Oral Cavity and Oropharyngeal cancer

Cancer develops when cells in a part of the body begin to grow out of control. Instead of dying they outlive normal cells and continue to form abnormal cells.

What is Oral Cavity and Oropharyngeal cancer?

Oral cavity includes the lips and its inside lining, cheeks and their inner lining, teeth, gums, floor of mouth below the tongue, bony roof of mouth, area behind the wisdom teeth and the front two thirds of tongue.

Oropharynx includes the back one third of tongue, tonsils, tonsillar pillar, soft palate and the back wall of the throat visible to the eye. Any cancer, which arises in these areas, is known as oral cavity or oropharyngeal cancer.

Risk factors are those variables that increase a person's chance of getting a disease. Having a risk factor means that the person is more likely to develop cancer than the general population. Head and neck cancer is mostly associated with tobacco, betel nut and alcohol abuse. Long-term irritation to the lining of the mouth caused by poorly fitting dentures has been suggested as one of the risk factor.

Clinical presentation:

A sore or lesion in the mouth that does not heal
A feeling that something is caught in the throat that does not go away
Difficulty moving the jaw or tongue
Numbness of any area in the mouth
Pain in the mouth that does not go away
Difficulty chewing or swallowing
A lump or mass in the neck
A persistent lump or thickening in the cheek
Development of asymmetry, in the tonsils.

How are these cancers diagnosed?

Physical Examination: Includes direct visual examination of the nose, mouth, throat and tongue and using a small mirror or a flexible lighted tube called endoscope for the voice box and roof of nose regions. The doctor will also feel the entire mouth using gloved finger.

CT scan: It is a series of detailed pictures of the head and neck created by computer linked to an X-ray machine.

MRI: It is a powerful magnet linked to a computer to create detailed pictures.
Chest X-ray: It is done to see if the cancer has spread to the lungs.
Biopsy: It is the only sure way to tell whether a person has cancer.

Questions you should ask your doctor:

Your doctor should be someone with whom you are comfortable with, one who listens to your concerns and answers all your questions thoroughly. It is your responsibility to ask questions and become educated about your health and treatment. Keep your doctor informed of your needs. Make sure that all of your concerns and questions are answered however small they may be.

Some of the more common questions you may think of are as follows:
What is the extent of my cancer (Stage)
What treatment do you recommend and why?
Will the treatment cure or only control the disease?
How long the treatment would last?
What are the common risks and side effects of the treatment?
Will I need to make changes in my work and family life?
If other specialists are involved, in my care who will coordinate the entire treatment plan?
What problems should I report right away?
What are the chances of cancer recurring back after treatment?
Is there any special food I should eat or not eat?
What are the costs?
Finally the best time to call the doctor for any question or concern.

How is Oral Cavity and Oropharyngeal cancer treated?

After the cancer is staged treatment choices are provided. It is important to take time and think about the choices including the chances of cure, impact of treatment on speech, swallowing and respiration.

The treatment options are surgery, radiation therapy and chemotherapy. These are given alone or in combination depending on the stage of the cancer.

Head and neck surgery often changes the patient's ability to chew, swallow or talk. The face and neck may be swollen and also parts of the neck may be numb because nerves have been cut.
Radiotherapy involves use of high energy x-rays to kill cancer cells. It often causes unwanted side effects like redness, irritation of eyes and mouth, dryness of mouth, alteration in taste, thick saliva, decreased appetite etc.

Chemotherapy is used to kill cancer cells throughout the body. In cancer of the oral cavity it is used in conjunction with surgery or radiation therapy as its effect alone is dismissal.

Is follow-up necessary?

Regular follow up is very important to make sure that the cancer has not returned and that a new cancer has not developed since patients who have had head and neck cancer have an increased chance of developing a new cancer in head and neck region. Regular dental check up and CT or MRI scans are needed.

(The writer is a Fellow at the Dept. of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA and can be reached at Kumaresh.krishnamoorthy@roswellpark.org)