oral biopsy (taking a section of the mass & studying under microscope) for suspicious lesions

o   Sentinel node biopsy: it provides details about nodal status & spreading of tumor

·       Radiology: Computed tomography scan, Magnetic resonance imaging, Ultrasonography, Positron emission tomography (PET) Color Doppler are useful tools.

·       PET scan helps in identification of distant spread of the tumor. Nuclear scintigraphy can provide details about activity of cancer cells. 

·       Advances: Raman spectroscopy & Gold nanoparticles are presently a topic under research and may change the course of diagnosis & treatment in future  

Stages:

Commonly accepted staging of cancer is based on tumor size (T),  lymph node involvement (N) & metastasis (M). A number from 0-4 is assigned for each of the above factors. The alphabet X is used if factor is absent. 

Stages being:

·       Stage1: Tumor is 2 cm or small & has not spread to local lymph nodes.

·       Stage 2: The tumor is approximately 2-4 cm & has not spread to nodes.

·       Stage 3: Tumor is larger than or 4 cm or has spread to local lymph nodes. Distant spread is absent.

·       Stage 4: The tumor cells have metastasized to distant sites in body & lymph nodes. The size can be variable. 

Treatment

The treatment is primarily aimed to cure the patient of cancer. The choice of treatment depends the site and size of lesion, the presence of local bone involvement, the ability to achieve adequate surgical margins and the presence or absence of metastases (spread of tumor)

·       Surgery to excise the mass. If tumor has extended to lymph nodes in neck then commando surgery of neck might be required. 

·       Radiation therapy is used to take care of residual cancer cells left post surgery.

·       Chemotherapy has also been used in conjugation with the above stated modalities and takes care of any distant metastasis.

·       Recent advances:

·       Chemotherapy and targeted therapy are used together with the principal therapeutic  techniques of radiation and surgery. Gene therapy & immunotherapy have potential for early treatment in future.

Risk/ complication: 

The treatment offered is associated with complications like altered speech, altered facial appearance, difficult swallowing & chewing, dry mouth in survivors and questionable prognosis. 

Increased incidence of dental caries owing to reduced salivation post radiotherapy is a major complication. Candidiasis a fungal infection is often seen.  

Am I the right candidate for surgery?

Your doctor would examine clinically & study the radiographs. Post evaluation a conclusion can be drawn for the right treatment and expected outcomes. It can surely be said that early diagnosis is associated with better survival rate in cancer patients. A prompt treatment is required for achieving better prognosis of disease. Surgery is recommended for all cases of oral cancer. 

Success rate: 

The most important factor in survival is the stage of disease. Surgery patients have shown 81% survival rate in 5 years. Surgery & radiation show survival of 70%. Indian institutes for cancer provide the most advanced treatment with highly qualified & leading specialists.  

Why MedcureIndia?

MedcureIndia focuses at provding the apt diagnosis and precise treatment planning. Aiming towards, helping patients to achieve better treatment & quality of life. It’s one of the most genuine places for medical tourism where both the efficacy of cost & treatment is a priority.  

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