Oral mucosal cancer

The oral cavity is a unique part of the human body. It performs a number of important functions, without which normal life is impossible. One of the main processes occurring in the oral cavity is the grinding and primary digestion of food. Biting, grinding and forming a food lump is performed mainly by the teeth, cheeks and tongue. At the same time, the carbohydrate components of food are broken down into simpler structural units under the action of amylase. Thus, the initial stages of digestion occur in the mouth.

The oral cavity is a protective barrier for the entire body. It contains the greatest diversity of microflora. It includes bacteria, viruses, fungi, which, by their way of life, can be obligate (permanent inhabitants of the oral cavity) and facultative (opportunistic). The balance of microflora prevents the development of pathogenic microorganisms and the occurrence of inflammatory and destructive diseases.

The respiratory function of the oral cavity manifests itself mainly under increased loads on the body. As a rule, in a tense state, a person inhales air through the nose and exhales through the mouth. This increases the efficiency of gas exchange.

The receptor function of the oral cavity is realized thanks to a large number of receptors located on the mucous membrane, in the periodontium of the teeth and on the back of the tongue. This allows you to regulate chewing pressure, feel the temperature of food, its consistency and taste.

The ability to reproduce sounds is mainly associated with the tongue, lips and teeth. With the correct interaction of these parts of the body, a person has the ability to express his thoughts and emotions verbally.

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Causes oral cancer

The functional complexity of the oral cavity implies the simultaneous occurrence of many biophysical and biochemical processes in it. The performance of various functions, direct contact with the environment creates a high risk for the occurrence of pathological processes in the oral cavity.

The main risk factor for oral cancer is the presence of a chronic damaging agent. It can be of any origin, but the pathogenesis of the disease is always the same. First, damage, or alteration, occurs. Then the body's defense system is activated in the form of inflammation, the formation of keratinized epithelium or hyperplasia of soft tissues in the area of damage. If the damaging factor is not eliminated for a long time, then a failure occurs in the cell division mechanism. As a result, they begin to divide faster, generating a large number of defective and non-functional cells. The latter are carried through the circulatory and lymphatic systems to different parts of the body, forming metastases. As a result, a tumor that has arisen in the oral cavity can spread to the lungs, liver, brain and other organs. Cancer cells do not perform any useful functions, since they are immature. However, their negative impact is difficult to overestimate. Almost any organ in which cancer cells are located gradually loses its functionality, and over time simply ceases to function. Thus, the main cause of the occurrence of a malignant tumor is a violation of the cell division mechanism, and the leading risk factor is chronic damage.

Mechanical trauma

The easiest risk factor to understand is chronic mechanical damage. It can be observed in people of any age, gender, and socioeconomic status. For example, a child with an abnormal bite or incorrectly positioned teeth may constantly injure the mucous membrane of the oral cavity. At the site of injury, the mucous membrane will begin to keratinize, which significantly reduces the symptoms of injury. However, the damaging factor will still injure soft tissues, provoking constant regeneration, that is, cell division.

Some people have damaged teeth with sharp edges. If, for various reasons, they do not seek dental care, chronic trauma to the tongue, cheeks and lips may occur. The main problem with chronic damage is that the body itself partially “levels” it out through compensatory reactions. As a result, the pathological process is protracted and mild. This helps a person gradually get used to it and not try to eliminate it.

Removable dentures made using incorrect technology can cause even combined damage. Mechanical trauma occurs when the denture does not fit correctly to the mucous membrane. As a result, areas of increased load and friction are formed. If the technical process was violated during the polymerization of the plastic of the denture, then the denture may contain monomer. Its particles have a toxic effect on the mucous membrane, causing inflammation and allergic reactions. If improperly welded and poorly fitting dentures are used for a long time, bedsores, erosions, ulcers, inflammatory reactions will inevitably appear. All these pathological elements and processes can provoke the occurrence of oral cancer.

It is also worth noting the traumatic effect of braces. Today, orthodontics is a very popular area of dentistry among the population. Teenage patients are increasingly being fitted with braces to treat bite or dental anomalies. However, the locks and arches of the orthodontic system can have a significant traumatic effect on the soft tissues of the oral cavity. And if we consider that in most cases braces are used continuously for two years, it is easy to imagine what consequences the patient may experience.

One of the traumatic factors that is rarely paid attention to is worn ceramics on an artificial crown. Many people prefer metal-ceramic structures due to their reasonable cost and aesthetic qualities. However, not everyone knows that the smooth surface of a metal-ceramic surface is created using a thin layer of the so-called "glaze". During the long-term functioning of the crown, the glaze can be worn off, after which the underlying layer of ceramics is exposed. All deep layers have a rough surface, which is why chronic trauma occurs as a result of friction of the mucous membrane against the crown.

Chronic stress, or rather its consequences, play a key role in the occurrence of mechanical damage to the mucous membrane. We are talking about biting the inner surface of the lips and cheeks. In modern life, almost all people are under stress. For some people, it manifests itself in the form of insomnia, for others - in the form of night grinding of teeth. But, very often, stress is accompanied by biting the mucous membrane of the lips or cheeks. This can happen consciously and subconsciously, however, the result in this case is one - chronic mechanical injury.

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Physical trauma

The most common type of physical trauma is thermal damage. Interestingly, people most often talk about acute thermal trauma. This is not surprising, because burns and frostbite are clinically very bright and cause great harm to the human body. However, chronic mechanical trauma is no less dangerous and even more insidious. A person who regularly consumes hot foods injures the mucous membrane of the oral cavity. As a result, the activity of keratinization processes increases, which is the first stage on the way to the emergence of pathological neoplasms.

Another example of physical damage is galvanosis. This is a disease that occurs as a result of the presence of different metal alloys in the oral cavity. For example, a person has stainless steel crowns on one tooth and cobalt-chromium alloy crowns on another. In this situation, an electric current will arise between these alloys. Moreover, it does not matter how far apart these structures are from each other. They can be located on different dental rows, but the electrical conductivity of human tissues, as well as saliva, contribute to the occurrence of microcurrents in the oral cavity. Clinically, galvanosis is manifested by a burning sensation, a metallic taste in the mouth, redness, inflammation, and sometimes erosions and ulcers on the mucous membrane. If the heterogeneity of metals is not eliminated, the above symptoms will become chronic and can even lead to pathologies such as oral cancer.

Chemical trauma

Chronic chemical damage to the oral mucosa most often occurs in smokers and drug addicts. The legal availability of cigarettes contributes to the fact that a huge number of people are consumers of this product. The chemical composition of most tobacco products is so "rich" that they contain more than 12,000 chemical compounds. Moreover, 196 of these substances are poisonous, 14 are narcotic, and 69 are carcinogens. Most people suffering from cancer pathologies of the respiratory tract are smokers. And given that smoke first gets into the oral cavity, the harmful effect of tobacco smoke on the oral mucosa becomes obvious. Chewing tobacco is no less dangerous. Although many consumers are naively convinced that chewing tobacco is harmless. They argue that it does not contain smoke and does not get into the lungs. This myth can be easily dispelled by saying that chewing tobacco is actively chewed in the oral cavity, which means that a large portion of it is absorbed through the mucous membrane. Moreover, tobacco particles enter the esophagus and stomach with saliva. This creates a risk of developing cancer in any part of the digestive system, including the oral cavity.

It is worth paying attention to the widespread use of synthetic smoking mixtures. Basically, they are a problem for society due to their psychogenic effect. Inadequate human behavior under the influence of synthetic smoking mixtures poses a high level of danger to others. Moreover, the smoker's nervous system is subject to irreversible degenerative changes over time. Due to these facts, the sale of such smoking mixtures is prohibited in most countries. However, manufacturers try in every possible way to disguise their product as aromatic herbs, spices, tea, as a result of which it reaches the end consumer. The problem of the carcinogenic effect against the background of the above is not perceived as impressive. However, a whole set of synthetic compounds that come into contact with the oral mucosa undoubtedly have high carcinogenic properties. With regular use of synthetic smoking mixtures, a person may develop oral cancer.

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Chronic inflammation

A sluggish, protracted inflammatory process of any localization is a great danger to the body. A long-term course of the disease depletes the body's immune system, increases the risk of diseases of other organs and systems. In addition, chronic inflammation is always a predisposing factor for the appearance of malignant neoplasms. Constant cell division in a certain area can get out of control, which will provoke the appearance of a tumor.

The oral cavity, as mentioned above, performs a number of functions and is subject to constant traumatic impact. Moreover, it is home to a large number of opportunistic microorganisms. It also communicates with the environment, which makes the oral cavity the first protective barrier against external pathological agents. These facts suggest that the development of an inflammatory process in the oral cavity is a common occurrence that everyone encounters. Stomatitis, gingivitis, glossitis, cheilitis, periodontitis - all these are inflammatory diseases that are localized in the oral cavity and can be chronic. Gingivitis, periodontitis and glossitis should be singled out separately. In most cases, these diseases do not respond to local treatment, since their occurrence can be associated with pathologies of other organs and systems. Particular attention is paid to the endocrine, digestive and excretory systems. If the primary pathology is not eliminated, then the inflammation in the mouth can last for years and eventually cause oral cancer.

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Symptoms oral cancer

Traditionally, the description of the clinical picture of various diseases begins with its first signs. However, in this case, we should first consider precancerous diseases. They very often precede the appearance of oral cancer itself. Precancerous pathologies are divided into optional and obligatory. Optional ones are characterized by a low degree of malignancy, and obligatory ones, on the contrary, require prompt medical intervention, since they have a high degree of malignancy.

Optional precancers are represented by the following diseases.

Flat leukoplakia is represented by a hyperkeratosis (increased keratinization) area. Most often it appears due to trauma, smoking, taking medications. It has a cloudy white or gray color, does not rise above the mucous membrane. Does not disappear when scraped. Does not bother clinically. To correct the condition, it is necessary to detect and eliminate the etiological factor.

Chronic ulcer of the oral cavity – most often occurs as a result of trauma. It is located near the traumatic agent (a destroyed tooth, the edge of a denture, etc.). The shape of the ulcer corresponds to the contours of the traumatic object. It periodically bleeds and hurts. For the ulcer to epithelialize, the traumatic factor should be eliminated.

Lichen planus and lupus erythematosus (erosive and hyperkeratotic forms) are chronic inflammatory autoimmune diseases, the clinical picture of which is quite diverse. Consultation with a dentist who specializes in diseases of the oral mucosa is required.

Chronic lip cracks - are most often localized on the lower lip and are vertical. With a long course, the crack may deepen, its edges may become denser and malignant. A chronic crack requires the intervention of a dentist.

Meteorological and actinic cheilitis is an inflammatory process of the red border of the lips, provoked by unfavorable weather conditions. Meteorological cheilitis occurs most often in the cold season, and actinic cheilitis - in warm sunny seasons. The disease manifests itself as redness, the formation of scales on the red border of the lips. If left untreated, this process can become malignant.

Verrucous and erosive leukoplakia are optional precancers with a high degree of malignancy. According to their names, verrucous leukoplakia appears as whitish growths, and erosive leukoplakia appears as erosions.

Oral papilloma is a benign neoplasm that develops from connective tissue papillae covered with epithelium. The shape is spherical, the tumor is located on a narrow or wide stalk, similar in color to the mucous membrane (sometimes it acquires a whitish tint). The condition requires consultation with a dental surgeon.

Cutaneous horn is a non-inflammatory disease that manifests itself as local keratinization. Despite the name, cutaneous horn can appear not only on the skin, but also on the red border of the lips, keratinized areas of the mucous membrane. Apart from unpleasant tactile sensations, cutaneous horn does not cause any symptoms, but requires surgical intervention.

Keratoacanthoma is a benign neoplasm that appears as a rounded keratinization site with a slightly sunken center. The appearance of this lesion can be compared to a crater. The tumor is an optional precancerous tumor and requires prompt removal.

Obligate precancers (which very often become malignant) include Bowen's disease, warty precancer, Manganotti's cheilitis and limited precancerous hyperkeratosis.

Bowen's disease - manifests itself as limited yellowish papular-scaly plaques. It has 4 forms of clinical course, so it is quite difficult to diagnose and requires specialist intervention.

Manganotti's cheilitis is an obligate precancer that affects only the lower lip and appears as bright red erosions. The red border of the lip around the erosion is hyperemic. The lesions may disappear and then reappear over many months. To prevent malignancy, it is necessary to eliminate the main etiologic factor and achieve epithelialization of the erosion.

Limited precancerous hyperkeratosis is the last obligate precancer in this list. Unlike the previous formations, this pathology is observed more often in young and middle-aged people. Based on the name, you can understand that this disease manifests itself in the form of a hyperkeratosis focus. As a rule, it is localized on the red border of the lips (usually on the lower one).

Stages

There is a universal classification system called "TNM" to assess the clinical stage of oral cancer. The name is an abbreviation consisting of the first letters of the words: "tumor", "nodus", "metastasis". If the primary tumor cannot be assessed, the designation "TX" is used. If there is no data on the tumor, the conclusion indicates "T0". The values "T1-T4" are used to conventionally record the tumor size. It is worth noting the designation "Tis", or "tumor in situ" - "cancer in place". This condition is a malignant tumor that has not yet spread to the underlying tissues. The lymph nodes are assessed according to a similar principle: "NX" - regional lymph nodes cannot be assessed, "N0" - there are no metastases in the lymph nodes, "N1-N3" - the degree of involvement of the lymph nodes. The presence of metastases is analyzed more concisely: “M0” – no metastases, “M1” – there are distant metastases.

Based on the TMN classification data, the stage of a malignant neoplasm can be determined. For example, Tis, or carcinoma in situ, is an initial stage (zero). If the tumor does not extend beyond the organ in which it began to develop, it is classified as stage 1 or 2, depending on its size. If the tumor extends beyond the "initial" organ, it is classified as stage 3. When distant metastases and lymph node involvement are detected during examination, such a tumor is classified as stage 4.

General information about the clinical picture of oral cancer

Oral cancer is most often preceded by one of the precancerous diseases discussed above. When a benign neoplasm becomes malignant, a cancerous ulcer, infiltrate or cancerous polyp is formed. The insidiousness of malignant neoplasms is that at the initial stages they do not cause the main symptom - pain. It is the pain syndrome that most often makes a person see a doctor. Therefore, the initial stage of oral cancer can be painless, unlike precancerous diseases.

A cancerous ulcer has differential features that distinguish it from other ulcerative lesions (tuberculosis, syphilis, actinomycosis, decubital ulcer). Firstly, a cancerous ulcer has dense, ridge-shaped edges that are raised above the level of surrounding tissues. In some cases, the ulcer has jagged, corroded edges. The shape of the formation is most often irregular, although before malignancy it was round or oval. The bottom of the ulcer is deepened and covered with a grayish-whitish fibrinous coating. It is worth saying that an ulcer of any origin can be covered with such a coating. However, after removing the film, fine-grained granulation tissue is exposed, which can bleed when touched with an instrument. This indicates that active cell division occurs in the ulcer, which is characteristic of malignant growth. A cancerous ulcer does not cause pain. Most of the above signs can be observed individually in other ulcerative lesions. But together they describe a clear clinical picture, which helps specialists suspect the presence of a cancerous ulcer.

A cancerous polyp is an abnormal growth of the mucous membrane that has acquired a malignant course. At first glance, it seems that it is difficult not to feel a polyp in the oral cavity. After all, our tongue has powerful tactile properties. However, much depends on the size and location of the polyp. Having a small volume and located in areas of the oral cavity hidden from the tongue, a polyp may not cause any sensations. Even gradually increasing in size, the tumor may remain invisible to a person. At a certain point, the patient still discovers a foreign formation in the mouth and seeks help.

Cancerous infiltrate is the most difficult form of cancer to diagnose, in which the tumor process is located in soft tissues. It does not rise above the surrounding tissues and has no specific clinical signs. Externally, it may not be determined at all or have the appearance of a swelling.

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Cancer of the floor of the mouth

This type of cancer most often manifests itself as an ulcerative-infiltrative form. The shape of the ulcerative defect, as a rule, depends on the localization. When located in the anterior part of the oral cavity floor, it will have a rounded shape. In the lateral parts, the ulcer has an elongated geometry. The symptoms of the disease are classic, as for all cancerous lesions of the oral cavity. That is, first a painful ulcer appears, which persists for a long time. It is a precancerous disease and often causes more complaints than cancer at an early stage. After malignancy, the ulcerative defect is felt as a foreign object near the tongue. As the tumor grows, the patient's condition worsens, since the neoplasm quickly spreads to the tongue, lower jaw, muscles of the oral cavity floor and salivary glands. In this case, speech, eating, salivation, etc. may be impaired.

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Cheek cancer

Cancerous lesions of the cheek area are caused by the mobility of this area and its frequent trauma. Almost every person, looking at the inner surface of the cheek, will see a white horizontal strip of keratinization, which is located in the projection of the lip closure. Its presence is physiologically acceptable and typical for most people. However, smoking, alcohol, consumption of carcinogen-containing products, genetic predisposition and living in an ecologically polluted region create a complex of factors. Such a set increases the risk of developing oral cancer several times. It is also worth noting the anterior part of the cheek area, or more precisely, the corners of the mouth. When chewing, talking, yawning, expressing emotions, the skin of the corners of the mouth is constantly moving. This creates constant friction of the skin and mucous membrane of this area. If you ignore the symptoms of a precancerous disease, then we can say that with cheek cancer, the clinical picture resembles that of cancer of the floor of the mouth. That is, a person feels a foreign body and discomfort in the affected area. As the tumor volume increases, the malignant process spreads to the masticatory and medial pterygoid muscles, which are responsible for the function of closing the mouth. This leads to asymmetry in the movement of the lower jaw and disruption of functions associated with opening the mouth.

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Cancer of the alveolar mucosa

Squamous cell carcinoma in this area is a fairly common problem. This is due to the direct contact of removable dentures with the mucous membrane of the alveolar process. Insolvent and deformed fixed structures are also often a chronic traumatic agent. If a cancerous ulcer or polyp is located under the flushing part of the denture or under the base of a removable denture, then a person may not even suspect the presence of a tumor process. In some cases, the patient feels pain while eating. As the tumor progresses, damage to the mandibular bone tissue is possible. This process can affect the mandibular nerve, leading to anesthesia of the teeth and skin of the chin area. When the tumor is localized on the upper jaw, the malignant process often spreads to the maxillary sinus.

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Lip cancer

Lip cancer is one of the most common problems in modern oncology. Despite the fact that the lips are only partially related to the vestibule of the oral cavity, neoplasms of this localization should be considered. The fact is that the lips are those parts of the vestibule of the mouth that are most affected by a person's bad habits. Cigarettes are held precisely due to the lips, hot products primarily contact the lips. It is also worth adding such irritating factors as lip biting, piercing, injection cosmetic procedures, etc. Lip cancer most often manifests itself in the form of an ulcer, which is dense and painless. Given the good visualization of this area, lip cancer is diagnosed in 85% of cases at the first or second stage.

Diagnostics oral cancer

Diagnosis of oral cancer begins with collecting anamnesis. The patient tells the doctor when he first discovered the tumor. If the tumor remained unnoticed by the patient, the specialist clarifies whether there are any symptoms in this area (pain, discomfort, feeling of a foreign body). After this, the dentist carefully examines the lesion. If it is an ulcer, its edges, center, base and surrounding tissues are assessed. Pain during palpation is also determined. When examining a polyp, attention is paid to its color, size, shape and structure.

If oral cancer is suspected, the patient is given a sample for cytological examination (a smear, scraping or puncture is performed). This analysis allows one to evaluate the structure of cells (size, shape), their location, the ratio of organelles and cytoplasm, i.e. to identify cellular atypia, which is characteristic of malignant neoplasms.

Histological examination is a more invasive diagnostic method. It is performed in cases where most clinical signs of a malignant tumor are present. In this case, a fragment of the neoplasm is taken surgically and sent for pathomorphological examination. The pathologist evaluates the nature of the tumor growth and issues a medical report.

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Treatment oral cancer

Treatment of oral cancer corresponds to modern principles of oncology. They involve the use of three main methods: surgical, chemotherapeutic and radiation. Most often, these methods are used in combination, since none of them has a total antitumor effect. Moreover, treatment should be aimed not only at removing the tumor, but also at preventing relapses.

The surgery is performed in the classic version: the tumor and 2-3 cm of healthy tissue around the neoplasm are removed. This stage is very important, since incomplete removal of tumor tissue can provoke further development of the tumor. In this case, a complex surgical operation will be useless.

Chemotherapy is a general treatment method and is used in the presence of metastases. Various antitumor drugs are combined with each other and administered according to a special program. It is worth noting that chemotherapy enhances the effect of radiation therapy, as radiosensitization occurs.

The radiation method is based on the effect of gamma radiation on cancer cells. A directed flow of gamma particles penetrates the malignant tumor and destroys cancer cells. This method is very effective and is carried out in 90% of cases. However, in most cases it is not able to cope with oral cancer on its own, so it is part of a combined treatment.

Some people are convinced that various neoplasms can be treated at home. There are cases when patients tried to cauterize the tumor, remove it themselves, or simply wait for it to go away on its own. Some people also consider it appropriate to use herbal medicine, homeopathy, and folk remedies. However, it is worth noting that these remedies can be effective in other clinical situations, but not in oral cancer. Malignant neoplasms, even with the current level of development of medicine, are a serious challenge for both the doctor and the patient. Even with a full arsenal of antitumor agents, it is not always possible to completely defeat the malignant process. Therefore, the ideal remedy for cancer has not yet been invented. The question of how long to live with oral cancer also remains open. But it is worth saying that each person is unique, and no one knows how this or that organism will react to the appearance of a malignant tumor in it. Therefore, the main task of each person is to minimize risk factors, strengthen the body and lead a healthy lifestyle.

Prevention

Statistics show that most often oral cancer affects people over 40 years of age, who make up more than 95% of all patients. However, this does not mean that young people do not have this pathology. It is also worth saying that 75% of patients with malignant tumors have bad habits associated with smoking or drinking alcohol. Previously, a significant predominance of men among those affected was noted. This is due to the fact that most people addicted to alcohol and smoking were male. However, it has now been established that the number of women with oral cancer has increased significantly. Today, the ratio between male and female patients is approximately 2:1.

To minimize the risk of disease, it is important to always strive to maintain a healthy lifestyle. You should get rid of bad habits and find ways to combat stress. Also, do not forget about regular visits to the dentist for preventive examination. If suspicious formations are detected, you must immediately contact a specialist.

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