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Q: What is oral cancer?

Oral cancer is cancer in the mouth. The oral cavity begins with the lips and includes the inner lining of the cheeks, teeth, gums, floor of the mouth, roof of the mouth, and most of the tongue. The base of the tongue, soft palate, tonsil area, and back of the throat comprise the oropharynx. Both the oral cavity and oropharynx are made up of several different types of tissue that are in turn made up of different types of cells. Various forms of cancer can develop from these individual cell types that will determine the correct and most effective form of treatment.

Q: What are the early signs of oral cancer?

Tumors of the oral cavity can be detected early with regular dental screenings and careful self-examination. In order to be effective in the fight against this disease we must be conscious of our bodies. If regular dental visits are not possible then we must be aware of the potential seriousness of certain symptoms. Symptoms such as a sore in the mouth that is not healing may be an early sign of tumor. The mouth is a very rapidly healing area; therefore, any prolonged soreness should alert one to seek medical or dental attention. A prolonged toothache may even be a cause for concern. These are a few symptoms which may cause one to seek medical attention especially if you are a large consumer of alcohol, use tobacco, or have been exposed to other carcinogens.

The following are some signs and symptoms frequently associated with tumors of the oropharynx and oral cavity:
  • Sore in the mouth that does not heal
  • Persistent oral pain
  • The presence of a lump or a thickening in the cheek
  • The prolonged presence of a white or red patch in the oral cavity
  • Prolonged sore throat
  • Difficulty chewing
  • Difficulty swallowing
  • Numbness in the mouth
  • Swelling in the jaw or mouth
  • Loosening of the teeth
  • Changes in one's voice
  • Weight changes
  • Presence of a lump in the neck
Any of these symptoms could herald the presence of a cancer. Consequently, it is important that the professional opinion of a dentist or doctor be sought if you are concerned about any of these symptoms. The head and neck area has an excellent blood supply helping it to heal quickly. Therefore, the failure of an area to heal should be a concern.

Q: What is the difference between benign and malignant tumors?

Benign tumors are the over production of cells in a tissue which remains contained in that specific area and does not invade surrounding tissues. There are many kinds of benign tumors which include fibroma, granular cell tumor, keratoacanthoma, papiloma, and various other types. Leukoplakia is an abnormal white area in the mouth or throat that may or may not be cancer. Erythroplakia, a red, raised area which bleeds easily when scraped, may also be cancer. Both leukoplakia and erythroplakia are types of dysplasia, a precancerous condition. Many times dysplasia will disappear if the causative agent (e.g. improperly fitting dentures or smokeless tobacco) is removed. Treatment with vitamin A may help eliminate some dysplastic conditions. Benign tumors are usually treated by surgery with a small chance of reoccurrence.

Malignant cancers are aggressive tumors that have the ability to spread to surrounding tissues. This spread of cancer away from its primary site is known as metastasis. According to the American Cancer Society more than 90% of cancers of the mouth and throat area are squamous cell carcinoma. Squamous cells are skin cells, which are flat and scale-like in appearance. Squamous cells normally line the oral cavity and oropharynx. Malignant tumors can be fatal even with early detection, however, early diagnosis will greatly increase one's chances for cure and survival.

Q: How do I reduce my risk of oral cancer?

Tobacco
First and foremost, do not use or discontinue the use of tobacco products. Smokeless tobacco products such as snuff and chew greatly increase one's risk for developing lip, gum, and cheek tumors by as much as 50 times. According to the American Cancer Society 90% of people with oral cavity cancers are tobacco users. Smokers are six times more likely to develop tumors of the head and neck than are non-smokers. Pipe smokers are more prone to lip cancers, and cigar smokers are at higher risk for tongue and other oral cancers. The nicotine in these products is highly addictive; so, quitting may be difficult. There are new medications and methods which may help you stop the use of these products. Please consult your physician.

Alcohol
The use of alcohol greatly increases one's risk for oral tumors. Roughly 80% of all people with oral cancers are frequent alcohol users. The combination of tobacco use and alcohol significantly increases one's chances of developing such tumors beyond the use of either by themselves. It is a proven fact that alcohol allows harmful chemicals to more easily penetrate cells and increasing the risk of damaging its DNA.

Dangerous Ultra Violet Light
Prolonged exposure to sunlight can lead to cancers of the lip and other skin cancers. Common areas that are at risk are the nose, ears and forehead. In order to reduce your risk of skin cancers please wear sun screen.

Constant Irritation
Prolonged irritation to an area in the oral cavity may lead to pre-cancerous or even tumor growth. Cancer is essentially the uncontrolled growth of cells. When your body is injured, it must regenerate the damaged cells. This constant regeneration to continually damaged areas may increases the probability that a tumor will arise. Avoid situations which will cause continual damage to areas in the mouth such as poorly fitting dentures. Regular dental visits will help prevent this situation from occurring.

TUMOR CLASSIFICATION SYSTEM

The current system of tumor classification is the TNM system. The T category indicates the size of the tumor primary site. The N category indicates the spread of the tumor to regional lymph nodes. (Lymph nodes are part of the bodies immune system and aid in fighting infections). The M category indicates whether the tumor has spread or metastasized to distant sites such as the lung, brain or liver.

T Classification System
T0: No primary tumor visible or apparent.
T1: Tumor present, 2 cm or smaller.
T2: Tumor between 2 and 4 cm.
T3: Tumor is greater than 4 cm.
T4: Tumor of any size which has invaded neighboring tissues or other body structures.

N Classification System
N0: No metastasis to lymph nodes nearby.
N1: Metastasis present in one lymph node (on same side as the primary site of the tumor). The size of the node is smaller than 3 cm.
N2: There are 3 subgroups =
N2a: Metastatic tumor in one lymph node between 3 and 6 cm.
N2b: Metastatic tumor in multiple lymph nodes smaller than 6 cm and on the same side as the primary site.
N2c: Metastitic tumor in one or more lymph nodes, all smaller than 6 cm, but on the same and opposite side as the primary tumor site.

M Classification
M0: No distant metastasis present.
M1: Distant metastasis exists.
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