Oral cancer symptoms first signs. What is oral cancer, its profilatika, symptoms and treatment
Among the malignant tumors of the head and neck oral cancer in frequency ranks second after laryngeal cancer. Malignant tumors diagnosed in the oral cavity are mainly different types of squamous cell carcinoma. According to the International Classification, malignant tumors originating from stratified epithelium are divided into:
- Intraepithelial carcinoma (carcinoma in situ).
- Squamous cell carcinoma
- Types of squamous cell carcinoma:
- verrucous carcinoma;
- spindle cell carcinoma;
- lymphoepithelioma.
When describing cancer of the mucous membranes of the oral cavity, there are three anatomical forms of the most common tumor growth: exophytic, or papillary; infiltrative and ulcerative-infiltrative.
Regardless of the anatomical form of the tumor and its localization, there are three periods of development of cancer of the mucous membranes of the oral cavity: the initial, the advanced and the neglect period.
Initial period. During this period, patients most often complain about the sensation of the presence of a foreign body, discomfort in the oral cavity. A number of patients complain of a burning sensation, moderate pain when eating. On examination of the oral cavity, erosion, small ulcers without severe infiltration, seals located on the mucous membrane of the cavity or in the submucosal layer, hyperkeratosis presented in the form of whitish spots, outgrowths of the mucous membrane with a whitish surface can be detected. Despite the diversity of the clinical picture in the initial period, the main symptom that forces you to see a doctor is pain.
Developed period. The main symptom of a developed period of cancer of the mucous membranes of the oral cavity is pain of varying degrees of intensity. The pain can be local or radiating most often in the ear, the temporal part of the corresponding side. In this period, the oral cavity mucosa is subdivided into anatomical forms.
Papillary cancer may develop on the background of papillomatosis, verrucous leukoplakia. In this form, the tumor has the appearance of compacted tissue, towering above the surrounding tissue. Education may have the appearance of an elevated hemisphere or have a base in the form of a wide leg. In the thickness of the tissue, according to the projection of the tumor, an infiltrate is palpated without clear boundaries. The surface of the tumor may be hilly, covered with areas of keratinized epithelium, in some cases represented by a fine-grained surface, bleeding easily with a minor injury.
Infiltrative cancer is quite rare, but it is she who presents the greatest difficulties in diagnosis. The disease begins with the appearance of a low-painful infiltrate in the thick of the tissues, the mucosa covering it is most often hypermetered. Over time, an increase in infiltration occurs, which limits the function of the oral organs.
Patients complain of pain, difficulty in eating, talking. With further course of the disease, the infiltration ulcerates, complaints of pain increase, and bleeding may occur.
Ulcerative Infiltrative Cancer occurs more often than others, its share among other clinical manifestations of oral mucous membrane cancer is about 65%. The tumor is presented as a cancer ulcer, the shape and size of which vary widely and depend on the location and stage of the process. The edges of the ulcer are roller-shaped raised above the surrounding tissues. The bottom is either in the form of necrotic tissue, or covered with fibrinous bloom, after removal of which the bottom of the ulcer is determined by a krate-like shape, made with fine-grained tissue that bleeds easily with a minor injury. At the base of the ulcer, a dense infiltrate is palpated, which, as a rule, exceeds the size of the tumor ulcer in size and often extends to adjacent anatomical structures.
Period of neglect. Depending on the location of the tumor, it spreads to the muscles of the floor of the mouth, the muscles of the cheek, and the skin grows.
Cancer of the mucous membrane of the alveolar part of the upper or lower jaw spreads to the bone tissue. With the localization of the tumor in the posterior oral cavity - on the palatine arches, lateral pharyngeal sections. Based on clinical observations, it should be noted that cancer of the posterior oral cavity is more malignant and metastasizes to the regional lymph nodes at an earlier date. Histological examination of the posterior oral cavity has, as a rule, low differentiation of tumor cells.
Cancer of the mucous membrane of the tongue
Most often, the tumor process affects the middle and posterior third of the lateral surface of the tongue.
The most common symptom in this location is pain, which is often associated with trauma to the tumor on existing teeth. Earlier, functional impairment occurs (chewing, swallowing, speech), which is associated with both pain syndrome and limited mobility of the tongue with a pronounced infiltrative component of the tumor. The ulcer on the lateral surface of the tongue has a round or oval shape, at the base of which is determined the infiltrate. On palpation, as a rule, there is a discrepancy between the size of the tumor (ulcer) and the infiltrate, which exceeds its size and can spread both to the tissue of the floor of the mouth and to the muscles, going beyond the midline, to the root, up to a total lesion of the entire tongue.
Cancer of the oral mucosa
In the area of the floor of the mouth cavity, the ulcer-infiltrative form of the tumor is more common. In the anterior regions of the floor of the mouth, the ulcer has a rounded shape, in the middle and posterior third it is slit-shaped, and in some cases of observation, one part of the tumor is located in the region of the floor of the mouth, and the other on the lateral or anterior surface of the tongue.
In the initial period, patients complain of a feeling of a foreign body. A painful symptom appears at the accession of a secondary infection and at a later date. Topographic and anatomical features of this localization determine the early spread to the tissues of the tongue, the mucous membrane of the alveolar part of the mandible. During the period of neglect, the tumor infiltrates the muscles of the floor of the mouth, submandibular salivary gland, destroys the alveolar part and the body of the mandible.
Cancer of the mucous membrane of the cheeks
Most often the tumor process is manifested in the form of ulcerative-infiltrative form. A typical localization of a tumor ulcer is the mucous membrane along the line of teeth closing, the retromolar region, the corners of the mouth, i.e. those anatomical areas of the cheek that are most often subjected to traumatization. In the initial period, patients complain of discomfort, foreign body sensation. More than half of patients noted that the disease began with the appearance of pain when eating, talking. With the progression of the disease, the tumor process extends to the muscles of the cheek, the skin, the mucous membrane of the transitional fold, the alveolar part of the upper or lower jaw. When the tumor is located in the distal parts and the process spreads to the chewing or internal pterygoid muscle, the opening of the mouth is limited. For tumors of the retromolar region is characterized by metastasis at an earlier date and involvement in the process of the tonsils and palatal handles.
Cancer of the mucous membrane of the palate
The most frequent localization of squamous cell carcinoma is the soft palate. On the hard palate, tumors from the small salivary glands are more common: malignant - adenocystic carcinoma, adenocarcinoma; benign - polymorphic adenomas. For squamous cell carcinoma of the mucous membrane of the palate, the ulcer-infiltrative form is more characteristic. At this location of the tumor, one of the earliest symptoms is the appearance of pain, which causes patients to consult a doctor.
Cancer of the mucous membrane of the alveolar process
The tumor with the same frequency is located on both the lingual and buccal side. The upper jaw also does not determine the predominant lesion of any side of the alveolar process (palatine or buccal). More common ulcerative infiltrative form. In the developed period, the bottom of the tumor ulcer is the dirty-gray bone tissue, although radiographically bone-destructive changes may not be detected. During the period of neglect, bone destruction occurs and the process spreads to the body of the lower jaw, surrounding soft tissues. In the upper jaw, the process destroys the bone tissue of the alveolar process and the subsequent germination of the tumor in the maxillary sinus. The tumor process manifests itself quite early and the main symptom is often pain, which increases with food intake.
Regional metastasis of oral mucous membrane cancer
The frequency of metastasis and localization of metastases depends on the location of the tumor in the oral cavity, its differentiation, and the characteristics of lymph circulation. In cancer of the mucous membrane of the lateral surface of the anterior and middle third of the tongue, metastasis occurs in the submandibular, middle and deep cervical lymph nodes. The frequency of metastasis in the defeat of the tumor process in these areas is 35-45%.
When the tumor is localized in the posterior third and root of the tongue, metastasis occurs much more frequently in the upper deep cervical lymph nodes and is about 75%.
With the defeat of the anterior process of the floor of the mouth cavity, the mucous membrane of the anterior alveolar part of the mandible, the mucous membrane of the cheek, metastasis occurs in the submandibular and submental lymph nodes. Cancer of the posterior regions of the floor of the mouth, the retromolar region, metastasizes mainly to the upper and middle jugular lymph nodes.
Tumors of the mucous membrane of the palate and the alveolar process of the upper jaw metastasize to the submandibular and posterior pharyngeal lymph nodes, sometimes metastasis is determined in the frontal ear nodes.
In cancer of the mucous membranes of the oral cavity, there are cases of contralateral and bilateral metastases on the neck.
In some cases, in the diagnosis of regional metastases, palpation examinations alone are not enough, there may be cases of both hyper- and underdiagnostics. Great importance for the presence of enlarged lymph nodes and possible damage to the tumor process is attached to methods of radiation diagnosis: computed tomography, ultrasound. Important for the diagnosis of regional metastases is a cytological method for the study of punctate from enlarged lymph nodes, the reliability of this method is 70-80%.
TNM clinical classification.The classification is applicable only for cancer of the oral mucosa:
- TX - Not enough data to evaluate the primary tumor.
- T0 - Primary tumor is not detected.
- Tis - Preinvasive carcinoma.
- T1 - Tumor up to 2 cm in the greatest dimension.
- T2 - Tumor up to 4 cm in the largest dimension.
- T3 - Tumor more than 4 cm in the largest dimension.
- T4 - Oral cavity: the tumor spreads to the adjacent anatomical structures - the cortical layer of the bone, the deep muscles of the tongue, the maxillary sinus, the skin.
- NX - Not enough data to evaluate regional lymph nodes.
- N0 - No signs of metastatic lesion of regional lymph nodes.
- N1 - Metastases in one lymph node on the affected side up to 3 cm in the largest dimension.
- N2 - Metastases in one lymph node on the affected side up to 6 cm in the largest dimension, or metastases in several lymph nodes on the affected side up to 6 cm in the largest dimension, or metastases in the lymph nodes of the neck on either side or on the opposite side up to 6 cm largest dimension.
- N2a - Metastases in one lymph node on the affected side up to 6 cm in the largest dimension.
- N2b- Metastases in several lymph nodes on the affected side up to 6 cm in the largest dimension.
- N2c - Lymph node metastases on either side or on the opposite side, up to 6 cm in the largest dimension.
- N3 - Metastases in the lymph nodes more than 6 cm in the largest dimension.
- MX - Not enough data to identify distant metastases.
- M0 - No signs of distant metastases.
- M1 - There are distant metastases.
Grouping by stages
| Stage | Grouping by stages | ||
| 0 | Tis | N0 | M0 |
| I | T1 | N0 | M0 |
| II | T2 | N0 | M0 |
| III | T3 | N0 | M0 |
| T1 | N1 | M0 | |
| T2 | N1 | M0 | |
| T3 | N1 | M0 | |
| IVA | T4 | N0 | M0 |
| T4 | N1 | M0 | |
| Any T | N2 | M0 | |
| IVB | Any T | N3 | M0 |
| IVC | Any T | Any N | M1 |
Treatment of oral mucosa cancer
The main methods of treatment are radiation, chemotherapy and surgery, as well as their combination with each other. Cancer of the mucous membranes of the oral cavity belongs to moderately radiosensitive tumors, but despite this, the radiation method is the most common. It is used in almost 90% of patients. The most common in the treatment of this group of patients received remote gamma therapy, which is carried out as an independent method of treatment, and in combination with other antitumor methods.
As an independent method of treatment in patients with cancer of the mucous membranes of the oral cavity, it is more often used for palliative purposes. In some cases, especially with low differentiation of tumor cells, with the prevalence of the tumor process T1-T2, it is possible to obtain a complete regression of the tumor. However, the clinical observations of many authors and their own allow us to conclude that radiation treatment as an independent method of treatment does not give a stable result. The best results were achieved with combined treatment, when surgery was included in the plan of antitumor methods, which can be performed after preoperative radiation treatment (the second stage of the combined treatment) and before the radiation treatment (the first stage of the combined treatment).
Surgical treatment of patients with cancer of the mucous membranes of the oral cavity is an important step, the features of which depend on the prevalence of the process and localization. Surgery is performed according to all the rules adopted in oncology, i.e. the tumor should be removed within healthy tissues, some distance from the defined boundaries 2.5-3.5 cm. As an independent method, the operation in this group of patients is practically not performed due to the high probability of recurrence. For T1 tumors after radiation therapy, it is possible to remove the tumor within the organ. An example is the operation of a half-resection of the tongue. Locally common tumors require combined operations when adjacent anatomical structures are included in the tissue to be removed.
Combined operations in the maxillofacial area lead to disfigurement of the patient, significantly violate such important body functions as the ability to eat, breathe, speak, etc. In this regard, an important component of surgical intervention is the restoration of lost organs and partial or complete restoration of function . Restoration of organs and functions can be performed during the operation in full, if this is not possible due to various circumstances, then the restorative part should be preparatory for subsequent interventions to restore lost organs and tissues and impaired functions.
Chemotherapy in patients with tumors of the mucous membranes of the oral cavity is indicated for a common process, the presence of metastases or relapses. Antitumor regimens of combination drugs with a different mechanism of action significantly increase the effectiveness of treatment. The use of chemotherapy before radiation treatment has a radiosensitizing effect - hypoxia is reduced, the blood supply to the tumor tissue improves, the size of the tumor decreases.
The most rational approach to the treatment of patients with cancer of the mucous membranes of the oral cavity is the use of a complex chemotherapy - radiation treatment - surgery.
"Diseases, injuries and tumors of the maxillofacial region"
by ed. A.K. Iordanishvili
Oral cancer is a group of malignant tumors that develop on the mucous membranes of the mouth. This type of cancer is distinguished by the possibility of early diagnosis, thereby increasing the chances of successful treatment.
Despite this fact, few people seek help from specialists in the presence of primary symptoms. In the end, this reduces the favorable prognosis.
According to statistics, oral cancer is several times more common in men than in women. The main risk group includes the elderly after sixty years.
Causes of Cancer in the Mouth
According to numerous studies, cancer mainly occurs on pathologically changed tissues formed due to dyskeratosis and many other inflammatory processes.
A special role in the development of malignant neoplasms is played by bad habits: the chewing of betel leaves (common among the people of India), the use of “nasa” (among the people of Central Asia), the use of alcoholic beverages and smoking. In addition, the appearance of cancer of the cavity is preceded by numerous mechanical injuries that are caused by sharp teeth, low-quality prostheses, etc.
Also in the development of oncology, the role of nutrition (the use of hot or spicy foods, insufficient vitamin A content) plays a role. In recent years, scientists have found that human papillomaviruses can affect the appearance of cancerous tumors.
Mouth Cancer Symptoms
Oral cancer is divided into three periods:
Elementary
In the area of the pathological focus, the patient notes strange sensations unfamiliar to him. Visual examinations of the mouth reveal numerous changes: superficial sores, white spots, papillary formations, mucosal seals, etc.
At the initial stage of development, the painful symptoms of oral cancer are observed in about 25% of cases, but they are associated with angina or diseases of the teeth. Three anatomical forms of this type of cancer are distinguished: ulcerative, nodular and papillary. In most cases, the ulcer is found, and in some people the sores grow at a very high rate, while others, on the contrary, grow very slowly. Unfortunately, conservative methods of treatment often do not lead to a reduction in the size of the ulcers.
The knotty form is a hardening in the tissues or coating with white spots of a seal on the oral mucosa. Seals develop much faster than with any other anatomical forms, and have fairly clear boundaries. Papillary form characterizes the development of dense formations above the mucous membrane. Usually the outgrowths are covered with intact mucous membranes and can develop very quickly.
Developed
This period has numerous symptoms: the manifestation of painful pains of varying intensity, increased salivation, fetid odor from the mouth. Pain is usually local in nature, but in some cases it can also give to the head.
Salivation increases due to the fact that the decay products of neoplasms irritate the mucous membrane. Offensive odor is formed due to decay and infection of a malignant tumor.
Launched
Oral cancer belongs to exclusively malignant and aggressive neoplasms, after the fact that this type of cancer can quickly spread and destroy all surrounding tissues. , that with lesions on the mucous membrane of the posterior part of the oral cavity, the disease is much more difficult than with other sites, and it is more difficult to treat. There are many locations of oral cancer, it can develop on the tongue, on the floor of the mouth, on the mucous membrane of the cheeks, gums, palate and alveolar region, as well as on the jaw itself.
The development of cancer of the tongue mainly occurs in the middle third of the lateral surfaces. Much less often, a neoplasm occurs at the tip and lower surface of the tongue. Cancer of the bottom is found in 25% of all cases of squamous cell carcinoma. Quite often, the bottom is secondarily infected with malignant tumors of the submandibular glands, gums, tongue or lower jaw. In cancer of the buccal mucosa, the histological picture is similar to cancer of the tongue and cancer of the bottom cavity.
The mucous membrane of the cheek, as well as in case of cancer of the bottom cavity, can be infected for the second time on the sides of the skin, lips and tonsils. Metastases are rare. In cancer of the mucous membrane of the sky, the development of malignant formations on the hard palate, which emanate from the small salivary glands. Cancer of the mucous membrane of the alveolar region of the lower and upper jaws has a squamous oncology structure. It manifests itself in the early stages of a strong toothache.
When the period is neglected, there is an active destruction of the surrounding tissues. Gum cancer can spread to the mucous membranes of the floor of the mouth and cheeks. Regional metastases are diagnosed in 30% of patients.
Common symptoms of oral cancer
Stages of cancer in the mouth
- 1st stage. The tumor reaches a diameter of one centimeter, without going beyond the limits of the mucous and submucous layers. Regional metastasis is absent.
- 2nd stage. The stage is divided into two sub-stages: 2A and 2B. At 2A, the diameter of the tumor is about two centimeters, and the underlying tissues can grow to a depth of one centimeter. The presence of regional metastases is not observed. Stage 2B is characterized by the presence of a single displaced regional metastasis on the affected side.
- 3rd stage. At stage 3A, the neoplasm reaches three centimeters, metastasis is not observed. At stage 3B, displaceable metastases are observed on the affected side.
- 4th stage. Stage 4A is characterized by damage to the entire anatomical region. The neoplasm can spread on the bones of the facial skeleton and surrounding soft tissue. There are no regional metastases. At stage 4B, there may be the presence of distant or unshifting regional metastases.
Diagnosis of cancer in the mouth
Diagnosis of cancer is usually started with a visual inspection of the mouth, neck and palpation of the lymph nodes. If there is a need, an otolaryngologist is connected to the examination, who, if indicated, prescribes an additional examination in his profile.
To detect a cancerous lesion, the larynx, pharynx, and nasal cavity are examined with the help of special tools or mirrors, which allow to examine the problem areas in detail and, if necessary, take the tissue for biopsy examination.
Peripheral blood analysis should be performed to detect anemia and assess the patient’s condition. Biochemical analysis of the blood can reveal damage to the liver or bones.
In order to identify the affected lung tissue during an oncologic process, computed tomography is performed. In CT, the management of the contrast agent determines the location, size and shape of the tumor. Computed tomography can detect an increase in lymph nodes.
To diagnose metastases, organs affected by squamous oncology are examined: an ultrasound examination of the liver and X-rays of the chest organs are performed, and blood is taken for biochemistry.
Oral Cancer Treatment
In the treatment of oral cancer, three main methods are commonly used: surgery, radiation and chemotherapy. They can be used both independently and in complex.
- Surgical intervention. This method involves the use of a variety of operations, depending on the stage of the process and the localization of the tumor. In order to restore the lost functions, reconstructive interventions are performed. If the malignant tumor of the mouth is mobile, then the elimination of the tumor is performed without removing the bone tissue. If the tumor has limited mobility, it is removed along with part of the jaw. A visible damage to the jaw with radiographs requires a more extensive excision of bone tissue.
In cancer of the lips, an operative micrographic method is used, the formation is removed in layers, followed by examination with a microscope. Thanks to the micrographic method, it is possible to remove the entire tumor with maximum preservation of healthy lip tissue.
Quite with cancer of the oral cavity, the neoplasm spreads to the cervical lymph nodes. If this fact is confirmed, it is an indication for their removal. The volume of surgical intervention depends on the extent of the spread of cancer cells, and in some cases the volume is significant — vessels, nerves and muscles are removed.
After surgery, side effects and complications may occur. After the elimination of the lymph nodes, the lower lip may fall, difficulty raising the arms above the head, and numb the ear. This is due to the fact that the removal of lymph nodes is associated with damage to the nerves.
In rare cases, with large tumors of the oropharynx, leading to difficulty breathing, the trachea is dissected with the introduction of a breathing tube. After the elimination of the malignant tumor, the tube is removed, thereby restoring normal breathing.
- Radiation therapy. This therapy may be a priority method in the treatment of cancer of small size. If the tumor is of considerable size, then radiation therapy is used in combination with surgical treatment, to remove all kinds of remaining cancer cells. In addition, radiation therapy is used to eliminate difficulty swallowing, stop bleeding and relieve pain. With the use of radiation therapy, side effects are possible, which are expressed by weakness, pain in the grief, loss of taste, dry mouth and redness of the skin.
- Chemotherapy. With this method, anticancer drugs are used. Used to reduce the size of the tumor before surgery or radiation therapy. Common side effects include bleeding, fatigue, balding, loss of appetite, nausea and vomiting.
About 1.5% of all human tumors are present. It occurs in men most often at the age of 40-60 years and 4 times more often than in women. Experience shows that in most cases they develop on pathologically modified tissues. Most often it is a long-lasting inflammatory processes of various etiologies and dyskeratosis, which belong to the so-called precancer. A significant role in the development of pathological processes in the oral cavity is played by such bad habits as smoking, abuse of hard liquor, the use of “nasa” among the peoples of Central Asia, and among the peoples of India - the chewing of betel leaves.
The same factors as chronic mechanical injury caused by a destroyed tooth crown, a sharp edge of the filling or a poorly made prosthesis. The nature of nutrition also has a certain significance for the development of pretumor states. Insufficient content in food of vitamin A or violation of its digestibility by the body leads to a change in keratinization processes. Undoubtedly and the harmful effects of systematic consumption of too hot and spicy food.
Oral Cancer Symptoms
The clinical course of cancerous tumors of the oral organs can be divided into three phases or periods: the initial, the advanced and the neglect period. Starting period. At this time, patients often note unusual sensations in the area of the pathological focus. On examination of the oral cavity, various changes can be detected:
- consolidation of the mucous membrane
- compaction of tissues
- superficial ulcers
- papillary neoplasms,
- white spots, etc.
During this period, it is necessary to carefully examine the organs of the oral cavity, as the analysis of observations shows that almost 10% of cases during the first visits to the doctor local lesions on the mucous membrane were not detected.
The pain that usually leads to a doctor is noted in the initial period of cancer in about 25% of cases. However, in more than 50% of cases, pain is associated with angina, tooth disease, etc. Especially often it is observed in cancer with localization in the posterior half of the oral cavity and the alveolar jaw. Often the attention of doctors goes the wrong way.
In the initial period of oral cancer, it is advisable to distinguish three anatomical forms:
- ulcerative;
- knotty;
- papillary.
The ulcer form is observed most often, in about 50% of patients the size of the ulcer increases slowly, others quickly. Conservative treatment usually does not reduce ulcers. This can be said about the following two forms. The nodular form manifests itself as a seal in the mucosa with whitish patches around or hardening in the tissues. In the latter case, the mucous membrane over hardening may be unchanged. Seals usually have clear boundaries and develop faster than with ulcerative form. Papillary form is characterized by the presence of dense outgrowths above the mucous membrane. They develop rapidly and are often covered with intact mucous membranes.
Developed period. Numerous symptoms appear at this time. First of all, almost all patients suffer pain of varying intensity, although sometimes, even with large tumor sizes, pain may be absent. The pains become excruciating, have a local character, or radiate to one or another region of the head, more often to the corresponding ear, the temporal region. In many patients, salivation increases as a result of irritation of the mucous membrane by the decay products of the tumor. A typical symptom is fetid odor from the mouth - a satellite of disintegration and infection of the tumor.
In the developed period of cancer of the oral mucosa, we distinguish two anatomical forms:
- exophytic form (papillary — fungal-shaped tumor with plaque-shaped or papillary outgrowths; ulcerative — the presence of an ulcer with an edge roll of active tumor growth, despite an increase in its size, it still remains superficial, and the tumor roller seems to delimit the process)
- endophytic form (ulcerative-infiltrative - an ulcer on a massive tumor infiltrate. Ulcers often take the form of deep crevices; the infiltrative form is characterized by a diffuse organ lesion. The mucosa is not ulcerated in these neoplasms).
Mouth Cancer
The division of cancer of the oral mucosa on the anatomical form aims to clarify the nature of tumor growth and determine the type of treatment. Clinical experience shows that endophytic forms of tumors characterized by diffuse growth have a more malignant course than exophytic forms with a limited type of growth. The period of neglect. Cancer of the mucous membranes of the oral cavity, rapidly spreading, destroys the surrounding tissue and should be attributed to those tumors that we consider to be exclusively aggressive and malignant. It should be noted that in general the cancer of the mucous membrane of the posterior half of the oral cavity proceeds more malignantly than the anterior one; it is also much more difficult to treat cancer of the organs of the posterior half of the oral cavity.
Cancer of the tongue - most often develops in the middle third of its lateral surface (62-70%) and in the root. Much less often it occurs on the lower surface of the tongue, sometimes on the dorsal surface (7%) and the tip of the tongue (3%). Cancer of the root of the tongue is observed according to different data in 20 - 40% of cases. More often it is squamous cell carcinoma of various differentiation. Malignant tumors originating from the small salivary glands in the tongue develop in about 1.5-3% of cases. Malignant lymphomas sometimes occur in the back of the tongue.
Cancer of the floor of the mouth - makes up 20% of all squamous cell cancers of the oral cavity, of which about 3% are adenocarcinomas of the small salivary glands. Often, the floor of the mouth cavity is infiltrated secondarily by malignant tumors of the tongue, gum, mandible, submandibular salivary glands. Treatment of patients for early medical care is rarely observed. More often we have to deal with tumor processes, when a secondary infection joins them and pain appears. Often, when you first go to the doctor, the spread of the tumor to the lower jaw and the muscles of the floor of the mouth is determined. During this period, approximately one third of patients have regional metastases.
Cancer of the buccal mucosa - the histological picture in this case is the same as in cancer of the tongue and floor of the mouth. However, malignant tumors of the small salivary glands are less common. Often the mucous membrane of the cheek is infiltrated with a tumor for the second time from the tonsils, lips and skin. Regional metastases are rarely observed when patients are first treated by a doctor, with the exception of tumors localized in the retromolar region and with their spread to the tonsils and the arms.
Cancer of the mucous membrane of the sky - malignant tumors emanating from the small salivary glands (adenoid cystic carcinoma — cylinders, adenocarcinoma) often develop in the hard palate. Mixed tumors (polymorphic adenomas) are observed less often here, the differential diagnosis of which is very often difficult even for histologists. Squamous cell carcinoma on a hard palate rarely develops. In the soft palate, neoplasms emanating from the small salivary glands are rarely observed and the absolute majority of tumors are squamous cell carcinoma. This morphological feature of the hard and soft palate tumors is largely reflected in their clinical course. Squamous cell carcinoma of the hard palate rather quickly ulcerates, causing discomfort or pain. Patients usually go to the doctor when the tumors are still small.
The neoplasms originating from the small salivary glands remain encapsulated for a long time, sometimes reaching considerable sizes. In such patients, the first and main complaint is the presence of a tumor in the hard palate. As the size of the neoplasm increases, its pressure on the mucous membrane increases and a site of ulceration appears, then an infection joins and pain occurs. It should be borne in mind that adenocarcinomas and mixed tumors of the hard palate in the initial period of development for a long time have similarities and mainly retain a tendency to encapsulated growth. Then the adenocarcinoma invades and destroys the underlying bone structures.
Cancer of the mucous membrane of the alveolar edge of the lower and upper jaws. These neoplasms almost always have squamous cell carcinoma. They manifest themselves quite early, as the teeth are involved in the process and toothache occurs. Often, these pains can be treated and even removed. Unreasonable tooth extraction contributes to the spread of cancer in the tooth hole, and then in the bone. In the initial period, the tumor is usually local and bleeding when touched. Infiltration of the underlying bone tissue (alveolar edge of the lower or upper jaw) occurs several months later and should be considered as a later manifestation of the disease. The extent of tumor spread to the bone is determined radiographically, however, it must be borne in mind that chronic dental diseases also cause a picture of bone demineralization. Cancer of the gums, depending on the location, also extends to the mucous membrane of the cheek, palate or floor of the mouth. Regional metastasis occurs early and is diagnosed in about a third of patients. Malignant tumors originating from the small salivary glands, are rare.
Diagnosis of Oral Cancer
Clinical recognition of squamous cell carcinoma of the oral mucosa is based on knowledge of the characteristics of the development of this form of a malignant tumor (as outlined above) and does not cause great difficulties. To do this, it is necessary to assess the localization of the tumor, its size, degree of spread, and clinical growth. Until now, the extent of tumor spread is determined visually and by palpation. Secondary tumor of the bones of the facial skeleton is determined using x-ray examination and scintigraphy. However, tumor infiltration of the periosteum in this way cannot be established, and therefore one has to be content with a clinical assessment of its involvement in the tumor process.
The task of the morphological method of research is to determine the tumor affiliation of the biopsy material, the histological structure of the malignant neoplasm, the differentiation of squamous cell carcinoma, the prevalence of tumor infiltration into the surrounding tissues and vessels. All these signs are important for predicting the course of the disease and the choice of treatment method. The cytological method is of particular importance for the differential diagnosis of tumors of small size and pre-tumor diseases.
Diagnosis of regional metastases, as a rule, presents no difficulties. To predict the course of the disease and select the most rational method of treatment, it is necessary to estimate the number of regional metastases and their localization in the respective groups of neck lymph nodes, which is determined by palpation and using ultrasound scanning. Cytological examination of punctates from the metastatic node allows making the correct diagnosis in 80% of cases. Diagnosis of distant metastases requires examination of the organs most frequently affected in squamous cell carcinoma. It is a chest X-ray, a functional liver test (biochemical blood test, radioisotope test), a liver ultrasound.,
Oral Cancer Treatment
Treatment of patients with cancer of the oral mucosa can be divided into two stages: the treatment of the primary focus and the treatment of regional metastases. Stage I - treatment of the primary focus. For the treatment of primary tumors using radiation, combined and surgical methods.
Radiation treatment for oral cancer
One of the most common treatments for cancer of the oral mucosa and oropharynx. It is used in 88.7% of patients with tumors of the oral organs, and in 72.4% - as an independent method. It is recognized as the main treatment in the early stages of tumor development.
Remote gamma-therapy is most often used, less often intracavitary and their combination. As for the results, according to domestic and foreign authors, in case of primary cancer of the movable part of the language corresponding to stages I and II (T1 and T2), the use of various methods of radiation therapy made it possible to cure 70-85% and 38-56% respectively within 5 years the sick. With cancer of the first stage of the floor of the mouth, 53 - 66% of patients are cured within 5 years, and stage II - 43-46%, with cancer of the cheek - 81 and 61%, respectively. The results of radiation treatment for cancer of the oral mucosa of stage III are significantly worse - 16-25%.
Combined treatment for oral cancer
Currently in our country is widely used combined method of treatment of cancer of the oral mucosa, the main component of which is surgery. The majority of specialists at the first stage of treatment recommend remote gamma therapy, and at the second - surgical intervention. The doses of preoperative irradiation are 35-45 Gy. The favorable results of a 5-year combined treatment of cancer of the tongue of stages I and II are comparable with the results of only radiation effects on the tumor and are 80-94% and 39-65%, respectively.
For tumors of other sites I and II, long-term cure was achieved in 30-53% of patients with cancer of the floor of the mouth, in 42.8% of the alveolar process of the mandible, and respectively in 94 and 65% of patients with cancer of the cheek. With stage III disease, the results of the combined treatment of cancer of any localization in the oral cavity amounted to 37% of cures within 5 years. This method is used as a guide for locally advanced cancer. The main component is an operation, its volume should correspond to the degree of spread of the primary tumor, the form of its development and its histological structure.
Surgical treatment of oral cancer
In tongue surgery, half of the electrical resection of the tongue is still widely used. This operation is performed both for cancer of stages I-II, and for large tumors as part of combined interventions (for 2 or more organs). Borders excision - at least 2-4 cm of healthy tissue. In locally advanced cancer of the movable part of the tongue and the floor of the mouth, a combined half-resection of the tongue is performed with resection of the floor of the mouth (for indications and resection of the mandible) with simultaneous plastic surgery with skin-muscle flaps of defects of the tissues of the tongue and floor of the mouth. Stage II - tactics of influence on the zones of regional metastasis. Regional metastases of cancer of the oral mucosa of all localizations are observed in 23-40% of cases.
The highest percentage of metastases in the lymph nodes of the neck is observed with a primary tumor of 4 cm or more. The following data of domestic and foreign authors speak about the influence of regional metastases on the fate of patients. With a primary tumor of 4 cm or more with morphologically confirmed metastases, only 17–20% of patients are alive without relapses and metastases for 5 years. Regardless of the size of the primary tumor with regional metastases, 9-33% of patients are alive, and in their absence - 50-70%. The leading method for the treatment of regional metastases is the surgical method. To this end, performed fascial-case excision of the neck tissue and operation Krajl. In order to prevent the development of regional metastases, a number of radiologists use elective irradiation of zones of regional lymphatic drainage.
Tumors of the oral cavity can be diagnosed at an early stage, during the examination at the dentist. There are several specific manifestations of cancer on the mucous membrane, and therefore, if they exist, the doctor sends the patient for an additional examination.
Signs of mucosal cancer
The oral cavity is subject to cancerous processes in predominantly elderly people, but there are many cases when young people are exposed to this insidious disease. The tumor can develop on the cheeks, the mucous of the palate, the lips, the tongue and is life threatening. The tumor grows through the tissues and grows uncontrollably, this process is always accompanied by pain that never subsides, which greatly affects the patient’s psychological and physical condition.
The main signs of cancer of the oral mucosa
- swelling of the mucous membrane, roughness appears on the lips, cheeks, gums;
- voice becomes hoarse, timbre changes;
- whitish spots appear on the mucous membrane, the color in the process may change, it becomes red;
- unreasonable bleeding from the sky, cheeks, lips;
- pain in the ears;
- difficulty in chewing and swallowing, moving the tongue and touching the palate causes severe pain;
- progressive weight loss, as a constant companion of oncology;
- feeling squeezing in the throat;
- ulcers in the face, palate, cheeks, tongue;
- numbness of the skin, oral mucosa.
There are several phases in the development of mucosal cancer symptoms.
- In the initial phase, discomfort is noted, unusual sensations in the oral cavity, the pain is still absent, but the membrane is compacted, ulcerative processes begin to develop, a white patina appears.
- In the second phase (developed), the ulcer becomes clearly pronounced, pain appears, it is at this stage that the patient most often seeks help.
- In the advanced phase, the symptoms become dangerous for the patient, the tumor progressively spreads to nearby areas of the oral mucosa, the tissues increase in size, all this is accompanied by unbearable constant pain.
Metastasis of the cancerous process of the mucous membrane occurs on the regional lymph nodes: submandibular, cervical. In a neglected form, metastases spread to vital organs.
Causes of oral cancer
Oral cancer develops quickly and almost immediately manifests itself with specific symptoms, and several factors can provoke this process:
- Bad habits - smoking, alcohol, drugs (some of them are rubbed into the gums).
- Genetic predisposition.
- The negative impact of prolonged exposure to the sun.
Mouth Cancer
Cancer of the mucous membrane can be localized on its various organs, such as the sky, tongue, cheeks or lips. All these processes can occur in various forms. We analyze the most common.
Ulcerative form
Ulcerative cancer of the mucous membrane - develops in half of cases from all forms, is presented in the form of ulcers, which progressively increase.
Knotty shape
Knotty cancer on the oral mucosa - represented by seals on the mucous membrane, it can rise above the healthy areas of the mucous membrane or remain at its level, covered with white bloom. Seals have clear edges, progressively expand throughout the mucous, go to the sky, cheeks.
Papillary form
Papillary form of oral cancer is a dense outgrowth, it hangs down into the oral cavity, this outgrowth is covered with a mucous membrane that does not change. The form is easily applied to the treatment, as it does not affect the surrounding mucous tissue.
Precancerous conditions
The precancerous processes of the oral cavity include leukoplakia, papilloma, warts, ulcers, fissures. A timely visit to the dentist allows you to identify these processes and prevent them from switching to malignant cancer. Chronic injuries, poor hygiene and the accession of a secondary infection can all trigger malignancy.
Sky cancer affects not only the physical condition, but also limits social opportunities. First of all, the patient's speech suffers, it slows down, the timbre changes a lot, the conversation is in the nose, and the conversation is accompanied by severe pain. The process is always accompanied by an unpleasant smell that cannot be eliminated.
Sky cancer occurs due to local irritants, it can be a frequent exposure to temperature stimuli, when the burn does not go away and is constantly irritated. Also the cause may be smoking, deficiency of certain vitamins, alcoholic beverages. Pre-cancerous conditions on the mucosa can be malignant (go into a malignant growth).
Among the symptoms of sky cancer, you can highlight the sensation of a foreign body, a change in the voice; when the tongue touches the pathological site, there is severe pain that does not go away after the removal of the stimulus. The consistency of the mucosa changes, it becomes sweaty, in some areas the tumor is already beginning to grow and this can be felt. When the process is already in the ulcerative form, then the patient turns to a specialist.
Diagnosis of sky cancer
Sky cancer is usually diagnosed by a dentist, as patients rarely attribute ulcerative manifestations on the mucosa to cancer and do not go to an oncologist in a timely manner. On examination at the dentist, a visual examination of the mucous membrane tissues is carried out, and if cancer is suspected, a diagnosis is prescribed.
The necessary information is collected, the history of life and illness, it is important to determine what bad habits are present, and from what moment the patient began to feel discomfort.
The next stage is a microbiological examination of the tissues of the mucous membrane, the presence of pathological cells is determined. Then treatment is prescribed, depending on the stage, the symptoms and the presence of concomitant diseases. The main method of treatment in oncology of the oral cavity emit radiation therapy. Launched processes are given to surgical treatment, and at the last stage it is rational to prescribe painkillers, sedatives and not carry out any operational measures, since the prognosis will remain unfavorable, and any interventions can only harm the cancer patient.
The prognosis for sky cancer is generally favorable. It is possible to cure the process in more than 85% of cases. The presence of metastases greatly complicates treatment, and can cause a relapse, which can be observed in 75% of patients.
Cancer process in the sky is considered one of the most dangerous, since the disease makes it impossible for normal eating, talking, taste sensations are lost, which affects all sensations, the patient loses interest in life, may be in a state of depression.
Cancer treatment
Cancer of the mucous membrane is amenable to traditional treatment, and at the first stage the growth of abnormal cells can be completely stopped. The course of treatment is prescribed individually, depending on the symptoms, it is obligatory to eat, regardless of the treatment option, the use of painkillers, as the cancer of the shell of the mouth always occurs with severe pain.
Radiation therapy is carried out after monitoring the state of the thyroid gland. The patient is placed in a special chamber, where he is undergoing radiation. There may be side effects such as burning the face, changing the voice, pain in the throat area.
Surgical treatment of cancer is rational when it is clearly localized and does not extend to nearby areas. After surgical treatment there is the possibility of recovering the removed organs by prosthetics.
Chemotherapy treatment is indicated after surgery to suppress the vital activity of pathological tissues of the oral mucosa. The choice of drugs depends on the phase of the tumor and the general symptomatic picture. Chemotherapy can lead to baldness, reduced immune activity, vomiting, diarrhea, and is therefore prescribed only when absolutely necessary and impossible to carry out other treatment measures.
How to prevent cancer
It is possible to avoid the cancerous process on the mucous membrane, since its early manifestations are palpable, and early diagnosis allows treatment to be carried out, which guarantees recovery. The problem is a negligent attitude towards pathological changes in the mucous membrane. Often patients come when the cancer is no longer able to eat and sleep due to severe pain and great size. The question is only in relation to their health. Pre-cancerous conditions found at an early stage can be cured, and therefore regular examination by a dentist will not only preserve the health of the teeth, but in some cases life.
Other prevention measures include the use of sunscreen, quitting smoking and safe oral sex. When it was not possible to prevent the disease, and the process is already irreversible, it is better to start a national treatment.
The oral cavity includes:
- Front 2/3 language
- Lower and upper gums
- Inner lining of cheeks and lips
- The bottom of the mouth
- Solid sky
- Fabrics behind wisdom teeth
Oral cancer
Among the tumors of the head and neck, cancer of the oral cavity takes the leading place. It occurs in any parts of the oral cavity.
Usually oral cancer affects people over 50 years old. Men suffer more often than women. Of the cells that line the oral cavity from the inside or cover the tongue, most tumors of the oral cavity develop. Such tumors are called squamous cells.
Causes of oral cancer
Smoking and alcohol abuse are the main causes of oral cancer. The simultaneous presence of these factors significantly increases the risk of cancer.
There is an increased risk of developing oral cancer on the background of malnutrition, poor oral hygiene and irregular dental examinations. Long-term exposure to ultraviolet radiation is considered a risk factor for developing lip cancer.
Signs and symptoms
There are two main symptoms of oral cancer:
- Pain or discomfort in the mouth
- Ulceration of the mucous membrane, not disappearing with time
Pain or ulceration does not always occur. Other symptoms of oral cancer include:
- Red or white spots on the mucous membrane of the mouth or pharynx, which do not disappear over time
- Swelling or thickening of the mouth, lip or throat
- Difficulty or pain when swallowing, chewing, or talking
- Numbness or bleeding in the mouth
- Tooth loss for no apparent reason
- Neck swelling
- Pronounced weight loss in a short time
- Bad breath
Such symptoms are found not only in cancer. Their appearance should be reported as soon as possible to your doctor or dentist. The chances of a cure increase the earlier detection of oral cancer.
Diagnosis of oral cancer
A dentist or attending physician carefully examines the oral cavity and pays special attention to the hyoid area. Consultation and additional examination of specialists require a visit to the clinic.
With the help of a small mirror and a lamp specialist examines the oral cavity. The doctor may use the endoscope for a more thorough examination of the posterior oral cavity and pharynx.
Diagnosis requires a biopsy. During the biopsy, the doctor removes a small piece of tissue for later examination under a microscope. This procedure is usually performed under general anesthesia, and requires a short stay in the clinic.
Further examination
Blood tests and radiographs of the chest organs are performed to assess overall health. Other methods of examination also help in the diagnosis of oral cancer and the identification of distant metastases. The most suitable method of treatment will help the doctor choose test results.
To identify bone damage, the doctor prescribes radiography facial cranium or neck. A special kind of X-ray study called orthopantomogram used to assess the condition of the jaws and teeth.
Magnetic resonance imaging (MRI). Electromagnetic radiation is used to obtain detailed images of tissues and organs.
Some patients are given a special dye intravenously. This contrast agent increases the clarity of images and allows you to better see tissues and organs.
Computed Tomography (CT) - This is a series of X-rays, which creates a three-dimensional image of the internal structures of the body. Scanning is painless and takes 10 to 30 minutes.
Bone scan. This study allows you to see the pathological formations in the bones. In this case, a small amount of a radioactive substance is injected intravenously. Scanning is carried out in 2-3 hours. Any deviations are displayed on the computer screen as brightly lit areas. Scanning does not increase the radioactive background of the body and is harmless to other people.
Determination of the stage and extent of the tumor
Stage definition
The size and spread of the tumor beyond the site of its initial occurrence describes the stage of cancer. The doctor can choose the most suitable method of treatment for this case, knowing the type and stage of the tumor.
TNM classification
The TNM classification system is most often used in determining the stage of cancer:
- Category T means tumor size
- Category N means the presence or absence of cancer in the lymph nodes
- Category M means the presence or absence of metastases
Specific values of T, N, and M categories depend on the type of cancer.
Numerical Classification of Cancer
Specialists use the numerical classification of cancer, in addition to the classification according to the TNM system. It implies the presence of three or four stages for each type of tumor.
The initial stages of cancer development corresponds to stage 1, when the tumor is still very small and does not spread. A progressive disease describes stage 4, in which the cancer metastasizes to other organs. Stages 2 and 3 are intermediate.
Also the numerical stage can be divided into sub-stages. Each substage describes in more detail the size and extent of the tumor. For example, stage 3 cancer can be divided into stage 3a, stage 3b, and stage 3c. At the same time, stage 3b differs from stage 3a either by the size of the tumor or by the presence of lymph node metastases.
Talk with your doctor about the stage of cancer
Over the past few years, a very complex system has become determining the stage of cancer. Now it is very detailed to describe the size and prevalence of various tumors by classifying cancer by stages. Staging of cancer greatly facilitates the choice of treatment and allows you to determine the prognosis of the disease.
When talking with patients, doctors significantly simplify information about the stage of cancer. Words like "local" or "early" can be used if the tumor has not spread. If the cancer has penetrated into the surrounding tissue or nearby lymph nodes, the doctor speaks of a "locally common" tumor. Cancer is called “common” or “progressive” when it spreads to distant organs. The doctor discusses with the patient the specifics of determining the stage of cancer in each particular case.
Degree of malignancy
The degree of malignancy depends on the appearance of cancer cells under a microscope and the behavior of cancer is determined.
Cancer cells are very similar to healthy cells with a low degree of malignancy. With a high degree of malignancy, tumor cells are very different from healthy ones. Tumors of a low degree usually grow slowly and spread much less frequently than tumors of a high degree of malignancy.
Treatment
The method of treatment depends on the stage and extent of the tumor, as well as on the general state of health. The attending physician explains to the patient what treatment methods are available in this case of oral cancer. He may also advise consulting other specialists. In order to collect as much information about the disease.
Treatment for oral cancer consists of:
- Surgical treatment
- Radiotherapy
- Chemotherapy
- Biological therapy
The patient is offered the method of treatment that is likely to help cope with cancer. It is necessary to discuss with the doctor the possible side effects of the selected treatment.
Both surgery and radiotherapy are equally effective in oral cancer in the early stages. If there is a possibility of pronounced speech and swallowing disorders after the operation, then the patient is given radiotherapy. The effects of the combined treatment, as a rule, are tumors of large sizes.
Surgery
Removal of the cancer is carried out along with a small area of surrounding healthy tissue. The volume of the operation depends on the position of the cancer in the oral cavity and its size.
Oral cancer often spreads to the lymph nodes in the neck. Therefore, the removal of lymph nodes: lymph node dissection. This reduces the chance of cancer recurring.
Finding a patient in the intensive care unit and intensive care requires complex and extensive operations.
Some patients require extensive surgical intervention. It may include the removal of jaw bones or portions of the tongue. In these cases, the surgery is performed by a maxillofacial surgeon. With the help of the skin or bone area, taken from any other department, recovery of lost tissue is carried out. The patient remains in the hospital for several weeks.
Micrographic operation - This is a special kind of surgery. In this method, the affected tissues are removed in layers with examination under a microscope during the operation itself. While cancer cells are found in the tissues, they are excised. This operation is usually prescribed for lip cancer.
Side effects of surgical treatment. Side effects depend on the type and volume of the operation. Some types of operations cause a change in the patient's appearance. It can also affect speech, swallowing, or smell and taste.
It is very important to work with a speech therapist and a nutritionist after surgery. Experts will help cope with the consequences of the operation.
Radiation therapy
High-energy X-rays are used to destroy cancer cells during radiotherapy. It also causes minor damage to surrounding healthy tissue.
In the early stages of oral cancer, radiotherapy is used as an independent method of treatment. Treatment may be prescribed before surgery. This reduces the likelihood of cancer recurring, as well as tumor recurrence after surgery. Radiotherapy is also used in cases of cancer of the neck lymph nodes.
Some patients are simultaneously given radiation treatment with chemotherapy ( chemoradiation treatment).
Internal radiotherapy, or brachytherapy is used for some small swelling of the lips or tongue. At the same time near the tumor is placed radioactive material in solid form.
Side effects of radiotherapy. Radiotherapy causes reddening, darkening or soreness of the skin in the radiation area, resembling a sunburn. This side effect appears in the second week of treatment and may persist a month after it ends. Sometimes the skin flakes or bursts. Your doctor will talk about the rules of skin care during the period of radiotherapy.
Often there is hoarseness. There are changes in the sense of smell and taste. A few weeks after the start of treatment may appear soreness in the mouth and throat, or ulceration of the mucous membranes. Eating causes difficulties, and swallowing can be painful. For the investment of these phenomena, the doctor prescribes special drugs.
Artificial nutrition through a probe is prescribed in cases where the patient is unable to eat and lose weight. The probe is inserted into the stomach through the nose or directly through the anterior abdominal wall. These measures are short-lived and are needed only until normal swallowing is restored.
Often, radiotherapy for oral cancer affects the salivary glands. They begin to produce less saliva. This leads to dryness of the mucous membranes of the mouth and pharynx, and makes swallowing and speech difficult. To relieve discomfort, you can use sprays with artificial saliva.
Most side effects after the end of treatment gradually disappear. But in some patients, xerostomia persists after the completion of radiotherapy.
Chemotherapy
Chemotherapeutic drugs destroy cancer cells.
Medicines are prescribed:
- Before radiotherapy or before surgery
- Simultaneously with radiotherapy
- After completing radiotherapy or surgery
- When a tumor recurs after treatment or the spread of cancer to other organs
Chemotherapy, prescribed after surgery, reduces the likelihood of recurrence of the tumor. Chemotherapy allows you to control the symptoms of a tumor during its recurrence. Chemotherapy is not commonly used to treat lip cancer.
Cisplatin and fluorouracil are the most commonly used chemotherapy for oral cancer. In case of cancer recurrence, other drugs are used, such as docetaxel (Taxotere), paclitaxel (Taxol) and gemcitabine (Gemzar).
Chemotherapy drugs are usually administered intravenously. They may temporarily cause a decrease in the number of blood cells. Infections develop more often with a deficit of leukocytes. Therefore, during the course of chemotherapy, the doctor prescribes blood tests.
Other side effects of chemotherapy include nausea, vomiting, diarrhea, soreness of the mouth, alopecia, severe fatigue. It is necessary to inform the doctor about the occurrence of any side effects. He will write out medicines to combat unpleasant phenomena.
Chemotherapy
Instead of surgery, a combination of radio and chemotherapy is used for some small tumors of the oral cavity. It has less effect on speech and swallowing, compared with surgery. It is important to cope with the two methods of treatment allowed by the patient's condition. With simultaneous appointment of radiotherapy and chemotherapy side effects are more pronounced. Surgery is prescribed if chemoradiation treatment has failed to cope with cancer.
In order to reduce the likelihood of cancer recurrence, chemoradiotherapy can be prescribed after surgery.
Biological therapy
Substances that are produced in the body are used to destroy cancer cells during biological therapy. These substances include monoclonal antibodies and cancer growth inhibitors.
Monoclonal antibodies - drugs that are capable of attaching to receptors located on various cancer cells.
Some tumors contain epidermal growth factor receptors. When chemical substances - growth factors are attached to these receptors, the development and division of cancer cells occurs. Monoclonal antibodies stop the growth of cancer cells by blocking receptors. These drugs also increase the sensitivity of cancer cells to radiotherapy and chemotherapy.
The drug cetuximab (Erbitux) is one of monoclonal antibodies. It is administered intravenously via an IV drip. Cetuximab is used in combination with radiotherapy to treat locally advanced squamous cell carcinoma of the oral cavity. In cases where the patient cannot tolerate chemotherapy with cisplatin or carboplatin, cetuximab is prescribed.
Cancer cell growth inhibitors
Cancer cells for growth and division use special chemical signals. These signals allow them to “communicate” with each other. This process is disturbed by cancer cell growth inhibitors. as a result, the development of the tumor stops. A growth inhibitor called gefitinib (Iressa) is used in clinical studies. It is prescribed for the recurrence of certain types of head and neck cancer, including oral cancer.
Dynamic observation
It is very important to undergo regular examination after completion of treatment. It includes radiography and, if necessary, CT or MRI. The survey may be conducted over several years. You should contact your doctor as soon as possible if there are any symptoms or causes for concern between regular check-ups.
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