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Oral cancer
Oral cancer involves abnormal, cancertissue growth in the mouth.
CausesOral or mouth cancer most commonly involves the tissue of the lipsor the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva(gums), or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinomas. These are malignant and tend to spread rapidly. The exact cause is unknown. Smoking and other tobaccouse are associated with 70 percent to 80 percent of oral cancer cases. Smoke and heat from cigarettes, cigars, and pipes irritate the mucous membranesof the mouth. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes. Heavy alcohol use is another high-risk activity associated with oral cancer. Other risks include poor dentaland oral hygieneand chronic irritation (such as that from rough teeth, dentures, or fillings). Some oral cancers begin as leukoplakiaor mouth ulcers. Oral cancer accounts for about 8 percent of all malignant growths. Men are affected twice as often as women, particularly men older than 40/60. SymptomsSkin lesion, lump, or ulcer:
Additional symptoms that may be associated with this disease:
Signs and testsAn examination of the mouth by the health care provider or dentist shows a visible and/or palpable (can be felt) lesionof the lip, tongue, or other mouth area. As the tumorenlarges, it may become an ulcerand bleed. Speech difficulties, chewing problems, or swallowing difficulties may develop, particularly if the cancer is on the tongue. A tongue biopsy, gum biopsy, and microscopic examination of the lesion confirm the diagnosis of oral cancer. Dentists are beginning to use a new FDA-cleared aid in examining the mouth, particularly for pre-symptomatic lesions. The ViziLite device is a short flexible wand, containing two liquids that, when mixed, produces a special light that aids the doctor in detecting abnormalities in the oral tissue. ?Chemiluminescence utilizing ViziLite may enhance the visualization of dysplastic [abnormal] and early malignant lesions that otherwise might be minimized or overlooked by either experienced or inexperienced clinicians. The technique consists of activating low energy, short wave length light that is absorbed by abnormal epithelium [surface cells]? The abnormal cells are reflected as a white mucosal surface color change (termed ?acetowhite?) that enhances clinical identification. This screening technique has proven sensitive in identifying dysplastic and malignant changes in the stratified squamous epithelium of the uterine cervix (histologically similar to oral epithelium). ViziLite has been approved by the FDA as a device.? [Sol Silverman Jr., DDS, Professor of Oral Medicine, UCSF; presentation at Symposium on Pathology & Reconstruction, American Association of Oral & Maxillofacial Surgeons, Sep. 30, 2004] The density of the nuclear content and mitochondrial matrix of abnormal cells is typically greater than normal cells. The increased molecular density may reveal the increased proliferative rate and metabolic activity of precancerous cells. A ViziLite chemiluminescent device enhances the dentist's ability to see the difference in the nuclear/cytoplasmic ratio of dysplastic cells. After rinsing with a dilute acetic acid solution, the dense nucleus of abnormal squamous epithelium tissue will appear white when viewed under the device's diffuse low-energy wavelength light. Normal epithelium will absorb the light and appear dark. ViziLite can identify an abnormality, but a definitive diagnosis can only be made by biopsy. ?Oral health care providers can also contribute to increased survival rates by early detection and treatment of pre-malignant and malignant lesions. Indeed, population-based oral cancer screening programs appear to be a promising health promotion strategy (especially in high-risk individuals) with significant increases in quality-adjusted life-years saved. However, the current protocol, conventional visual inspection and palpation of oral soft tissues for the early detection of pre-malignant or malignant changes appears to be deficient. This assessment is supported by the evidence that at least one third of the patients diagnosed with a malignancy have undergone an oral cancer screening examination within the past 3 years. *** If visual inspection under incandescent overhead and halogen dental illumination and palpation is the principal strategy used to detect abnormal oral epithelial changes, the adjunctive application of technology to highlight such lesions may increase the diagnostic yield. Neoplastic epithelial cells tend to have an altered nuclear-cytoplasmic ratio. Dehydration with acetic acid highlights this higher nuclear density and imparts an ?acetowhite? appearance to the tissue. This phenomenon can be further amplified by replacing conventional lighting with diffuse blue-white chemiluminescent illumination. The normal epithelium takes on a blue hue, while the ?acetowhite? lesions appear distinctly white.? [?Acetic Acid Wash and a Chemiluminescent Light Source as an Adjunct to Conventional Oral Soft Tissue Examination for the Detection of Dysplasia: A Pilot Study? MA Huber, DDS, SA Bsoul, BDS, GTTerezhalmy, DDS, MA, Quintessence Intl, May 2004] TreatmentSurgical excision (removal) of the tumor is usually recommended if the tumor is small enough. Radiation therapyand chemotherapywould likely be used when the tumor is larger or has spread to lymph nodes in the neck. Surgery may be necessary for large tumors. Rehabilitation may include speech therapyor other therapy to improve movement, chewing, swallowing, and speech. Complications
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