Oral Cancer: Overview, Causes, Symptoms and Treatment

Introduction

Oral cancer is a serious condition that affects thousands of people globally. It primarily occurs in the mouth, lips, tongue, cheeks, gums, and throat. If left undiagnosed, it can be life-threatening, making early detection crucial. Despite being a common form of cancer, awareness about its symptoms, risk factors, and prevention remains low. 

This guide will explore everything you need to know about oral cancer, from its stages and symptoms to treatment and prevention strategies.

What is Oral Cancer?

Oral cancer is the uncontrolled growth of malignant cells in the mouth, lips, tongue, gums, or throat. It often begins as a persistent sore, lump, or abnormal tissue that does not heal. Most cases originate in the squamous cells that line the oral cavity and throat. Common risk factors include tobacco use, excessive alcohol consumption, HPV infection, and prolonged sun exposure.

Early detection significantly improves treatment outcomes. Symptoms may include mouth pain, difficulty swallowing, voice changes, and unexplained weight loss. If left untreated, oral cancer can spread to nearby tissues, lymph nodes, and distant parts of the body.

Common Locations of Oral Cancer

Oral cancer can develop in various parts of the mouth, including:

• Lips
• Inside the cheeks
• Gums
• Tongue
• Floor of the mouth
• Roof of the mouth
• Tonsils
• Upper throat (oropharyngeal cancer)

Staging Oral Cancer

Cancer staging is crucial in assessing the severity of oral cancer and determining the most effective treatment plan. The staging system helps doctors classify the extent of cancer growth and its spread. Oral cancer is divided into four main stages, from early detection (Stage I) to advanced progression (Stage IV). Each stage influences the treatment approach and prognosis.

Stage I

At this initial stage, the tumour is 2 cm or smaller in size and remains localised within the oral cavity. It has not yet spread to the lymph nodes or other distant organs. Many patients diagnosed at this stage have a higher chance of successful treatment, often requiring surgery or radiation therapy. Early detection is crucial, as symptoms may be mild or unnoticed.

Stage II

In this stage, the tumour grows between 2 cm and 4 cm but still remains within the oral cavity. There is no evidence of cancer spreading to nearby lymph nodes or distant sites. While the tumour has increased in size, it is still considered a localised cancer, making treatment more effective. Surgery, radiation therapy, or a combination of both may be recommended, depending on the tumour’s location and depth.

Stage III

Stage III oral cancer indicates significant progression. The tumour is either larger than 4 cm or has spread to one nearby lymph node, though it has not yet reached distant organs. Cancer at this stage is considered locally advanced, meaning it has begun to extend beyond its original site. Treatment often involves a combination of surgery, radiation therapy, and sometimes chemotherapy to prevent further spread. The prognosis depends on the tumour’s size, location, and response to treatment.

Stage IV

The most advanced stage of oral cancer, Stage IV, signifies that the cancer has spread beyond the mouth to deeper tissues, multiple lymph nodes, or distant organs such as the lungs, liver, or bones. It may also involve significant damage to surrounding structures like the jawbone or neck. Treatment at this stage is more complex, typically requiring a combination of surgery, radiation therapy, chemotherapy, targeted therapy, or immunotherapy. The prognosis varies based on the extent of spread and response to treatment. Palliative care may also be considered to improve the patient’s quality of life.

Oral Cancer Symptoms

Symptoms of oral cancer can vary but often include:

• White, red, or speckled patches in the mouth: Discoloured patches inside the mouth may indicate abnormal cell growth, which can be an early sign of oral cancer.
• Persistent pain or numbness in the mouth: Ongoing discomfort, tingling, or loss of sensation in the lips or tongue could signal nerve involvement due to cancerous growth.
• Difficulty chewing, swallowing, or speaking: Tumours in the mouth or throat can obstruct normal functions, making it hard to eat, drink, or articulate words clearly.
• Hoarseness or voice changes: A persistent change in voice, including hoarseness or a rough quality, may result from cancer affecting the throat or vocal cords.
• Ear pain without an infection: Unexplained ear pain or a persistent ache without signs of infection can occur due to nerve irritation from throat or mouth cancer.
• Swelling or stiffness in the jaw: A growing tumour may cause the jaw to feel stiff, swollen, or painful, making it difficult to open or close the mouth.
• Unexplained weight loss: Cancer often leads to weight loss due to reduced appetite, difficulty eating, or metabolic changes caused by the disease.
• Chronic bad breath: Persistent bad breath that does not improve with oral hygiene may result from tissue decay or infection linked to oral cancer.

If any of these symptoms persist for more than two weeks, consult a healthcare professional.

Oral Cancer Risk Factors

Several factors can increase the risk of developing oral cancer. These include:

1. Smoking

Cigarette, cigar, and pipe smoking significantly raise oral cancer risk. Smokers are up to six times more likely to develop oral cancer than non-smokers. The harmful chemicals in tobacco damage the mouth’s cells, leading to abnormal growths that may become cancerous over time.

2. Smokeless Tobacco Use

Chewing tobacco and snuff expose the mouth’s tissues to harmful carcinogens, increasing the risk of cancer in the gums, inner cheeks, and lips. These products contain nicotine and other chemicals that promote cellular mutations, making oral cancer more likely in users of smokeless tobacco.

3. Drinking Too Much Alcohol 

Heavy alcohol consumption is a significant risk factor for oral cancer. Alcohol weakens the mucous membranes in the mouth, making it easier for carcinogens to penetrate. When combined with tobacco use, the risk increases dramatically, as alcohol enhances the harmful effects of tobacco-related toxins.

4. Excessive Sun Exposure

Prolonged exposure to ultraviolet (UV) radiation can lead to lip cancer, particularly in individuals who spend long hours outdoors. Using a lip balm with SPF, wearing a wide-brimmed hat, and avoiding excessive sun exposure can help reduce the risk of sun-induced oral cancers.

5. Human Papillomavirus 

HPV, particularly strain HPV-16, is linked to oropharyngeal cancers. This virus spreads through sexual contact, including oral sex. Infections can cause abnormal cell changes in the throat, increasing the likelihood of developing cancer in the back of the mouth and tonsils.

6. Age

Most cases of oral cancer are diagnosed in individuals over 55, as cell damage accumulates with age. However, HPV-related oral cancers are increasingly affecting younger people. Regular dental check-ups can aid in early detection, especially for those in high-risk age groups.

7. Gender

Men are twice as likely as women to develop oral cancer. This discrepancy is largely due to higher rates of tobacco and alcohol use among men. However, lifestyle changes and increased awareness have helped reduce gender-based disparities in recent years.

8. Poor Diet

A diet low in fruits and vegetables may contribute to oral cancer risk. Antioxidants, vitamins, and minerals found in plant-based foods help protect cells from damage. A lack of essential nutrients weakens the immune system, making it harder for the body to fight off cancerous growths.

9. Weakened Immune System 

A compromised immune system due to conditions like HIV/AIDS, chemotherapy, or immunosuppressive medications increases the risk of oral cancer. The body’s reduced ability to repair damaged cells and fight off infections makes it easier for cancerous growths to develop and spread.

Oral Cancer Survival Rate

The survival rate of oral cancer largely depends on how early it is diagnosed and how far it has spread at the time of detection. If oral cancer is detected in its early stages, the five-year survival rate is approximately 86%, meaning most patients have a strong chance of successful treatment and long-term recovery. However, if the cancer has spread to nearby tissues or lymph nodes, the survival rate drops to 69%, as treatment becomes more complex and the likelihood of recurrence increases. In cases where the cancer has spread to distant parts of the body, such as the lungs or liver, the survival rate significantly decreases to 40%, making treatment more challenging. Early detection, regular dental check-ups, and prompt medical attention for unusual symptoms can improve survival rates.

Oral Cancer Diagnosis

Oral cancer is often detected during routine dental checkups. If an abnormality is found, further tests may be conducted, such as:

• Oral Exam: A doctor examines the mouth for lumps, sores, or discolorations.
• Biopsy: A tissue sample is collected and examined for cancer cells.
• Imaging Tests: CT scans, MRIs, and X-rays help determine tumor size and spread.
• Endoscopy: A flexible tube with a camera is used to examine the throat and oral cavity.
• HPV Testing: If oropharyngeal cancer is suspected, HPV testing may be performed.

Oral Cancer Treatment

The treatment for oral cancer varies depending on its stage, location, and whether it has spread to other parts of the body. A combination of therapies is often used to achieve the best results.

1. Surgery

Surgical intervention is one of the primary treatments for oral cancer. The procedure involves the removal of the tumour and surrounding affected tissues to prevent further spread. In more advanced cases, reconstructive surgery may be required to restore function and appearance, especially if large portions of the tongue, jaw, or throat are removed. Surgery is often combined with other treatments to reduce the risk of recurrence.

2. Radiation Therapy

Radiation therapy utilises high-energy X-rays or other radiation sources to destroy cancer cells. It is particularly effective in the early stages or as an additional treatment after surgery. This method can also be combined with chemotherapy to enhance its effectiveness in advanced cases. Side effects may include dry mouth, difficulty swallowing, and irritation of the surrounding tissues.

3. Medication Therapy

Advanced oral cancer cases may require medication-based treatments that specifically target cancer cells. Different types of drug therapies are available, including:

• Chemotherapy: This involves the use of powerful anti-cancer drugs to kill cancer cells and prevent their growth. The drugs can be administered orally or intravenously, often in combination with other treatments such as radiation therapy. Side effects may include nausea, fatigue, and a weakened immune system.
• Immunotherapy: This approach stimulates the body’s immune system to recognise and attack cancer cells. It is often used in cases where other treatments have failed or where the cancer is resistant to standard therapies.
• Targeted Therapy: This treatment uses specialised drugs that attack specific molecules involved in cancer cell growth. Unlike chemotherapy, which affects both healthy and cancerous cells, targeted therapy minimises damage to normal cells and reduces side effects.

Oral Cancer Prevention

Reducing risk factors and following preventive measures can help lower the chances of developing oral cancer:

• Quit Smoking: Avoid tobacco in all forms.
• Limit Alcohol Consumption: Drink in moderation.
• Use Sun Protection: Apply SPF lip balm and wear a hat.
• Get Vaccinated: The HPV vaccine reduces the risk of HPV-related oral cancer.
• Eat a Balanced Diet: Include plenty of fruits and vegetables.
• Practice Good Oral Hygiene: Brush, floss, and visit a dentist regularly.
• Conduct Self-Exams: Check your mouth for unusual changes.

Conclusion

Oral cancer is a serious and potentially life-threatening condition, but early detection and timely intervention can significantly improve outcomes. Regular dental check-ups, self-examinations, and avoiding risk factors like tobacco, excessive alcohol consumption, and prolonged sun exposure can lower the risk of developing oral cancer. If diagnosed early, the chances of successful treatment and recovery are much higher. By understanding the causes, symptoms, and available treatments, individuals can take proactive steps to maintain good oral health and prevent the progression of this disease.

Frequently Asked Questions (FAQs)