Oral cavity cancer

What is it?

Oral cancer affects the tongue, gums, inner cheek, lips, fundus of the mouth, hard palate, or the gum area behind the wisdom teeth. In Italy, it occurs in 0.4 new cases per 100,000 people per year, but worldwide the highest incidence is in India. The ratio between men and women is in favor of the former, but is gradually leveled out due to the growth of alcohol habit also among women and affects mainly the age from 50 to 60 years. In Italy, the most affected areas are the lips and the tongue, with a risk of 30%.

Known causes are smoking and drinking habits, pre-tumor lesions such as leukoplakia, erythroplakia, lichen, submucosal fibrosis and Fanconi anemia, constant small microtraumas due to neglected teeth, altered dentures and poor dental care.

It all starts with a small lesion that rapidly enlarges to form a deep ulcer that, in the case of the tongue, penetrates the muscle or, in the case of the gums, the bone. At least 95% of oral malignancies are squamous cell carcinomas.

Which are the symptoms?

Symptoms are often nuanced: the patient may feel a mass or swelling, moderate bleeding, or report small blisters, ulcers, or painful non-healing wounds. If the disease progresses, severe pain, inability to stick out the tongue, tongue deviation, or even inability to open the mouth may occur. Severe halitosis, heavy salivation, saliva mixed with blood, and swollen lymph glands under the jaw and/or in the neck are also important symptoms.

  • presence of a mass or swelling
  • bleeding
  • presence of small blisters
  • painful ulcers or non-healing sores
  • inability to stick out the tongue
  • tongue deviation
  • inability to open the mouth
  • halitosis
  • profuse salivation
  • swollen lymph glands under the jaw and/or in the neck
  • saliva mixed with blood

How is it diagnosed?

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How is it treated?

Treatment of the early stages (T1) consists only of radiation therapy or surgery. It is also the only part in the head and neck area that can benefit from brachytherapy in the early stages.

The choice between radiotherapy and surgery depends on the location of the tumor, its size, and the depth of infiltration, but in general the two methods are equivalent in terms of the likelihood of cure.

In the intermediate stage (T2), however, the size of the neoplasm must be carefully considered, because if the maximum diameter is less than 3 cm, with infiltration less than 1 cm and thickness less than 4 mm, surgery is the treatment of choice, whereas radiotherapy or brachytherapy may be considered only if the disease is remote from the bone. On the other hand, if the maximum diameter is greater than 3 cm, the infiltration is more than 1 cm, and the thickness is 4 mm or more, surgery followed by radiotherapy should certainly be resorted to if risk factors are present, such as a high degree of dedifferentiation (G3), nerve involvement (perineural invasion) or blood vessels (vascular invasion), followed by chemotherapy if the resection edges are close or the lymph nodes have continuous solutions in the capsule (extracapsularity).

On the other hand, in locally advanced disease (T3-T4), a surgical approach is considered first, followed of course by radiotherapy, but if surgery is not possible, combined treatment with chemotherapy and radiotherapy is standard, or, alternatively, radiotherapy alone in cases where the general clinical condition or age does not allow adding chemotherapy.

In advanced cancers, the goal is to chronicle the disease with chemotherapy, possibly in combination with biological therapy, and secondly, for patients in good general condition, immunotherapy according to recent approval or further chemotherapy.

These treatments may be combined with radiotherapy for symptomatic or bleeding/fracture risk areas, as well as surgical treatment of individual metastases.

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