oral cancer

Oral cancer is the abnormal growth of cells anywhere in the mouth, lips, tongue, floor of the mouth, cheeks sinuses, pharynx, soft and hard palate. If not treated on time, oral cancer can be life threatening.

Oral cancer is also popularly called mouth cancer that can be detected by these symptoms:

• Unexplained bleeding in the mouth
• Thickening or swelling of the lips, tongue and mouth; bumps or lumps inside the mouth and visible rough spots or erosions.
• Visibility of patches in the mouth in the form of red, velvety white or speckled marks
• Feeling of soreness in the mouth, mostly in the back of the throat
• Persistent sores in the mouth that never heal
• Dramatic weight loss
• Massive ear pain
• Changes in structures of your teeth as fitted by dentures
• Changes in your voice, difficulty with swallowing, and speaking

Those at higher risks of oral cancer are individuals who smoke cigars, cigarettes and pipes quite often; consume excessive amount of alcohol, use or chew smokeless tobaccos, remain exposed to the sun most of the time, have a family history of oral cancer and have human papillomavirus.

It is possible that a very low percentage of individuals who do not smoke and drink occasionally get oral cancer. The diagnosis of oral cancer involves routine dental examinations, oral cancer screening exams, biopsy tests (scalpel/excisional/incisional), etc.

Treatment of oral cancer is determined by the type and stage of the cancer. There are typically four stages of oral cancer- stage 1, stage 2, stage 3 and stage 4. Stages 1 and 2 are the initial stages where small tumours develop inside the mouth, but have not spread to the lymph nodes. Stages 3 and 4 are the advanced stages where the cancer cells have spread beyond tumours in the mouth to other parts of the body.

The treatment options for oral cancer are classified as:

• Surgical procedure
• Radiation therapy
• Targeted therapy

Get ready by taking a few essential steps before the treatment of oral cancer.

• You have to go through a series of tests and exams to ensure you are fit for oral cancer surgery. Blood tests help to check your general health and whether your kidneys are working fine, an ECG test is done to check your heart conditions, breathing tests are done to check your lung functions, an echocardiogram and a chest x-ray for inside picture of your mouth and lungs.
• Pre-assessments appointments with your doctor help you to learn a lot of things about the oral cancer treatment option you are going through, whether surgery or chemotherapy or radiation therapy, etc. Ask your doctor any question you have on mind and clear any doubts related to the surgery, for instance, what to expect after the operation, the type of treatment option you are going to have, about the extent of your oral cancer, the possible associated risks and the benefits of the surgery.
• Talk to your anaesthetics and learn the effects of anaesthesia that will be given to you just before the surgery. Tell about the medications you are on and whether you have any health condition. The anaesthesiologist may ask you to stop certain medicines while suggest you to start taking newer ones.
• A clinical nurse specialist will check your general health, blood pressure, weight temperature and pulse before oral cancer treatment.
• Discuss with your dietician about the best possible diet before the surgery, the side effects of surgery, how to increase calories and nutrients and the type of nutritional supplements you should have before the surgery.
• Consultation with a physiotherapist is required to learn about breathing and leg exercises and about the recovery after oral cancer treatment. You may be worried about your speech problems after having surgery in the oropharynx and mouth, but the therapist will help you out with communication problems, if any.
• Smoking and chewing tobacco is one of the major risk factors associated with oral cancer. It is, therefore, important to stop smoking or chewing tobacco before and after the treatment.
• The evening before the surgery, you are given a carbohydrate rich drink. The drink is essential to give speed up your recovery and give you energy. If you find drinking and eating difficult, you are given fluids through a dip into the arm just before the surgery. This prevents your body from getting dehydrated.

Surgery

If oral cancer is diagnosed at an early stage, surgery helps to remove tumours and restore the function and appearance of the affected tissues. There are different types of oral cancer surgeries performed that include tumour resection, glossectomy, maxillectomy, robotic surgery, laryngectomy, etc. This is how these surgeries are performed:

Tumour resection- A small tumour is performed through the opening of the mouth, while large tumours that grow in the oropharynx are removed by creating an incision in the neck and then by cutting the jaw bone.

Glossectomy- The procedure is required to treat cancer of the tongue. Partial glossectomy removes a part of the cancer, while total glossectomy removes the entire tongue.

Maxillectomy- This type of operation involves removing the front part of the roof of your mouth or the maxilla bone. A special denture called prosthetics is used to fill the hole in the mouth of the roof.

Robotic surgery- Robotic surgeries help to remove pharynx cancer completely where the cancer is. It is a minimally invasive surgery and is performed by creating tiny incisions.

Laryngectomy- The procedure helps to remove the voice box. Incisions are made in the neck through which the doctor removes your larynx. Surrounding lymph nodes are also removed during the procedure. After the larynx is eliminated, the doctor creates a stoma in front of the trachea. It creates a link to the outside of your lungs to help you breathe. Once the surgery is done, the incisions are closed safely. A drainage tube may be fitted in your neck for draining of liquid.

Chemotherapy

 If the cancer has spread to other parts of your body, then you may be given chemotherapy in the form of oral pills or through an IV channel in the arm into your bloodstream.

Radiation therapy

Patients with larger cancer may need radiation therapy with a surgery or a targeted drug therapy. After your surgery, radiation therapy is administered along with chemotherapy to kill any additional deposits of cancer. Radiation helps to shrink the cancerous tumours before a surgery is done. The patient is asked to lie down and radiation beams are targeted on to the specific areas to kill cancer cells.

Immediately after the operation, you are taken to the intensive care unit where you recover gradually. After the drowsiness of anaesthesia wears off, you slowly wake up to find a breathing tube fitted to your neck, a gastronomy tube fitted to your stomach, a tube fitted to your bladder, etc. You will feel pain in the first one week, so you are given painkillers.

After a few days, you can move around, while a physiotherapist will visit you to help you with leg and breathing exercises. Your wounds are covered with bandages for 3-7 days after the operation, or more if the doctor feels so.

Whether you are able to drink or eat after the surgery depends upon the type of surgery that is performed. For the first several days, you are given a liquid diet through a feeding tube. The recovery of oral cancer treatment takes time and you may see changes in your talking, breathing, eating, chewing, and even changes in your appearance.