Early detection of oral cancer may lead to successful treatment outcomes, recovery

Dr Shailendra Sivalingam, a consultant in otorhinolaryngology, head and neck and skull base surgery, discusses the topic of oral cancer while highlighting the importance of early diagnosis and treatment.

Oral cancer is defined as cancer of the oral cavity and may appear as ulcers or white patches on the floor and roof of the mouth, tongue, lips, cheeks, gums, salivary glands and tonsils. “Depending on the cancer’s location, it can quickly spread to the throat or lymph nodes due to the oral cavity’s rich lymphatic drainage system, enabling tumor cells to disseminate early,” Shailendra explained.

Causes of oral cancer

Genetic, environmental, and lifestyle factors have important roles in the development of oral cancer. Further, human papillomavirus (HPV) infection may increase the risk of oral cancer. A case-control study of patients newly diagnosed with oral cancer showed presence of HPV DNA, specifically of HPV-16, in their oral exfoliated cells. Hence, HPV infection is strongly linked to oral cancer, particularly tonsil-related cancers. [Oral Oncol 2008;44(3):242–250]

“Risks for oral cancer include HPV infection, excessive or prolonged smoking, excessive alcohol consumption, and poor dental hygiene, which introduce carcinogens to the oral cavity, causing genetic mutations that may lead to the development of cancerous cells,” Shailendra noted.

A key lifestyle factor especially among the South Asian population, betel nut chewing may also lead to oral cancer. The World Health Organization has issued a warning on betel nut as a carcinogenic ingredient and its impact on cancer. [https://news.un.org/en/story/2003/08/76352 Accessed on 26 July 2024] The betel nut is of strong acidic nature and contains the alkaloid arecoline, which when chewed with slaked lime and kept in the mouth for a long time, can cause lesions and alter the mouth’s microbiome and oral mucosa, resulting in cancer, he said. [Technol Cancer Res Treat 2022;21:15330338221146870]

Early detection and treatment of oral cancer

Patients with symptoms such as ulcers that persist for longer than 1 week or unusual bleeding in the oral cavity, cheek, or throat should be referred to the ENT surgeon for further investigation, diagnosis and treatment. In later stages, patients may have symptoms such as changes in their voice, dysphagia and noticeable weight loss, and treatment becomes more difficult. Early detection can significantly improve the chances of successful treatment and recovery, Shailendra said.

He noted that diagnosing oral cancer is a detailed process involving biopsy for cancer staging, which shows the difficulty in early detection. Treatment for oral cancer may range from surgery in early stages to a combination of surgery, chemotherapy, and radiation in more advanced stages. Surgical interventions potentially affect patients’ quality of life due to the possibility of disfigurement and difficulties in speaking and swallowing when the tumor is removed from the tongue, cheek, lip or tonsil area. [Oral Oncol 2004;40(7):751–757]

Key preventive measures including abstaining from tobacco and betel quid chewing, maintaining oral hygiene, and attending regular dental check-ups, can lower the risk of oral cancer considerably. Also, early administration of HPV vaccine has been shown to reduce the presence of HPV in oral cavities by 88 percent which may reduce the risk of oral cancer. [Cancer Discov 2017;7(7):OF6] However, the vaccine must be given prior to HPV infection or cancer development.