Oral Cancer: Symptoms, Causes and Treatment

Oral cavity and oropharyngeal cancer is a frequent tumor. In Spain it accounts for almost 5% of all tumors, and more than 4,500 cases are diagnosed each year. It is a tumor that arises from the mucosa of the mouth and oropharynx. At first it appears as a localized lesion, which may look like an ulcer or an irregular thickening of the mucosa. If not treated in time, the lesion grows, invading adjacent tissues, and developing metastases in the lymph nodes of the neck. Later, distant metastases may appear in the lung, brain or bones, although this is rare.

What are the symptoms?

Symptomatology, at the beginning, is very scarce. They are initially painless lesions, which only begin to show local symptoms months later, such as pain, itching or local irritation. Pain from oral cavity cancer, once it starts, is usually quite intense, and typically radiates to the ear and neck. Depending on the location of the tumor, pain may occur when swallowing, chewing or moving the tongue to speak or eat.

In more advanced lesions more or less abundant bleeding may occur when the tumor area is irritated by friction or certain foods. When there are lymph nodes infiltrated by the tumor, these manifest themselves as lumps in the neck, of variable size, and once enlarged they are usually painful.

What are the causes of oral cancer?

Oral cancer generally arises as a consequence of chemical aggressions caused by tobacco (above all) and alcohol (which acts as an enhancer of the harmful effect of tobacco). A diet poor in fresh fruits and vegetables has also been associated with an increased risk of oral cavity cancer. Some patients with medical diseases of the mucosa of the mouth, such as erosive lichen planus, or dermatological diseases such as psoriasis, are more at risk for this type of cancer, even if they are not smokers.

In recent years there has been an increase in cancers related to viral infections, specifically some types of papillomavirus. These viruses are similar to those that cause cervical cancer, and also appear to be frequently sexually transmitted. Most of these papillomavirus-related tumors are located in the pharynx, and fewer in the mouth.

What is the treatment?

The treatment of oral cancer must always be approached in a multidisciplinary way: surgery, radiotherapy and chemotherapy are necessary, to a greater or lesser extent, depending on the size of the lesion and certain characteristics of the tumor. In addition, due to its location, nutritional treatment, rehabilitation and psychological support are very important, both during the medical-surgical treatment stage and in the long term.

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Most tumors must be surgically removed, which often necessarily implies the removal of parts of the upper jaw, the mandible, the tongue and adjacent structures. Often the cervical lymph nodes must also be removed (called cervical dissection). After surgery, in the case of more aggressive or larger tumors, treatment with radiotherapy is added, often combined with chemotherapy.

What are the latest advances in the treatment of oral cancer?

Advances in the treatment of oral cavity tumors have been very great in recent years. The routine use of increasingly advanced and precise imaging techniques with high spatial resolution (CT, MRI, PET-CT) allows tumor resection to be much more precise, safer and cleaner than in the past.

Reconstruction of the defects produced by surgery is becoming more and more precise and functional. Transplantation techniques with microsurgery can be performed with increasingly less “morbidity” (injury) to the donor areas of the tissues. The computer revolution and 3D design make the reconstruction of the maxillary and mandibular bone more accurate, and patients’ teeth can even be rehabilitated with osseointegrated implants inserted in the precise position thanks to the three-dimensional planning made possible by the computer.

Radiotherapy techniques have advanced in parallel with the development of computer technology and 3D planning. The three-dimensional concepts applied to radiotherapy make it a very precise tool that achieves maximum irradiation of the tissues that require it, almost completely reducing the radiation of healthy tissues.

In recent years, chemotherapy has increased the quantity and selectivity of the drugs used in cancer treatment. Classic chemotherapy has been joined by monoclonal antibodies that block certain cell receptors that cancer cells need to grow, as well as drugs that activate the body’s immune response against the tumor. In fact, a group of drugs (anti-PD-1) that inhibit the inhibition that the tumor itself provokes in the immune system (that’s a bit of a tongue twister), show encouraging results in the treatment of advanced tumors.