Mouth Cancer

Mouth cancer, also called oral cancer or oral cavity cancer, is a type of head and neck cancer that affects various parts of mouth including lips, gums, tongue, roof and floor of mouth, and interior lining of the cheeks.

Mouth cancer, like other head and neck cancers, is treated by surgery, radiation and chemotherapy.

If you have a mouth cancer, you may experience signs and symptoms like:

• Sore or growth in the mouth which persists
• Swelling in your mouth
• A white or reddish patch inside your mouth
• Loosened teeth
• Ill-fitting dentures
• Painful tongue
• Stiffened or painful jaw 
• Chewing difficulty often causing pain 
• Swallowing problems which may be painful
• Sore throat

When to see a doctor?

Visit your doctor or dentist if you experience signs and symptoms that last longer than 2 weeks. The signs and symptoms of mouth cancer are similar to those caused by other common conditions such as an infection. Therefore, your doctor will first look for other causes while making a diagnosis.

Like other types of cancer, a mouth cancer is caused by DNA changes (DNA mutations) especially in the cells lining your lips and interior of your mouth.

These mutations cause “out-of-control” growth and multiplication of cells. Unlike normal cells, these cancer cells live longer and accumulate to form a tumor that can invade nearby tissue or may spread (metastasize) to other body parts including other head and neck regions.

The most common form of mouth cancer is the one affecting thin, flat cells (squamous cells) lining your lips and interior of your mouth. Squamous cell carcinomas account for most cases of mouth cancer.

The causes behind such mutations have not been identified yet but risks factors of mouth cancer are well documented.

Your doctor reviews your medical history, evaluates the signs and symptoms and assesses your risk factors while making a diagnosis of mouth cancer.

Since the signs and symptoms of mouth cancer are not specific to the condition and may be caused by other more common conditions such as an infection. The diagnosis of mouth cancer involves: 

• Physical exam: A physical exam involves a thorough investigation for typical signs such as sores or white patches (leukoplakia) in your lips and mouth.
• Removing a sample of tissue or biopsy: A sample of tissue from suspicious area is removed by using a brush or a scalpel and the sample is examined in the lab to determine presence of cancer or precancerous cellular changes.

Stages of Mouth cancer

Staging your mouth cancer helps to determine the extent of damage, appropriate treatment and possible outcomes. Roman numerals from I to IV are used to assign different stages to your mouth cancer. Remember that IV represents advanced tumor that has affected other parts of your body while stage I means the cancer cells have not spread beyond the site of origin. Following tests are used to determine your mouth cancer stage:

• Examining your throat using a lighted tube: This process is also called endoscopy. In this process, a lighted tube is passed down your throat to detect if your cancer has affected nearby tissues. 
• Imaging tests:  Imaging tests such as X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) scans can be used to detect if your cancer has spread to other parts.

Mouth cancer is treated by different ways depending upon where the cancer is located, how severe it is, and your general health status. Your doctor can recommend a single treatment or combination of treatment options.

Some treatment options for mouth cancer include:

• Surgery: Surgery for mouth has following approaches:

1. Surgery to remove the tumor: It involves surgical removal of the tumor and nearby healthy tissues. Minor surgeries are used to remove smaller cancers while a more advanced surgery may be required to remove a larger tumor. 
2. Surgery to remove the cancer that has spread to the neck: It involves surgical removal of the tumor, affected lymph node and nearby neck tissues. 
3. Surgery to reconstruct the mouth: These reconstructive surgeries can normalize your appearance after a surgery for mouth cancer. Apart from improving your appearance, the surgery can also help to restore your ability to talk and eat. 

Common risks of surgery include possible bleeding and infection. After a surgery, you may observe changes in your appearance and experience impaired ability to speak, eat and swallow. You may talk to your doctor about consulting specialists who can help you.

• Radiation therapy: In a radiation therapy, high-energy beams, such as X-rays, are used to destroy cancer cells. If the source of radiation is kept outside your body, it is called external beam radiation and when it is kept inside your body near the cancer, it is called brachytherapy. For a small tumor, only radiation therapy is sufficient to destroy it while for an advanced mouth cancer, radiation therapy can be used to relieve signs and symptoms. In some cases, a combination of radiation therapy and chemotherapy may be used. It can cause various side effects such as dry mouth, tooth decay, mouth sores, bleeding gums, jaw stiffness, fatigue and red, burn-like skin reactions.
• Chemotherapy: It uses chemicals to destroy cancer cells. You may have to take one or more chemotherapy drugs to treat your mouth cancer. In some cases, chemotherapy may be used in combination in other cancer treatments, such as, it is combined with radiation therapy to increase effectiveness of the treatment. The side effects of chemotherapy depend on specific drug being administered but some side effects such as nausea, vomiting and hair loss are common to all. 
• Targeted drug therapy: This therapy uses chemicals that attack specific but critical targets in cancer cells. Cetuximab is one such drug which works by targeting a specific protein that’s more common in cancer cells. Targeted drugs may be combined with chemotherapy or radiation therapy. Cetuximab is approved for use in head and neck cancers in certain situations. 

No one knows how to prevent mouth cancer. But after reading this, you will definitely know how you can minimize the risk factors: 

• Don’t use tobacco: If you use, quit and if you don’t, don’t start. 
• Limit your alcohol intake.
• Eat a diet rich in fruits and vegetables as they contain essential vitamins and antioxidants that may cut your risk of mouth cancer. 
• Limit sun exposure to your lips. Consider applying a sunblock for your lips. 
• Schedule routine dentist visits.

Complementary or alternative remedies are not effective in treating mouth cancer itself. However, they can help to manage fatigue, the most common side effect of cancer treatment. Talk to your doctor before using any alternative remedies. Here are some tips to help you: 

• Stay active: Exercise for at least 30 minutes in a day. Low intensity exercises such as brisk walking can help reduce fatigue. 
• Massage therapy: Visit a massage therapist to find a soothing massage that relaxes you.
• Relaxation: Practice simple relaxation techniques like deep breathing, writing a poem (if you think it’s possible!!!), listening to a good music or even watching a movie.

Lifestyle modifications are necessary in order to cope with mouth cancer.

The two most important lifestyle changes that you need are:

• Quitting tobacco
• Quitting alcohol

Diagnosis of cancer is stressful and causes a heap of pain and uncertainty. We have worked out some simple techniques to help you live a near-normal life with mouth cancer:

• Expand and update your knowledge on mouth cancer so that you will be able to make better decisions for yourself. But do not rely on information from unreliable sources.
• Join a support group in your community or online (for example message board run by the Oral Cancer Foundation) to share your feelings with someone similar to you. Contact your local chapter of the American Cancer Society. 
• Find yourself some peace and happiness. Engage in activities that make you happy and free from the thoughts of mouth cancer.
• Stay close to family and friends.

There are several risks and complications associated with mouth cancer, which include:

• Tobacco use which includes cigarettes, cigars, pipes, chewing tobacco and snuff.
• Excessive alcohol consumption.
• Excessive sun exposure to your lips.
• A sexually transmitted infection caused by a virus called human papillomavirus (HPV).