Cancer of the oral mucosa

The oral cavity is a unique department 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, chopping and forming a food lump is performed mainly at the expense of teeth, cheeks and tongue. At the same time, carbohydrate components of food under the action of amylase break down into simpler structural units. Thus, the initial stages of digestion occur precisely in the mouth.

The oral cavity is the protective barrier of the whole organism. In it the greatest variety of microflora is concentrated. It includes bacteria, viruses, fungi, which in their way of life can be obligate (permanent inhabitants of the oral cavity) and optional (conditionally-pathogenic). Balance microflora prevents the development of pathogenic microorganisms and the emergence of inflammatory and destructive diseases.

Respiratory function of the oral cavity is manifested mainly with increased stresses on the body. As a rule, in a stressed state, a person inhales air through the nose, and exhales through the mouth. This improves the efficiency of gas exchange.

The receptor function of the oral cavity is realized due to the 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 adjust the chewing pressure, feel the temperature of the food, its consistency and taste.

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

[1], [2], [3]

Causes of the oral Cancer

Functional complexity of the oral cavity implies the simultaneous occurrence in it of a variety of biophysical and biochemical processes. 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 the appearance of 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, there is damage, or alteration. Then, the body's defense system is activated in the form of inflammation, the formation of keratinized epithelium, or soft tissue hyperplasia in the area of injury. If the damaging factor is not eliminated for a long time, then the mechanism of cell division fails. As a result, they begin to share faster, generating a large number of defective and non-functional cells. The latter are carried along the blood and lymphatic system to different parts of the body, forming metastases. As a result, a tumor that has arisen in the mouth can go to the lungs, liver, brain and other organs. Cancer cells do not perform any useful functions, because 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 in time it simply stops working. Thus, the main cause of malignant tumors is a violation of the mechanism of cell division, and the leading risk factor is chronic damage.

Mechanical Injury

The easiest to understand risk factor is chronic mechanical damage. It can be observed in people of any age, gender and socio-economic status. For example, a child with an abnormal bite or incorrectly placed teeth can permanently injure the mucous membrane of the oral cavity. In the place of damage, the mucosa begins to become cornificate, which significantly reduces the symptoms of trauma. However, the damaging factor will still injure soft tissues, provoking a constant regeneration, that is, cell division.

Some people have shattered teeth with sharp edges. If, for various reasons, they do not consult a dentist, a chronic trauma to the tongue, cheeks and lips may appear. The main problem of chronic damage is that it is partially "leveled" by the body itself through compensatory reactions. As a result, the pathological process has a protracted, weakly expressed character. This helps the person to gradually get used to it and not try to eliminate it.

Removable dentures, manufactured by the wrong technology can cause even combined damage. A mechanical injury occurs when the prosthesis does not fit properly to the mucosa. As a result, zones of increased load and friction are formed. If during the polymerization of the plastic of the prosthesis the technical process has been disrupted, then a monomer may be present in the prosthesis. 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, there will inevitably be bedsores, erosions, ulcers, inflammatory reactions. All these pathological elements and processes can trigger the occurrence of oral cancer.

It is also worth noting the traumatic impact of bracket systems. To date, orthodontics is a very popular field of dentistry among the population. Patients in adolescence are increasingly installing braces to treat bite abnormalities or dentition. However, locks and arcs of the orthodontic system can have a significant traumatic effect on the soft tissues of the oral cavity. And if we take into account that in the majority of cases the braces are used continuously for two years, it is not difficult to guess what consequences the patient may have.

One of the traumatic factors, which rarely pay attention to, is the worn out ceramics on an artificial crown. Metal-ceramic designs are preferred by a lot of people because of their reasonable cost and aesthetic qualities. However, not everyone knows that a smooth surface of a metal-ceramic surface is created with the help of a thin layer of so-called "glaze". In the process of prolonged functioning of the crown, the glaze can be erased, after which the underlying ceramic layer is exposed. All deep layers have a rough surface, because of which as a result of friction of the mucous membrane, a chronic injury occurs on the crown.

Chronic stress, or rather their consequences, occupy one of the key places in the occurrence of mechanical damage to the mucous membrane. It's about biting the inner surface of the lips and cheeks. In the conditions of modern life, almost all people are in a state of stress. In some people, it manifests itself in the form of insomnia, in others - in the form of a night gnashing of teeth. But, very often, stress is accompanied by biting the mucous lips or cheeks. This can happen consciously and subconsciously, however, the result in this case is one - a chronic mechanical trauma.

[4], [5], [6]

Physical trauma

The most common type of physical injury is temperature damage. It is interesting that people often speak of acute thermal trauma. This is not surprising, because burns and frostbite clinically proceed very brightly 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 food causes an injury to the mucous membrane of the oral cavity. As a result, the activity of the keratinization processes is increased, which is the first step on the path to the appearance of pathological neoplasms.

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

Chemical Injury

Chronic chemical damage to the oral mucosa often occurs in smokers and drug addicts. 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 - narcotic, and 69 - carcinogens. Most people suffering from cancer pathologies of the respiratory tract are smokers. And considering that smoke first of all enters the oral cavity, it becomes obvious the harmful effect of tobacco smoke on the mucous membrane of the oral cavity. No less dangerous is chewing tobacco. Although many consumers are naively convinced that chewing tobacco is harmless. The argument is that it does not contain smoke and does not enter the lungs. This myth is easy to destroy, saying that chewing tobacco in the oral cavity is actively chewed, which means that a large proportion of it is absorbed through the mucous membrane. Moreover, with the saliva, the tobacco particles enter the esophagus and stomach. This creates a risk of oncological diseases 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 represent a problem for society because of its psychogenic effect. Inadequate behavior of a person under the influence of synthetic smoking mixtures represents a high level of danger for the surrounding people. Moreover, the nervous system of the smoker with time is subject to irreversible degenerative changes. In connection with these facts, the sale of such smoking mixtures is prohibited in most countries. But, manufacturers in every possible way try to veil their product under aromatic herbs, spices, tea, as a result of which it reaches the end user. The problem of a carcinogenic effect against the background of the above is not perceived as impressive. However, a whole range of synthetic compounds that come into contact with the oral mucosa undoubtedly have high carcinogenic properties. With the regular use of synthetic smoking mixtures in humans, oral cancer can appear.

[7], [8], [9], [10],

Chronic inflammation

Sluggish lingering inflammatory process of any localization represents a great danger to the body. A prolonged 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 in the appearance of malignant neoplasms. The constant division of cells 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 permanent traumatic effects. Moreover, it contains 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 the inflammatory process in the oral cavity is a common occurrence that everyone faces. Stomatitis, gingivitis, glossitis, cheilitis, periodontitis are all inflammatory diseases that are localized in the oral cavity and can have chronic course. Separately it is necessary to distinguish gingivitis, periodontitis and glossitis. In most cases, these diseases are not amenable 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, the inflammation in the mouth can last for years and, as a result, cause cancer of the oral cavity.

[11], [12], [13], [14], [15],

Symptoms of the oral Cancer

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

Optional pre-cures are represented by the following diseases.

Leukoplakia is flat - it is represented by a site of hyperkeratosis (increased keratinization). Most often appears on the background of trauma, smoking, medication. Has a dull white or gray color, above the level of the mucosa does not rise. When scraping does not disappear. Clinically does not bother. To correct the condition, it is necessary to detect and eliminate the etiologic factor.

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

Red flat lichen and lupus erythematosus (erosive and hyperkeratotic forms) are chronic inflammatory autoimmune diseases, the clinical picture of which is quite diverse. It is necessary to consult a dentist who specializes in diseases of the oral mucosa.

Chronic lip cracks - are localized most often on the lower lip and have a vertical arrangement. With a long flow, it is possible to deepen the crack, seal its edges and malignancy. Chronic fracture 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 - in warm sunny seasons. The disease is manifested by reddening, the formation of scales on the red border of the lips. In the absence of treatment, this process may become malignant.

Leukoplakia eruptive and erosive - are facultative precursors with a high degree of malignancy. Accordingly, their names, verukoznaya leukoplakia manifests itself in the form of whitish growths, and erosive in the form of erosion.

Papilloma of the oral cavity is a benign neoplasm that develops from the papillae of connective tissue covered with epithelium. The form is spherical, the tumor is located on a narrow or wide stem, in color is similar to the mucous membrane (sometimes acquires whitish shade). The condition requires consultation of a dental surgeon.

The cutaneous horn is a non-inflammatory disease that manifests itself in the form of local keratinization. Despite the name, the skin horn can appear not only on the skin, but also on the red border of the lips, the keratinized areas of the mucosa. In addition to unpleasant tactile sensations, the skin horn does not cause any symptoms, but requires surgical intervention.

Keratoakantoma - a benign neoplasm, which manifests itself in the form of a rounded foci of keratinization with a slightly sinking center. The appearance of this lesion can be compared with a crater. The tumor is an optional precancer and requires prompt removal.

To obligate pre-cancer (which is very often associated with malignancy) is Bowen's disease, warty pre-cancer, Manganotti cheilitis and limited precancerous hyperkeratosis

Bowen's disease - manifested in the form of limited yellowish papular-scaly plaques. It has 4 forms of clinical course, therefore it is diagnosed rather difficult and requires specialist intervention.

Halit Manganotti is an obligate precancer that affects only the lower lip and is manifested as erosions of bright red color. Around the erosion, the red border of the lip is hyperemic. Elements of defeat can disappear, and then re-appear for many months. To prevent malignancy, it is necessary to eliminate the main etiologic factor and achieve epithelization of erosion.

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

Stages

To assess the clinical stage of oral cancer, there is a universal classification of "TNM". The name is an abbreviation, which consists of the first letters of the words: "tumor" - tumor, "nodus" - lymph nodes, "metastasis" - metastasis. If the primary tumor can not be evaluated, then the designation "TX" is used. If there is no tumor data, then the conclusion is "T0". Values of "T1-T4" are used for conditional recording of tumor dimensions. It should be noted the designation "Tis", or "tumor in situ" - "cancer in place." This condition is a malignant formation, which has not yet spread into the underlying tissues. Assessment of lymph nodes is carried out on the same principle: "NX" - regional lymph nodes can not be evaluated, "N0" - there are no metastases in lymph nodes, "N1-N3" is the degree of involvement of lymph nodes. The presence of metastases is analyzed more concisely: "M0" - there are no metastases, "M1" - there are distant metastases.

Based on the TMN classification data, it is possible to establish the stage of malignant neoplasm. For example, Tis, or cancer in place, refers to the initial stage (zero). If the tumor does not go beyond the body in which it began its development, then it refers to 1 or 2 stages, depending on the size. If the tumor has gone beyond the "initial" organ, then it refers to the 3 stages. When the examination reveals distant metastases and lesions of the lymph nodes, then this tumor is in 4 stages.

General information about the clinical picture of oral cancer

Oral cancer is most often preceded by one of the precancerous diseases discussed above. At malignization of a good-quality new growth the cancer ulcer, an infiltrate or a cancer polyp is formed. The insidiousness of malignant neoplasms is that in the initial stages they do not cause the main symptom - pain. It is the pain syndrome that most often causes a person to see a doctor. Therefore, the initial stage of oral cancer can be painless, in contrast to precancerous diseases.

Cancer ulcer has differential signs that distinguish it from other ulcerative lesions (tuberculosis, syphilis, actinomycosis, decubital ulcer). First, the cancer ulcer has dense, cylindrical edges that are raised above the level of surrounding tissues. In some cases, the ulcer has torn, pitted edges. The form of education is often incorrect, although before the 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 such a touch can be covered with an ulcer of any origin. However, after removing the film, fine granular tissue is exposed, which can bleed when touched by the instrument. This indicates that in the ulcer there is an active division of cells, which is characterized by malignant growth. Painful sensations do not cause cancer. Most of these symptoms can be seen separately in other ulcerative lesions. But in the aggregate they describe a clear clinical picture, which helps specialists to suspect the presence of cancer ulcers.

Cancer polyp is an abnormal proliferation of the mucous membrane, which has acquired a malignant course. At first glance it seems that the polyp in the oral cavity is hard not to feel. After all, our language has powerful tactile properties. However, much depends on the size and localization of the polyp. Having a small volume and located in the hidden areas of the oral cavity, the polyp can not cause any sensations. Even increasing gradually in size, the tumor can remain invisible to humans. At some point the patient still discovers a foreign formation in the mouth and seeks help.

Cancer infiltrate is the most difficult form of cancer for diagnosis, in which the tumor process is located in soft tissues. He does not rise above the surrounding tissues, does not have specific clinical signs. Outwardly, it may not be defined at all or have the appearance of a swelling.

[16], [17], [18]

Cancer of the bottom of the mouth

This type of cancer affects most often in the form of a ulcerative infiltrative form. The form of the ulcerative defect, as a rule, depends on the localization. When placed in the anterior part of the bottom of the oral cavity, it will have a rounded shape. In the lateral parts of the ulcer has an elongated geometry. The symptomatology of the disease is classic, as for all cancers 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 the initial stage. After malignancy, the ulcer defect is felt like a foreign object near the tongue. As the tumor grows, the condition of the patient becomes worse, as the neoplasm quickly spreads to the tongue, lower jaw, muscles of the bottom of the mouth and salivary glands. It may be a violation of speech, eating, saliva, etc.

[19]

Chest cancer

Cancerous damage to the buccal region is due to the mobility of this zone and its frequent traumatization. Almost every person, glancing at the inner surface of the cheek, will see a white horizontal strip of keratinization, which is located in the projection of the closing of the lips. Its presence is physiologically acceptable and inherent in most people. However, smoking, alcohol, the use of carcinogenic products, genetic predisposition and living in an ecologically polluted region create a set of factors. Such a set raises the risk of developing oral cancer several times. It is also worth noting the anterior part of the buccal region, or rather the corners of the mouth. When chewing, talking, yawning, expressing emotions, the skin of the corners of the mouth constantly moves. This creates a constant friction of the skin and mucous membrane of this area. If you miss symptoms of precancerous disease, then we can say that with cancer of the cheek, the clinical picture resembles that of cancer of the bottom of the mouth. That is, a person feels a foreign body and discomfort in the area of defeat. With an increase in tumor volume, the malignant process extends to the chewing and medial pterygoid muscles, which are responsible for the function of closing the mouth. This leads to an asymmetry in the movement of the lower jaw and a violation of the functions that are associated with opening the mouth.

[20], [21]

Cancer of the mucous membrane of the alveolar process

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. Insecure and deformed non-removable structures are also often a chronic traumatic agent. If the cancer ulcer or polyp is under the washing part of the prosthesis or under the basis of a removable prosthesis, then the person may not even suspect the presence of a tumor process. In some cases, the patient feels pain while eating. With progression of tumor growth, it is possible to damage the mandibular bone tissue. This process can affect the mandibular nerve, leading to anesthesia of the teeth and skin of the chin area. When the tumor is located on the upper jaw, the malignant process often spreads into the maxillary sinus.

[22], [23], [24], [25], [26]

Lip Cancer

Lip cancer is one of the most common problems in modern oncology. Despite the fact that the lips only partially belong 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 mouth that most of the harmful habits of the person are directed at. Cigarette retention occurs precisely at the expense of the lips, hot foods are primarily in contact with the lips. Also it is necessary to add such irritating factors, as a biting of lips, piercing, injecting cosmetology procedures, etc. Lip cancer most often manifests itself in the form of an ulcer that is dense and painless. Given the good visualization of this zone, lip cancer in 85% is diagnosed in the first or second stages.

Diagnostics of the oral Cancer

Diagnosis of oral cancer begins with the collection of anamnesis. A person tells a doctor when he first discovered a tumor. If for the patient the tumor remained imperceptible, the expert specifies, whether there are in this area any signs (a pain, a dyscomfort, feeling of a foreign body). After this, the dentist carefully examines the lesion. If this is an ulcer, then its edges, center, base and surrounding tissues are evaluated. It also determines the soreness of palpation. When examining the polyp, attention is drawn to its color, size, shape and structure.

In case of suspected cancer of the oral cavity, the patient is sampled for cytological examination (a swab, scraping or puncture is performed). This analysis allows you to evaluate the structure of cells (size, shape), their location, the relationship of organelles and cytoplasm, i.e. To reveal the cellular atypia, which is characteristic for malignant neoplasms.

Histological examination is a more invasive method of diagnosis. It is performed in those cases when the majority of clinical signs of a malignant tumor are present. In this case, the fragment of the neoplasm is taken by the surgical method and sent to a pathomorphological study. A pathologist assesses the nature of tumor growth and issues a medical report.

[27], [28], [29], [30],

Treatment of the oral Cancer

Treatment of oral cancer meets modern principles of oncology. They suggest the use of three main methods: surgical, chemotherapeutic and radiation. Most often, these techniques 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.

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

The chemotherapeutic method is a common treatment method and is used in the presence of metastases. Various antitumor drugs are combined with each other and administered by a special program. It is worth noting that chemotherapy enhances the effect of radiation therapy, since radiosensitization takes place.

The radiation method is based on the effect of gamma radiation on cancer cells. A directed flux of gamma particles penetrates into the malignant tumor and destroys the 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 alone, therefore it is part of the combined treatment.

Some people are convinced that different neoplasms can be treated at home. There are cases when patients tried to burn a tumor, removed themselves or simply waited for it to pass by itself. Also, some people consider it expedient to use phytotherapy, homeopathy and folk remedies. However, it should be noted that these drugs can be effective in other clinical situations, but not with 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 antineoplastic agents in hand, it is not always possible to completely defeat the malignant process. Therefore, an ideal remedy against cancer has not yet been invented. The question remains as to how much to live with oral cancer. 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 a healthy lifestyle.

Prevention

Statistics show that most people with oral cancer are over 40 years old, who make up more than 95% of all those who suffer from it. However, this does not mean that young people do not have this pathology. Also it is necessary to say that 75% of patients with malignant tumors have bad habits associated with smoking or drinking alcohol. Previously, there was a significant predominance of men among the sick. This is due to the fact that the majority of alcohol and smoking-dependent people were male. However, it has now been established that the number of women with oral cancer has increased significantly. To date, the ratio between sick men and women is approximately 2: 1.

To minimize the risk of disease, it is important to always strive to maintain a healthy lifestyle. It is necessary to get rid of bad habits and find ways to deal with stress. Also, one should not forget about a regular visit to a dentist for a preventive examination. When detecting suspicious formations, you should immediately contact a specialist.

[31], [32], [33], [34]