Oral and Oropharyngeal Cancer

Oral and Oropharyngeal Cancer

Oral and oropharyngeal cancers are among the most common cancers in the head and neck region. These cancers impact the mouth and the oropharynx (the area behind the mouth), affecting a person’s ability to chew, swallow, breathe, and speak.

Anatomy of the Mouth and Oropharynx

Mouth (Oral Cavity) Includes:

• Lips

• Buccal Mucosa (the lining of the cheeks and lips)

• Gingiva (gums covering the upper and lower jaw)

• Front two-thirds of the tongue

• Floor of the mouth (underneath the tongue)

• Hard Palate (roof of the mouth)

• Retromolar Trigone (the area behind the last molars)

Oropharynx Includes:

• Soft Palate (back part of the roof of the mouth)

• Tonsils

• Back wall of the throat

• Base of the tongue

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Common Types of Oral and Oropharyngeal Cancer

• 90% of these cancers are squamous cell carcinomas, which originate in the flat squamous cells lining the mouth and throat.

• Common Sites:

• Tongue

• Tonsils

• Oropharynx

• Gums

• Floor of the mouth

Statistics

• India: Oral cancer is the second most common cancer.

• Annual Incidence: 135,929 new cases (2020 data).

• 5-year survival rate: In the United States, it is 68%.

Risk Factors

• Tobacco Use:

• 85% of head and neck cancers are associated with tobacco (cigarettes, cigars, beedis, chewing tobacco, snuff).

• Passive smoking also increases risk.

• Marijuana users are also at a higher risk.

• People using chewing tobacco or snuff have 50% higher chances of developing oral cancer.

• Alcohol Consumption:

• Heavy, prolonged drinking significantly increases the risk.

• The combination of alcohol and tobacco multiplies the cancer risk.

• Sun Exposure:

• Prolonged exposure to UV radiation is linked to lip cancer.

• Human Papillomavirus (HPV):

• HPV infection, particularly from oral sex, is linked to oropharyngeal cancers.

• HPV-associated cancers are more common in the tonsils and base of the tongue.

• Other Factors:

• Male gender: Men are more prone to these cancers than women.

• Fair skin: People with fair skin are at higher risk of lip cancer.

• Age: The risk increases after 45 years, though it can occur at any age.

• Poor oral hygiene and ill-fitting dentures can increase cancer risk.

• Poor nutrition (lack of fruits and vegetables) and Vitamin A deficiency.

• Suppressed immunity: Weakened immune systems increase cancer risk.

Prevention

• Avoid tobacco and alcohol.

• Practice safe sexual behavior to reduce HPV exposure.

• Protect your lips from sun exposure using sunscreen.

• Maintain good oral hygiene.

• Eat a balanced diet rich in fruits and vegetables.

Symptoms

• Non-healing sores in the mouth or lips.

• Red or white patches on the gums, tongue, or tonsils.

• Lumps or swelling in the cheek or throat.

• Persistent sore throat or a feeling of something stuck in the throat.

• Voice changes or hoarseness.

• Numbness in the mouth or tongue.

• Bleeding in the mouth.

• Difficulty chewing, swallowing, or moving the tongue or jaw.

• Pain in the ear or jaw.

• Persistent bad breath.

• Changes in speech.

• Loose teeth or poorly fitting dentures.

• Unexplained weight loss and fatigue.

Diagnosis

1. Oral Examination: The doctor checks for abnormalities in the mouth and throat.

2. Endoscopy: A thin, lighted tube is used to inspect the mouth and throat. If suspicious areas are found, a biopsy may be performed.

3. Biopsy: A small tissue sample is removed and examined under a microscope to confirm cancer.

4. Oral Brush Biopsy: A simple test using a brush to collect cells for analysis.

5. HPV Testing: To determine if HPV is involved.

6. Imaging Tests:

• X-ray

• Barium Swallow Test

• CT Scan

• MRI

• Ultrasound

• PET-CT Scan

Treatment

1. Surgery

• Primary Tumor Surgery: Removal of the tumor along with a margin of healthy tissue.

• Glossectomy: Partial or complete removal of the tongue.

• Mandibulectomy: Removal of part or all of the jawbone.

• Maxillectomy: Removal of part or all of the upper jaw.

• Neck Dissection: Removal of lymph nodes from the neck if cancer has spread.

• Laryngectomy: Removal of the larynx if necessary.

• Robotic and Laser Surgery: Minimally invasive techniques.

2. Radiation Therapy

• External Beam Radiation Therapy (EBRT): Radiation from an external machine.

• Internal Radiation Therapy (Brachytherapy): Implanting radioactive sources near the tumor.

• Radiation is often used alone or after surgery.

• Chemoradiation: Combines chemotherapy with radiation for better results.

Side Effects of Radiation:

• Skin irritation, redness, and dry mouth.

• Loss of taste, difficulty swallowing, and fatigue.

• Reduced salivary production.

• Hoarseness or voice changes.

• Thyroid hormone deficiency may develop; regular monitoring is needed.

3. Chemotherapy

• Drugs like cisplatin, fluorouracil (5-FU), and docetaxel are commonly used.

• Can be given before surgery (neoadjuvant therapy) or along with radiation (chemoradiation).

• Side Effects: Fatigue, nausea, vomiting, hair loss, and mouth sores.

4. Immunotherapy

• Uses drugs like nivolumab (Opdivo) and pembrolizumab (Keytruda) to boost the immune response.

5. Targeted Therapy

• Cetuximab (Erbitux) targets cancer cells and can be combined with radiation for localized cancers.

Follow-up Care

• Regular check-ups and imaging tests to monitor recovery and detect recurrence.

• Management of side effects such as dry mouth or dental issues.

• Counseling and support to address emotional and psychological challenges.

Early detection of oral and oropharyngeal cancers improves treatment outcomes. Avoiding tobacco, limiting alcohol, maintaining good oral hygiene, and getting vaccinated for HPV are effective

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