Oral, Mouth or Tongue Cancer

Oral Functioning and the Issues Related to Oral Cancer

The necrosis and growth of abnormal tissue in cancer patients may impair bodily functions critical for speaking, eating, and immune activity alongside essential social engagements. Cancers within the oral pharyngeal cavity are especially malignant as they can metastasize, leading to necrosis of pharyngeal and laryngeal tissue and causing further complications such as disfigurement, intense pain, and destruction of vital structures. These malignancies also pose further danger through thermoregulatory disturbances and disseminated lesions. Without prompt intervention, systemic lymph accumulation can be life-threatening. Thus, these forms of neoplasia must be addressed quickly to alleviate excessive pain while salvaging what remains of oral anatomy.

Due to the rampant use of tobacco and alcohol in certain regions, oral cancer types are among the most prevalent cancers globally. It often results from genetic alterations in the squamous epithelial cells lining the mouth, which begin to proliferate uncontrollably. Early-stage oral cancer has promising clinical outcomes, but its diagnosis is often masked by benign oral conditions with overlapping symptoms. Enhanced education, reduction of risk factors, and proactive screening can significantly improve survival rates worldwide.

Classification Pertaining to Primary and Secondary Oral Tumours

• Primary Oral Cancer: Initiates within the tissue components of the oral cavity. The most prevalent type is Squamous Cell Carcinoma (SCC), accounting for over 90% of cases. Other less frequent types include Verrucous Carcinoma, Mucoepidermoid Carcinoma, and Adenoid Cystic Carcinoma. Rarely, salivary gland tumors may also occur.
• Metastatic Oral Cancer: Results from cancers of other organs such as the breast, kidneys, or prostate metastasizing to the oral cavity. Though rare, these can infiltrate jawbones or soft tissues and indicate advanced systemic disease.

Primary Causes and Associated Risk Factors

• Chewing or smoking tobacco products leading to cancers of the lips and oral cavity.
• Chronic sun exposure, especially linked with lip carcinomas.
• Chronic alcohol consumption.
• HPV infection—particularly HPV 16—is associated with oral malignancies.
• Poor oral hygiene and neglect of dental care.
• Nutritional deficiencies and weakened immune systems.

Signs and Symptoms of Oral Cancer

• Persistent, painless sores or ulcers in the mouth lasting more than two weeks.
• Red or white patches on the tongue or gums.
• Painful and restricted mouth movements while chewing, swallowing, or speaking.
• Chronic throat pain or hoarseness.
• Unexplained weight loss and fatigue.
• Jaw pain, loose teeth, or numbness in the mouth region.
• Persistent ear pain unrelated to ear infection.
• Swelling, coarse sensation, or persistent ulcers in the oral cavity.

In early stages, oral cancer symptoms can mimic non-cancerous conditions, often causing diagnostic delays.

Diagnosis of Oral Cancer

Diagnosis involves a combination of clinical examination, imaging, microscopy, and staging:

• Clinical Assessment: Includes a thorough examination of the mouth, neck, and face for abnormal lesions or swelling.
• Imaging Studies: CT and MRI scans for local and regional disease progression; PET scans to detect metastasis; Jaw and chest X-rays if bone or lung involvement is suspected.
• Tissue Biopsy: Surgical removal of suspicious lesions for microscopic analysis to determine the cancer type and grade.
• Endoscopy: Internal examination of the throat and nearby structures to assess tumor spread.
• Staging: Evaluates tumor size (T), lymph node involvement (N), and metastasis (M) to guide prognosis and treatment planning.

Oral Cancer Treatment

Treatment is personalized based on the cancer type, size, location, stage, and the patient’s overall health.

• A. Conventional Treatment Methods
• B. Advanced and Alternative Treatment Options
• C. Surgical Management of Oral Cancer

1. Surgical Methods

• Wide Local Excision: Removal of the tumor along with a margin of healthy tissue.
• Neck Dissection: Surgical removal of potentially affected lymph nodes.
• Reconstructive Surgery: Performed post-tumor excision to restore function and appearance.

2. External Beam Radiation Therapy

Used post-surgery or for non-operable cases to destroy residual malignant cells. Side effects may include mucositis, dry mouth, and swallowing difficulty.

3. Chemotherapy

Systemic agents such as carboplatin, cisplatin, and 5-fluorouracil are commonly used. Often combined with radiation therapy in advanced stages. Side effects can include mouth ulcers, nausea, and immunosuppression.

Advanced Treatments for Oral Cancer

• Microinvasive Therapies and Surgeries: Cryosurgical ablation uses extreme cold to destroy malignant tissue.
• Targeted Therapies: Cetuximab and pembrolizumab target PD-1 and EGFR receptors, offering precise control over tumor growth with fewer side effects.
• Brachytherapy: Radioactive implants (Iodine-125 or Palladium-103) are used for localized radiation treatment, especially in tongue and lip cancers.
• Stem Cell and Immunotherapies: CAR-T and checkpoint inhibitor therapies (anti-PD-1/PD-L1) use the body’s immune system to target and destroy cancer cells.

Screening, Prevention, and Behavior Change

• Complete elimination of tobacco and smokeless tobacco products.
• Moderation or avoidance of alcohol.
• HPV vaccination to prevent oropharyngeal cancers.
• Regular dental checkups and maintenance of oral hygiene.
• Balanced diet rich in antioxidants.
• Minimized sun exposure to the lips.
• Regular monitoring of high-risk populations (smokers, drinkers, or those with previous cancer history).

Prognosis Factors and Statistics

Prognosis largely depends on the stage of diagnosis. Early detection followed by surgery or radiotherapy results in 5-year survival rates above 75%. However, late-stage or metastatic disease reduces survival to 30–40%. Timely screening and multimodal treatment greatly improve outcomes.

Conclusion

Oral cancer remains a major public health challenge due to its complex causes and frequent late diagnosis. However, innovations in immunotherapy, targeted therapies, and refined surgical approaches offer renewed hope. Public awareness, early detection, and prevention remain the most powerful tools in reducing the global burden of oral cancer.