Oral Cancer : Mouth, Throat and Neck Cancers

Disabled World (disabled-world.com)

Revised/Updated: Monday, 30th March 2020

Synopsis and Key Points:

Mouth cancer refers to cancer that develops in any portion of the mouth such as on the lips, tongue, gums, inside lining of the cheek, the floor or roof of the mouth.

Mouth cancer is one of a number of forms of cancer grouped into a category called, 'head and neck cancers.'

Hypopharyngeal cancer (laryngopharyngeal cancer) begins in the hypopharynx (laryngopharynx) - the lower part of the throat, just above the esophagus and windpipe.

Main Document

'Mouth cancer,' refers to cancer that develops in any portion of a person's mouth. Mouth cancer may occur on a person's lips, tongue, gums, inside lining of their cheeks, the floor or roof of a person's mouth. Cancer that occurs on the inside of the mouth is at times referred to as, 'oral cancer,' or, 'oral cavity cancer.'

• Head and Neck Cancer - Defined as cancer that arises in the head or neck region (nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx (voice box).
• Throat Cancer - Defined as cancerous tumors that develop in your throat (pharynx), voice box (larynx) or tonsils.
• Mouth Cancer - Also called oral cancer or oral cavity cancer, is defined as a cancer that develops in any of the parts that make up the mouth. Mouth cancer is one of several types of cancer grouped in a category called head and neck cancers. Mouth cancer and other head and neck cancers are often treated similarly.

Mouth cancer is one of a number of forms of cancer grouped into a category called, 'head and neck cancers.' Mouth cancer and other head and neck cancers are many times treated in a similar fashion. Mouth cancer has a number of symptoms associated with it, such as:

• Sore throat
• Loose teeth
• Tongue pain
• Jaw pain or stiffness
• Poorly fitting dentures
• A sore that does not heal
• Painful or difficult chewing
• Painful or difficult swallowing
• A feeling that something is caught in the throat
• A reddish or white patch on the inside of the mouth
• A thickening or lump of the skin or lining of the mouth

Causes

Mouth cancer occurs when cells on a person's lips or in their mouth develop mutations in their DNA. The mutations allow cancer cells to grow and divide when cells that are healthy would die. The accumulating mouth cancer cells may form a tumor. Over a period of time, they might spread to additional areas of a person's mouth and on to other areas of their neck and head, or other parts of the person's body.

Mouth cancers most often start in the flat and thin cells that line a person's lips and the inside of their mouth. The majority of oral cancers are squamous cell carcinomas. It is not clear what causes the mutations in squamous cells that lead to mouth cancer, yet doctors have identified factors that might increase someone's risk of mouth cancer.

Oral cancer awareness ribbon consisting of three colors; Lilac which is the universal color of Dentistry or Oral Stomatology, White and Red representing Leukoplakia and Erythroplakia (white and red spots respectively) which predominantly considered as tissue manifestation seen in most of the oral pre-malignancy (cancer) conditions - Awareness ribbon design credit: Arturo P. De Leon, DMD, MAEd, FPPS; Dean of College of Dentistry, Our Lady of Fatima University. Current President Philippine Association of Dental Colleges.

Types

'Mouth cancer,' is a general term that applies to cancers that occur on a person's lips and throughout their mouth. Terms for these forms of cancer that are more specific include the following:

• Lip cancer
• Gum cancer
• Tongue cancer
• Hard palate cancer
• Salivary gland cancer
• Floor of mouth cancer
• Cancer affecting the inside portion of the cheeks

Initial Cancer Site:

• Glottic cancer begins in the vocal cords.
• Hypopharyngeal cancer (laryngopharyngeal cancer) begins in the hypopharynx (laryngopharynx) - the lower part of the throat, just above the esophagus and windpipe.
• Nasopharyngeal cancer begins in the nasopharynx - the part of the throat just behind the nose.
• Oropharyngeal cancer begins in the oropharynx - the part of the throat right behind the mouth that includes your tonsils.
• Subglottic cancer begins in the lower portion of the voice box, below the vocal cords.
• Supraglottic cancer begins in the upper portion of the larynx and includes cancer that affects the epiglottis, which is a piece of cartilage that blocks food from going into the windpipe.

Risk Factors

Some different risk factors for mouth cancer exist. Risk factors that can increase a person's chance of getting mouth cancer include:

• Heavy alcohol use
• Diet lacking fruits and vegetables
• Gastroesophageal reflux disease (GERD)
• Excessive sun exposure to the person's lips
• A sexually transmitted virus known as, 'human papillomavirus (HPV)'
• Tobacco use of any kind such as cigars, cigarettes, chewing tobacco, pipes or snuff

Throat Cancer Symptoms

• Coughing: Coughing is a common symptom and common side effect of throat cancer. The growing tumor irritates the throat and stimulates coughing. The cough is characterized as dry and irritating and usually does not resolve even with cough medicine. A blood stained sputum may be observed and may also have a foul smell which is due to cancer growth that has become ulcerated and bleeding.
• Difficulty in breathing: Difficulty breathing is experienced on the advance stage of throat cancer. The growth or the continual increase in the size of the tumor within the throat is causing obstruction in the airway passage thereby resulting in difficulty in breathing or may also result to asphyxiation or suffocation.
• Difficulty Swallowing: Difficulty swallowing simultaneously occurring with hoarseness of the voice and lingering for more than a month is an early warning sign of throat cancer. The pain associated with the growth of tumor in the throat makes swallowing difficult. The pain perceived can be so severe that it can radiate to the ear and the head.
• Fatigue: Fatigue, general body weakness and tiredness are common during the late stage of throat cancer which is also the usual in other forms of cancer and wasting disease.
• Changes in Voice: Hoarseness or changes in voice that continually progresses is the initial sign of throat cancer during the early stage of the condition. A noticeable rough quality of voice that persists for more than three weeks is an early symptom signifying throat cancer.
• Crowing Sound: Laryngeal stridor or a high pitched crowing sound occurs during the advance stage of throat cancer. The laryngeal stridor is the result of glottic obstruction or an obstruction in the airway passage brought by the tumor growing within the region of the throat.
• Swollen Neck: A puffy neck is apparent during the advance stage of throat cancer. The puffiness is the result of the tumor that is developing and increasing in size which will push the other structures of the neck to accommodate the growing tumor.
• Sore Throat: Sore throat is another early symptom that lingers for more than 6 weeks. It usually develops in the mouth and the throat which typically appear as a small sore similar to canker sore during the initial onset. Depending on the region of the throat affected, the sore can rapidly increase in size and the color can go from flesh to very dark color. The most common site for sore throat development is the roof of the mouth, under the tongue and at the back of the throat.
• Ear and Head Ache: Throat pain is the result of swelling and ulceration in the throat. The pressure in the ear and nose may also develop due to the increasing size of the tumor which can later bring earache and headache that can be so severe. The severe pain can hinder the appetite and disrupt the eating habit and cause difficulty in swallowing.
• Weight Loss: Usually due to a disruption in the eating habit brought by the discomfort of sore that has developed in the mouth and at the back of the throat causing pain and difficulty in swallowing. The weight loss even without the lack of interest to eat may be implicated in the deficiency or the inability to absorb nutrients as a result of damage cells within the esophagus or salivary glands or may be due to the rapid growth of the tumor causing the body to absorb nutrients faster than the other cells.

Questions Your Doctor May Ask

If you notice any new signs and symptoms that are persistent make an appointment with your doctor or health-care provider.

NOTE: Many throat cancer symptoms are not specific to cancer, your doctor will advise you further.

A doctor is likely to ask a person with mouth cancer several questions. Being ready to answer these questions might allow more time later to cover points an affected person wants to address. For example, a doctor might ask:

• Do you drink alcohol
• How severe are your symptoms
• When did you first start to experience symptoms
• What, if anything, seems to worsen your symptoms
• Have your symptoms been occasional, or continuous
• Do you at this time, or have you ever used tobacco products
• Have you ever received radiation therapy to your neck or head area
• What, if anything, appears to improve the symptoms you experience

It is important to avoid doing things that worsen your signs and symptoms. If you experience pain in your mouth, avoid spicy foods or hard foods that might cause additional irritation. If you are having difficulties with eating due to pain, consider drinking nutritional supplement drinks. The drinks can provide the nutrition you require until you can meet with your doctor or dentist.

Tests and Diagnosis

A couple of different tests are available to diagnose mouth cancer. These tests and procedures include the following:

• A Physical Examination: A doctor or dentist will examine your lips and mouth to look for things such as sores, areas of irritation, or white patches known as, 'leukoplakia.'
• Removal of Tissue for Testing: If a suspicious area is discovered, a doctor or dentist might remove a sample of cells for laboratory testing in a procedure referred to as a, 'biopsy.' Unusual cells may be scraped away with a brush, or cut away using a scalpel. In the laboratory, the cells are analyzed for precancerous changes that indicate a risk of future cancer, or cancer itself.

Stages of Mouth Cancer

After a person has been diagnosed with mouth cancer, a doctor works to determine the stage or extent of the mouth cancer. Mouth cancer staging tests might include:

• Using a Scope to Inspect Your Throat: During a procedure called, 'endoscopy,' a doctor might pass a lighted scope down the affected person's throat to look for signs that cancer has spread beyond the person's mouth.
• Imaging Tests: A number of imaging tests may assist with determining whether cancer has spread beyond the person's mouth. Imaging tests may include X-rays, magnetic resonance imaging (MRI), computerized tomography scans (CT), or positron emission tomography (PET) scans. Not everyone requires each type of test; a doctor determines which ones are appropriate based upon the person's condition.

Stages of mouth cancer are indicated using Roman numerals I through IV. A lower stage indicates a smaller cancer confined to one area. A higher stage, such as stage IV, indicates a larger tumor, or that cancer has spread to additional areas of the person's neck, head, or other parts of their body. A person's cancer stage helps their doctor to determine the person's treatment options.

Throat Cancer Survival Rate

The survival rate for throat cancer is dependent on the stage of the cancer by the time it was diagnosed and also depends on the overall health status of the patient and the response to treatment.

• Stage 1 - 5 year survival rate treated with a radiation therapy alone while surgical removal has a higher survival rate compared to radiation therapy of stage 1 cancer.
• Stage 2 - Throat cancer treated with radiation therapy alone has a 5 year survival rate.
• Stage 3 - Throat cancer on the other hand has a survival rate of below 5 years as most cancers in this stage are usually diagnosed during advance stages where lymph nodes in the neck and throat has been swollen.
• Stage 4 - Poor survival rate. The patient usually requires comprehensive treatment. Surgery is the primary method of treatment following a pre-operative radiation therapy while postoperative chemotherapy is necessary.

Treatments and Medications

Treatment for mouth cancer is dependent upon the cancer's stage and location, as well as the person's overall health and their personal preferences. The person might have only one type of treatment, or they may undergo a combination of cancer treatments. It is important for the person to discuss their options with their doctor.

• Surgery: Surgery for mouth cancer might include some different goals. The goals of a surgeon in relation to the mouth cancer a person experiences might include the following:
• Surgery to Remove Cancer that has Spread to the Neck: If cancer cells have spread to the lymph nodes in a person's neck, their surgeon might recommend a procedure to remove cancerous lymph nodes and related tissue in their neck.
• Tumor Removal Surgery: A surgeon may cut away the tumor and a margin of healthy tissue surrounding it. Smaller cancers might be removed through minor surgery. Larger tumors may need more extensive procedures. For example; removing a larger tumor might involve removing a section of the person's jawbone, or a part of their tongue.
• Surgery to Reconstruct the Mouth: Following an operation to remove the person's cancer, their surgeon might recommend reconstructive surgery to restore the appearance of the person's face, or to help the person regain the ability to eat and talk. The surgeon may transplant grafts of skin, bone, or muscle from other parts of the person's body to reconstruct their face. Dental implants might be used to replace the person's natural teeth.

Bear in mind that surgery carries with it a risk of infection and bleeding. Surgery for mouth cancer often times affects a person's appearance, as well as their ability to eat, swallow, or speak. A doctor might refer the person to a specialist who can assist the person with coping with the changes.

Radiation Therapy

Radiation therapy uses high-energy beams such as X-rays to kill cancer cells. Radiation therapy may be delivered from a machine outside of the person's body, or from radioactive, 'seeds,' and wires placed near to the person's cancer. Radiation therapy may be the only treatment a person receives if they have an early-stage mouth cancer.

Radiation therapy can also be used following surgery. In other instances, radiation therapy might be combined with chemotherapy. The combination increases the effectiveness of radiation therapy, yet also increases the side-effects the person may experience. In instances of advanced mouth cancer, radiation therapy might help to relieve the signs and symptoms caused by the cancer such as pain. Side-effects of radiation therapy to a person's mouth may include:

• Fatigue
• Dry mouth
• Tooth decay
• Mouth sores
• Jaw stiffness
• Bleeding gums
• Red and burn-like skin reactions

Chemotherapy

Chemotherapy is a type of treatment that uses chemicals to kill cancer cells. Chemotherapy drugs may be administered alone, in combination with other chemotherapy drugs, or in combination with other types of cancer treatments. Chemotherapy might increase the effectiveness of radiation therapy, so the two are often combined. Side-effects of chemotherapy depend on which drug the person receives. Common side-effects include nausea, vomiting and loss of hair.

Targeted Drug Therapy

Targeted drugs treat mouth cancer by altering specific aspects of cancer cells that fuel their growth. 'Cetuximab,' is one targeted drug therapy that has been approved for the treatment of neck and head cancers in some situations. Cetuximab stops the action of a protein that is found in a number of types of healthy cells, but is more prevalent in some types of cancer cells. Additional targeted drugs are being studied in clinical trials. Targeted drugs may be used in combination with radiation or chemotherapy.

Mouth and Oral Cancer Facts and Statistics

• Anyone can get oral cancer, but the risk is higher if you are male, over age 40, use tobacco or alcohol or have a history of head or neck cancer.
• Survival rates for oral cancer depend on the precise site, and the stage of the cancer at diagnosis.
• Survival rates of patients diagnosed with oral cancer have not significantly improved in decades.
• Infection with human papillomavirus (HPV), particularly type 16, is a known risk factor and independent causative factor for oral cancer.
• Some studies in Australia, Brazil and Germany pointed to alcohol-containing mouthwashes as also being etiologic agents in the oral cancer risk family.
• Chewing betel, paan and Areca is known to be a strong risk factor for developing oral cancer.
• Oral cancer treatments may include surgery, radiation therapy or chemotherapy. Some patients have a combination of treatments.
• Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough, and if surgery is likely to result in a functionally satisfactory result.
• In the US oral cancer accounts for about 8 percent of all malignant growths.
• Men are affected twice as often as women, particularly men older than 40/60.
• In 2013 oral cancer resulted in 135,000 deaths up from 84,000 deaths in 1990.
• Five-year survival rates in the United States are 63%.
• 75 percent of oral cancers are linked to modifiable behaviors such as tobacco use and excessive alcohol consumption
• Oral cancer is the sixteenth most common cancer in the UK (around 6,800 people were diagnosed with oral cancer in the UK in 2011), and it is the nineteenth most common cause of cancer death (around 2,100 people died from the disease in 2012).

List of Famous People Who Died from Head and Neck Cancers.

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