Oral cavity cancers are the second most common in head and neck cancers after larynx cancers. Oral cavity includes lips, tongue, floor of the mouth, soft palate, hard palate, cheek, gingiva and the junction of the lower-upper jaw. The most common cancer areas in these regions are lips and tongue.
In which patients are oral cavity cancers seen most common and what are the risk factors for its occurrence?
It is more common after the ages of 30-40 and in both genders. Long-term exposure to sunrays (Especially it is important in the development of lip cancers),the use of tobacco products (cigarettes, tobacco chewing, cigar, etc.), alcohol, poor oral hygiene and Human papilloma virus (HPV) infection are important risk factors.
What symptoms do we encounter most often?
These patients apply to the otolaryngologists with wound that does not heal in the mouth, long-lasting swellings, white (leukoplakia) or red (erythroplakia) spots, bad breath (halitosis), pain in case of jaw or nerve involvement, bleeding, chewing and swallowing problems, shaking teeth, limited tongue and jaw movements, pain in the ear, globus sensation, swelling in the neck (in case of spreading to the neck lymph nodes).
How is the disease diagnosed?
First, a full of otolaryngologic examination should be performed. In the examination of the oral cavity; the presence and size of a mass in the mouth, whether it is fluffy from the surface, in the examination of the neck; whether or not there is a neck mass due to the involvement of the neck lymph nodes are evaluated.
CT scans and / or magnetic resonance imaging (MRI) should be performed to assess the size of the cancer, its spread to the deep tissues, and the condition of the neck lymph nodes. In advanced stage cancers, PET (positron emission tomography) may be required, especially to evaluate distant spreads (lung, bone, brain tissues, etc.).
A biopsy should be taken from a mass in the mouth or tongue, especially if there is a suspicion of cancer. The biopsy can be taken easily under local anesthesia and then is diagnosed by a pathologist.
How are these tumors treated?
The primary treatment for these tumors is surgical excision. The second treatment alternative is radiation therapy. However, the type of cancer, the location of the cancer in the mouth and other areas where it has spread, the patient’s age and general status should also be taken into consideration when determining the course of treatment. In some advanced stage cancers, radiation therapy after surgery should also be added to the treatment protocol.
Chemotherapy is not the first choice, but sometimes it is used in combination with radiation therapy or in situations where surgery is not possible, or in cases where the cancer does not disappear or the cancer recur despite surgery and radiotherapy.
In early stage tumors, lymph node involvement in the neck is less likely, but this possibility increases as the tumor stage increases. In addition to the tumor surgery performed at the site of the cancer, the stage of the disease and the condition of the neck lymph node may require lymph nodes removal surgery (neck dissection).
What is the success rate of oral cavity cancer treatments?
Early detection of cancer is very important as in all types of cancer. Tumors detected in early stages have an over 80% chance of success when treated with appropriate treatment methods. As the stage of the tumor increases or in the presence of lymph node involvement in the neck, the chances of success in treatment decrease but still have a high chance of recovery.
Does swallowing and speech function deteriorate in the post-operative period?
Patients detected in the early stages are less likely to lose their swallowing and speech function after surgery. However, as the stage of the tumor increases, the size of the surgery to be performed and the amount of tissue to be removed increases. In such cases, it is necessary to bring tissues from areas close to mouth or far to fill the gaps (such as reconstructing with flaps or grafts). In this way, possible loss of function is tried to be reduced, but it is inevitable that these functions will partially decrease after advanced stage tumor surgeries. During these surgeries, rarely and usually in advanced stage tumors, a tracheostomy procedure is required, which is temporary and is closed after a while.
