Oral cancer encompasses a range of malignancies affecting the mouth and surrounding structures. Recognizing the signs of oral cancer at an early stage is important for effective treatment and improved outcomes.
Understanding Early Oral Squamous Cell Carcinoma
Oral squamous cell carcinoma (OSCC) is a type of cancer that originates in the squamous cells, which are flat, thin cells lining the lips and the inside of the mouth. This malignancy accounts for over 90% of all oral cancers. OSCC commonly develops in various parts of the oral cavity, including the tongue, floor of the mouth, gums, inner cheek, and lips.
When OSCC is described as “early,” it generally means the cancer is localized, relatively small, and has not yet spread to distant parts of the body. Early-stage lesions might appear as flat, discolored areas, often referred to as leukoplakia (white patches) or erythroplakia (red patches).
Identifying Early Indicators
Early oral squamous cell carcinoma can be indicated by several visual and sensory changes. Persistent sores or ulcers in the mouth or on the lip that do not heal within two to three weeks are a common sign. These lesions can sometimes be mistaken for common mouth ulcers, but their prolonged presence warrants medical attention.
Red or white patches inside the mouth, known as erythroplakia or leukoplakia, are also significant indicators. Erythroplakia appears as red, flat, or velvety lesions, while leukoplakia presents as white, often hyperkeratotic, plaques. The presence of a lump, thickening, or mass in the lips, mouth, or cheek should also be noted. Other symptoms include unexplained bleeding from the mouth, persistent numbness or pain in the tongue, lip, or other areas of the mouth, and a persistent sore throat or feeling that something is caught in the throat. These symptoms might not cause pain in their early stages, emphasizing the need for professional evaluation of any persistent oral changes.
Factors Contributing to Development
Oral squamous cell carcinoma development is linked to several risk factors. Tobacco use, in all its forms including cigarettes, cigars, pipes, chewing tobacco, and snuff, significantly increases the risk. Heavy alcohol consumption also elevates the risk; the combination of heavy smoking and drinking dramatically increases the likelihood of developing OSCC, potentially by 38 to 100 times. Alcohol can act through its metabolic product, acetaldehyde, which may damage DNA.
Human Papillomavirus (HPV) infection, particularly types 16 and 18, is another growing risk factor for oral cancers, though it is identified in oral cancer less often than in oropharyngeal cancer. While HPV is a common virus, in some individuals, it can lead to cellular changes that contribute to cancer development. Other factors include prolonged sun exposure for lip cancer, certain nutritional deficiencies, and chronic irritation within the mouth, such as from dental caries or ill-fitting dentures.
Confirming a Diagnosis
Confirming an oral squamous cell carcinoma diagnosis starts with a thorough clinical oral examination by a dentist or doctor. During this examination, the healthcare professional visually inspects the oral cavity and may feel for any lumps or abnormalities in the mouth, jaw, and neck.
If a suspicious lesion is identified, a tissue biopsy is performed to obtain a definitive diagnosis. This procedure involves taking a small tissue sample from the suspicious area for histopathological examination under a microscope. An incisional biopsy, where a portion of the lesion is removed, or an excisional biopsy, where the entire lesion is removed, are common methods. Imaging tests, such as CT, MRI, or PET scans, are used after a biopsy confirms cancer to determine the extent of the disease and whether it has spread to nearby lymph nodes or distant sites, rather than for the initial diagnosis itself.
Approaches to Early Stage Management
For early oral squamous cell carcinoma, surgical removal is a primary treatment option. The goal of surgery is to excise the tumor completely, along with a margin of healthy tissue surrounding it. The extent of surgery depends on the tumor’s size and location, with less invasive approaches preferred for early-stage disease to minimize impact on appearance and function.
Radiation therapy is another treatment approach for early OSCC, sometimes used alone for very small lesions or as an adjuvant treatment after surgery. Both surgery and radiation therapy can be equally effective in treating early-stage oral cavity cancers. The choice between these treatments often depends on factors like the patient’s preferences and the expected side effects, including potential impacts on speech and swallowing. Early detection and treatment are associated with favorable prognoses, with localized tongue cancer having a five-year survival rate of over 75% and lower lip cancer around 90%. Regular follow-up care is important to monitor for any recurrence or the development of new lesions.