Cancer of the oral cavity

Oral cancers are twice more common among males than among females. Periodical visits to the dentist make early diagnosis possible.

What are they?

Oral cancers include cancers occurring in the mouth, mainly in the lower lips, as well as cancers in the laryngeal, bronchia and those behind the salivary glands. The mouth floor and tongue areas tend to be the most vulnerable to cancer. Almost all oral cancers are caused by the mucosa covering the mouth, the tongue and the lips and the multifold squamous epithelium (squamosa) cells. Oral Cancers are of interest to Otolaryngology and Head and Neck surgeons. Oral cancers are twice more common in than in women.

What are the symptoms?

• White or red-white macula or scars appear in the mouth or lips. White maculae are named 'leukoplakia' and such lesions may turn into malign tumors. Red-white macula are referred to as 'erythoplakia' and are at a higher risk of becoming cancerous.
• Permanent lesions in the mouth and the lips,
• Repeated lesions which cause bleeding or loss of teeth,
• Dysphagia (failure to thrive),
• Swelling or the occurrence of a bulk in the neck,
• Pain striking the ear.
• Pain striking the ear.

What are the risk factors?

There is no clear scientific explanation why some people are more vulnerable to oral cancer than others with the same lifestyle. However, one well-known fact is that this is not contagious. In other words, a person cannot acquire an oral cancer from another person! However, studies indicate that some factors are effective in the incidence of oral cancer.
• Smoking : This is the primary cause of almost all oral cancers. The risk is quite high for heavy smokers or to those who have smoked for many years. The risk of catching an oral cancer is higher with people who also consume alcohol. 90% of oral cancers appear in smokers.
• Alcohol: Those who consume alcohol are known to be facing a higher incidence of oral cancer than those who do not. The risk increases in direct proportion to the amount of alcohol consumed.
• Sun : The sun accounts for a significant share of lip cancers as in all types of skin cancers. Their importance is more significant among smokers.
• The risk is higher in the event of a family history of cancer, poor nutrition, bad living conditions and various other health problems.
• The risk is higher to people who were treated against head and neck cancer before and who keep smoking.
• The incidence of oral cancer is relatively high among people with fractures, sharp-edged dentures or chronic lesions caused by teeth and among people who continue smoking.

What are the methods of diagnosis?

Early diagnosis is of vital importance in treatment of oral and lip cancers, as in all types of cancer. In the early diagnosis of the cancer, regular examinations by physicians and dentists are beneficial, as well as check-ups.

If the physician sees any suspicious lesions or swelling in the mouth, the tongue, cheeks, gingival or mouth floor and lips during examinations, he or she may recommend a biopsy. The tissue specimen taken under local or general anesthesia is microscopically analyzed for the presence of cancer cells. If cancer cells are found, the disorder is held subject to staging for the determination of the tumor extent and its spread to other organs. For this, new medical checks must be performed. For the purpose of preparing a treatment plan, radiological analyses such as direct graphs, computed tomography and magnetic resonance imaging, as well as endoscopic examinations and laboratory tests are required.

How is it treated?

Specialized physicians such as otorhinolaryngologists, medical oncologist and radiation oncologists prepare the treatment plan in coordination whit the patient. If the disorder is to be surgically treated, the application of chemotherapy and/or radiotherapy after the operation is reviewed and put into practice. Plastic surgeons, speaking therapist and dieticians may be involved in the progress of treatment if necessary.

Surgery: The removal of the tumor and the adjacent tissues affected by the tumor requires cleaning of the lymph nodes. Treatment of pain occurring as a result of eating difficulties may be necessary for a while after the surgery. In particular, the disappearance of swelling and of the tissue edema may last for several weeks. Within this period, nutritional deficiencies may be eliminated by the application of appropriate dietary programs. A treatment is to be continued with radiotherapy or chemotherapy after the patient is surgically treated. 

Radiotherapy: Radiotherapy is applied to prevent the spread of cancer by removing cancer cells with high-energy beams applied to the mouth and throat. Radiotherapy doses are determined by taking into account the size and the place of the tumor. Today, advanced devices that give tumor-specific beams are used at the Acibadem Radiotherapy Clinics. The devices increase effectiveness of the treatment, while reducing the side effects of radiotherapy. The most frequent side effects are xerostomia (dryness of the mouth), loss of teeth, throat pain, bleeding and pain in gingival, delay in oral lesions, local infections, stiffness in the chin, changes in the smell and taste senses, slight  burns in the skin and exhaustion. Oral care of the patient must be performed carefully during treatment. Despite the side effect, otorhinolaryngologists help patients recover with an appropriate supportive treatment program.

Chemotherapy: In chemotherapy, drugs are used to prevent the proliferation of cancer cells. Chemotherapy is sometimes applied with surgery and radiotherapy.  Medications used in chemotherapy have side effects, including temporary adverse effects on the liver and the kidneys. Therefore, chemotherapy is mostly applied to patients whose liver and kidneys are functioning normally. Another side effect is alpopecia (hair loss). However, this is temporary. Hair grows again after the treatment. Nausea and vomiting are most frequently observed side effects. Loss of appetite and exhaustion are other possible side effects. As chemotherapy drugs may weaken the immune system, albeit temporarily, patients may be more vulnerable to infections. Chemotherapy is therefore defined as a type of treatment that must be applied very carefully.