The oral cavity (mouth) and the upper part of the throat (pharynx) play important part in many functions of the body, including breathing, talking, chewing, and swallowing. Many different cell types make up these different structures.
Oral cancer includes cancer of your lips, mouth, tongue, gums and salivary glands. Throat cancer involves cancer of the part of your throat just behind your mouth.One defining feature of cancer is the rapid creation of abnormal cells which grow beyond their usual boundaries, and which can invade adjoining parts of the body and spread to other organs by traveling along lymphatic vessels and nerves or through the blood stream, a process referred to as metastasis. Several types of malignant cancers occur in the mouth and throat. Squamous cell carcinoma involving the lining of mouth and pharynx is by far the most common type, accounting for more than 90% of all cancers.Other less common cancers of the mouth and throat comprise minor lymphoma and salivary gland tumors.
The outcome of the disease depends upon when, what and how the treatment has been delivered? The American Cancer Society estimates more than thirty thousand new cases of oral and throat cancer occur annually in the United States out of which seven thousand die of . The incidence and death rates pertaining to oral cancers have been steadily decreasing over the past twenty years. According to the World Health Report 2004, cancer accounted for 7.1 million deaths in 2003 and it is estimated the in general number of new cases will rise by fifty percent in the next twenty years.Oropharyngeal cancer is more widespread in developing than developed countries.
These cancers can build up at any age but occur most frequently in people aged forty five years and older. The prevalence of oral cancer is particularly high among men, the eighth most common cancer worldwide. In south-central Asia, cancer of the oral cavity ranks among the three most common types of cancer. In India, the age consistent incidence rate of oral cancer is 12.
6 per one hundred thousands population.It is notable that sharp increases in the incidence rates of oral/pharyngeal cancers have been reported for a number of countries and regions such as Denmark, France, Germany, Scotland, central and Eastern Europe and to a lesser extent Australia, Japan, New Zealand and the USA. The cancer epidemic in developed countries, and increasingly in developing countries, is due to the combined effect of the ageing of populations, and the high or increasing levels of prevalence of cancer risk factors. It has been estimated that forty-three percent of cancer deaths worldwide are due to tobacco, unhealthy diet, infections and physical inactivity.Tobacco use and undue alcohol consumption have been expected to account for about ninety percent of cancers in the mouth. The oral cancer hazard increases when tobacco is used in combination with alcohol or areca nut.
The proof that smokeless tobacco causes oral cancer was confirmed recently by the International Agency for research on Cancer. (Jann Aldredge-Clanton, 1998) Among the avoidable risk factors, tobacco use is by far the most common risk factor for cancers of the mouth and throat. Both smoking and “smokeless” tobacco (snuff and chewing tobacco) increase the risk of developing cancer in the mouth or throat.All forms of smoking are linked to these cancers, including cigarettes, cigars, and pipes.
Tobacco smoke can cause cancer anywhere in the mouth and throat as well as in the lungs, the bladder, and many other organs in the body. Pipe smoking is particularly linked with lesions of the lips, where the pipe comes in contact with the tissue. Smokeless tobacco is linked with cancers of the cheeks, gums, and inner surface of the lips. Cancers caused by smokeless tobacco use often begin as leukoplakia or erythroplakia. Frequent use of alcohol makes people six times more prone to develop such cancers.Ultraviolet light exposure while outdoors, are more likely to cause cancer of the lip.
Chewing betel nut, a prevailing practice in India and other parts of South Asia, has been seen to culminate in cancer of mucous membrane of cheeks. Several strains of Human papillomavirus infection are linked to cancers of the cervix, vagina, vulva, and penis. The HPV infection is believed to increase the risk of oral cancers in some people having oral sex. Many people who have no risk factors but develop mouth and throat cancer. On the other hand, many people with numerous risk factors don’t.
A variety of symptoms or signs noticed in people with such cancers ranging from a painless white or red patch on mouth inner lining, a painless lump, un-healing sore lip or inner mouth or throat, unexplained moth pain or bleeding, chronic sore throat, difficulty with chewing or swallowing, jaw swelling, voice hoarseness to unexplained ear pain. If one has any of such symptoms he/she must see his/her doctor immediately. The health care provider begins the process of identifying the type of abnormality. His goal will be to rule out or validate the diagnosis of cancer.
After a careful review of the symptoms, detailed history about life style and assessment of the risk factors patient is referred to a cancer specialists called oncologists specialized in treating cancers of the head and neck, which includes cancers of the oropharynx. A thorough examination of the head and neck is done to look for lesions and abnormalities by laryngoscopy or nasopharyngoscopy or pharyngoscopy or fibre optic laryngoscopy and panendoscopy. This gives the most exhaustive possible examination and can permit biopsies of areas suspicious for malignancy.At this stage complete physical examination will look for signs of metastatic cancer or other medical conditions that could affect the diagnosis or treatment plan. No blood tests can identify or even suggest the presence of a cancer of the mouth or throat.
The appropriate next step is biopsy of the lesion, in which a sample of cells or tissue is removed (or the entire visible lesion if small) by special techniques and sent for hitopathological examination. (Patrice Pinell, David Madell, 2002). If the pathologist finds cancer, he or she will identify the type of cancer and report back to your health care provider.The next step is to stage the cancer. This means to determine the dimension of the tumor and its extent, that is, how far it has spread from its origin. Staging is important because it not only gives guidelines for the best suitable treatment but also the prognosis for post treatment survival.
Like other cancers in oropharyngeal cancers, the stage is based on the size of the tumor, involvement of the lymph nodes in the head and neck, and evidence of spread to distant parts of the body. Likewise, cancers of the oral cavity and pharynx are staged as 0, I, II, III, and IV., with 0 being the least severe meaning cancer has not yet invaded the deeper layers of tissue under the lesion and IV being the most severe meaning cancer has spread to an adjacent tissue, such as the bones or skin of the neck, to many lymph nodes on the same side of the body as the cancer, to a lymph node on the opposed side of the body, to engage critical structures such as main blood vessels or nerves, or to a remote part of the body. Stage is determined on the basis of physical findings, endoscopic findings and imaging studies like X-rays, CT scan, MRI, and, occasionally, a nuclear medicine scan of the bones to detect metastases.
After evaluation by a surgical or radiation oncologist to treat your cancer, you will have liberal opportunity to discuss, which treatments are obtainable for you. Your doctor explaining the pros and cons of each treatment will make recommendations for ultimate treatment. Treatment for head and neck cancer depends on the age, over all health, type of cancer and metastases. The decision about which treatment to follow is a combined one, but ultimately, the decision is yours. With oral cancers, it is especially important to understand the side effects of treatment.
Like many cancers, head and neck cancer is treated on the basis of cancer stage. Most commonly used therapies are surgery and radiation therapy. Chemotherapy is used in some advanced cases. Treatment plan will be individualized for specific situation.
Your medical team may include an ear, nose, and throat surgeon; an oral surgeon; a plastic surgeon; and a specialist in prosthetics of the mouth and jaw called prosthodontist; radiation therapy specialist called radiation oncologist and medical oncologist. Dietitian advice is sought to ensure that you get adequate nutrition during and after your therapy.A speech therapist may be needed to help you improve your speech or swallowing abilities after treatment. A physical therapist may be needed to help you improve function compromised by loss of muscle or nerve activity from the surgery. A counselor, social worker or member of the clergy will be available to help you and your family copes with the emotional, social, and economic levy of your treatment. (H.
Gilbert Welch, 2004) Medical treatment comprises definitive care as well as supportive care. Surgery is the treatment of choice for early stage cancers and many later stage cancers.The tumor is excised, along with neighboring tissues, including but not limited to the lymph nodes, blood vessels, nerves, and muscles that are involved. High energy radiation beam is used to kill cancer cells in radiation therapy. Radiation can be used as a substitute of surgery for many stage I and II cancers.
In stage II cancers, tumor location determines the best treatment. A treatment plan that will have the least side effects is generally chosen. Stage III and IV cancers are nearly all treated with both surgery and radiation. Radiation after surgery destroys any remaining cancer cells.
Unfortunately, radiation affects healthy cells in addition to cancer cells. Harm to healthy cells accounts for the special effects of radiation therapy. Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy alone may reduce tumor size, but the effect does not last longer. In head and neck cancers, chemotherapy is used in combination with radiation therapy and surgery for large or extensive cancers. Angiogenesis inhibitors, Cetuximab (Erbitux) is a drug that arrests the development of new blood vessels that cancers need to grow.
This drug has recently been approved for use along with chemotherapy in cancers of the oral cavity. The side effects vary depending upon the drug being given. Nausea and vomiting, severe heartburn-type pain, diarrhea, hair loss, mouth sores, loss of appetite, fatigue or weakness, and increased risk of infection are some common side effects. Medications are prescribed to treat some of the side effects like nausea, dry mouth, mouth sores, and heartburn.
Weight loss is also common effect like other cancers, in people with head and neck cancers.Uneasiness from the tumor itself, in addition to the effects of treatment on the chewing and swallowing structures and the digestive tract, often thwarts eating. Speech therapist consultation helps you learn to cope with the changes in your mouth and throat after treatment so that you can eat, swallow, and talk. Treatment of recurrent tumors varies by size and location of the recurrent tumor. The treatment given formerly is also taken into consideration. (Peter Vandoren, 1999) Oral surgery depends on how far the cancer has spread from where it started.
Removal of tissues and the resulting scars can cause problems with the normal functions of your mouth and throat. These disruptions may be either temporary or permanent. Chewing, swallowing, and speaking are the functions most likely to be disrupted. During follow-up after surgery a team work of surgeon, radiation oncologist, or both if you received chemotherapy is required. You will also follow-up with your medical oncologist as per the schedule recommended.
Staging tests again after completing treatment is done to determine how well the treatment worked and to exclude any residual cancer.Afterwards, during regular scheduled visits physical examination and tests are done to ascertain that cancer has not come back and that a new cancer has not appeared. Follow-up care of 5 years is recommended, and many people opt to continue visits without letting up. Swallowing and speech therapy will continue for as long as required to bring back these functions. The best way to prevent head and neck cancer is to avoid the risk factors.
Eat a balanced diet to avoid vitamin and other nutritional deficiencies. Make sure you eat foods with vitamin A, including fruits, vegetables, and supplemented dairy products.Living with cancer presents much new challenges for patient’s family and friends. Many people feel anxious and depressed.
Some people feel angry and resentful; others endure powerless and overwhelmed. For many cancer patients, talking about their feelings and concerns helps. Friends and family members could be very supportive. (Darren Flynn, 2003) Post–therapy, average 5-year survival rate for people with head and neck cancer has been reported to be 56%.
Precise survival statistics depend on the tumor location, staging, type of treatment, and the presence or absence of other medical conditions.
