Terrible with its complications, the pathology - cancer of the oral cavity, can form at any age. A favorable prognosis is acceptable only with early diagnosis of the tumor. Therefore, experts urge people to apply for medical care- at the slightest discomfort in the oral cavity. For example, a long-term non-healing ulcer on the buccal mucosa, unreasonable loss of one or more teeth. A complex therapeutic effect will allow not only to overcome cancer, but also to prevent the recurrence of the disease.
According to its morphological features and stages of the course in the oral cavity, a malignant neoplasm can be classified by specialists into the following types:
Cancer of the oral cavity in its localization can be of the following varieties:
Clarification of the diagnosis - how exactly the cancer of the mouth was formed in the patient, allows modern laboratory and instrumental methods of research.
As the practice of oncologists convincingly shows, a tumor on the tissues of the oral cavity most often forms in already injured areas. Long-term inflammatory processes prepare the mucosa for the appearance of a focus of atypical cells - the risk of a cancerous tumor increases several times.
Negative hereditary predisposition also makes a significant contribution to the occurrence of one form or another of a malignant tumor of the mouth. So, in families where there have already been cases of diagnosed cancer, the risks that in subsequent generations a malignant disease will manifest itself are much higher.
Predisposing factors:
If there is at least one of the above predisposing factors, it is recommended to be more careful about your health and contact your dentist more often for a preventive examination.
Alarming symptoms that may indicate the occurrence of a tumor in the oral cavity, experts call discomfort during eating - not a single one, quite explainable by any acute process, for example, stomatitis, but daily, lasting several weeks. In this case, simultaneous numbness can be observed in one of the sections of the tongue or gums, cheeks. A person can even indicate a certain time interval from which he had unpleasant sensations.
The causeless loss of one or more teeth should also be alarming. There were no reasons for this - a severe form of caries, trauma. Whereas a dental examination may reveal localized weakening of the gums and looseness of the adjacent teeth, marked swelling of the jaw.
Discomfort and even soreness when eating can also accompany a conversation, opening the mouth for hygiene procedures. The intensity and nature of discomfort increases over time, changes - intensifies, and does not decrease, as in inflammatory processes.
An increase in the nearest submandibular, cervical lymph nodes is also observed - this system is one of the first to respond to the appearance of a tumor of the oral tissues, since cancer cells also enter the nodes with the lymph flow. The involvement of the lymphatic system in the tumor process indicates the transition of cancer to the second or third stage of the course of the disease.
Gradually, the patient's voice changes - it becomes hoarse, hoarse, whispering. Speech loses its clarity, the person seems to lisp, protecting himself from additional unpleasant sensations in the mouth. The symptoms of oral cancer, if ignored, do not go away on their own. The tumor requires complex treatment. Otherwise, the human condition deteriorates significantly, up to death from cancer intoxication.
A careful examination of the entire oral cavity at the time of hygiene procedures is the key to good health and early detection of dental diseases. Experts urge to immediately seek medical help if the following warning signs have been identified:
Signs and symptoms of oral cancer may be different - a putrid, unhygienic smell, loss of appetite, constant fatigue, decreased performance, subfebrile persistent temperature. Only a highly qualified specialist can conduct an adequate differential diagnosis. Therefore, you should not delay consulting a doctor. Early detection of the tumor and its complex treatment- the key to a quick and successful victory over cancer.
After a comprehensive diagnosis - using modern laboratory and instrumental methods, the specialist will select the optimal scheme for influencing the tumor.
Having established the type and stage of the course of the neoplasm - oral cancer can have several variants of the course, the oncologist decides on the optimality of one or another method of treating the tumor.
In the early stages of cancer - with a small size of the tumor, its local location, the possibility of excision, surgeons prefer the surgical method of fighting cancer. After removal of the main focus, further procedures are carried out to restore injured tissues.
Radiation therapy is recognized as effective - it helps to reduce the volume of the tumor, and after its excision, reduce the severity of the pain syndrome, and prevent the recurrence of cancer. According to individual needs, they resort to the help of brachytherapy - internal irradiation of the cancer focus. Rods with material for irradiation are introduced directly into the tumor itself.
If it is impossible to resort to a surgical or radiation method, oncologists will recommend intravenous or oral administration of special anticancer drugs. Chemotherapy allows not only to reduce the symptoms of cancer intoxication, but also to suppress the growth and reproduction of tumor cells in parts of the body remote from the main focus.
Early detection of cancer in one of the areas of the oral cavity is a favorable prognosis for the patient. Modern methods antitumor therapy can effectively fight almost any type of cancer.
Whereas when a person ignores the first “bells” - unpleasant sensations in the mouth, voice changes, non-healing mucosal defects, the tumor progresses, passes to an inoperable stage of development. The prognosis is much worse if the cancer is diagnosed at stages 3B–4 of the course. In this case, a person is provided with palliative care, designed to facilitate his well-being as much as possible, improve the quality of life.
Each person is the "blacksmith" of his own happiness and health. In order not to have to deal with a disease such as cancer, it is necessary to carefully monitor the condition of the oral cavity and undergo annual preventive medical examinations.
- a malignant neoplasm originating from the epithelium and soft tissues of the oral cavity. In the early stages, it is asymptomatic, it is a nodule or sore. Subsequently, the oral cancer increases in diameter, pain appears, first local, then radiating to the head and ears. Increased salivation. When decay occurs, bad breath occurs. Secondary infections are often associated. With lymphogenous metastasis, there is an increase in regional lymph nodes. Diagnosis is based on examination and biopsy data. Treatment - radiotherapy, surgical removal, chemotherapy.
Oral cancer - malignant tumor, localized in the area of the tongue, buccal mucosa, gums, bottom, palate or alveolar processes of the jaws. The incidence rate depends on the region, the disease more often affects residents of Asian countries. In Russia, oral cancer accounts for 2-4% of the total number of oncological diseases, in the USA - 8% (probably due to the large number of emigrants from Asian countries), in India - 52%. Usually found in patients over 60 years of age. Rarely diagnosed in children. There is a marked predominance of males.
65% of oral cancer is represented by neoplasms of the tongue, 13% - buccal mucosa, 11% - floor of the mouth, 9% - hard palate and mucous membrane of the alveolar processes of the upper jaw, 6.2% - soft palate, 6% - mucosa of the alveolar processes of the lower jaw , 1.5% - uvula, 1.3% - palatine arches. Epithelial tumors are detected more often than sarcomas. Oral cancer often develops against the background of precancerous processes, usually occurring at the age of 40-45 years. Treatment is carried out by specialists in the field of oncology and maxillofacial surgery, sometimes with the participation of otolaryngologists.
The causes of oral cavity tumors have not been precisely established, however, experts have been able to identify a number of factors contributing to the development of this pathology. Play a leading role in the development of oral cancer bad habits especially the combination of smoking and alcohol abuse. The inhabitants of Asian countries have great importance chewing betel and eating nas. As the second most important factor provoking oral cancer, oncologists consider repetitive mechanical injuries: the use of low-quality dentures, wounds that occur when in contact with the sharp edge of a filling or a tooth fragment.
Less often, in the anamnesis of patients with oral cancer, single mechanical damage: maxillofacial injuries or wounds with dental instruments during the extraction or treatment of teeth. Oncologists and dentists point out the importance of oral hygiene, tartar removal, treatment of caries and periodontitis, and the inadmissibility of installing dentures made of different materials(this causes galvanic currents and contributes to the development of diseases of the oral cavity).
Recent studies by American oncologists indicate a connection between neoplasms of the mouth and nasopharynx and the human papillomavirus, sexually transmitted, with kisses or (less often) with household contacts. The virus does not always provoke tumors, but increases the risk of their occurrence. In some patients with oral cancer, there is a connection with occupational hazards: work in heavily polluted rooms, contact with carcinogens, prolonged exposure to high humidity, high or low temperature. In addition, the development of oral cancer is promoted by the use of spicy or too hot food and vitamin A deficiency, in which the processes of keratinization of the epithelium are disturbed. Neoplasms often appear against the background of chronic inflammatory and precancerous lesions.
Taking into account the characteristics of the histological structure, the following types of squamous cell carcinoma are distinguished:
Taking into account the characteristics of tumor growth, three forms of oral cancer are distinguished: ulcerative, nodular and papillary. The ulcerative form is the most common, manifested by the formation of slowly or rapidly growing ulcers. Nodular oral cancer appearance represents the dense knot covered with whitish spots. With papillary neoplasms, rapidly growing dense outgrowths appear in the oral cavity.
To determine the tactics of treating the disease, a four-stage classification of oral cancer is used:
In the early stages, the disease is asymptomatic or manifests itself with poor clinical symptoms. Patients may notice unusual sensations in the mouth. An external examination reveals an ulcer, a crack, or an area of compaction. A quarter of patients with oral cancer complain of local pain, explaining the appearance of pain syndrome with various inflammatory diseases of the nasopharynx, teeth and gums. With the progression of the oncological process, the symptoms become more pronounced. The pains intensify, radiate to the forehead, ear, zygomatic or temporal regions.
There is an increase in salivation due to irritation of the mucosa by the decay products of oral cancer. Due to the decay and infection of the neoplasm, a putrid odor from the mouth appears. Over time, the tumor invades neighboring anatomical structures, causing facial deformities. An increase in one or more regional lymph nodes is detected. Initially, the lymph nodes are mobile, then they are soldered to the surrounding tissues, sometimes with decay phenomena. Hematogenous metastases are found in 1.5% of patients, usually affecting the brain, lungs, liver, and bones.
Cancer of the tongue usually occurs on its lateral surface, less often located in the root zone, on the lower surface, back or tip. Already at the initial stages, oral cancer causes chewing, swallowing and speech disorders, which facilitates timely diagnosis. Subsequently, pain occurs along the trigeminal nerve. If the root is damaged, breathing difficulties are possible. Early formation of secondary foci in regional lymph nodes is characteristic.
Cancer of the floor of the mouth in the early stages is asymptomatic. Patients turn to the dentist after a tumor-like formation is detected, which is felt as a painless growth. Oral cancer grows early in nearby tissues. With progression, regional lymph nodes are affected, pain and increased salivation occur. Bleeding is possible.
Cancer of the buccal mucosa is usually localized at the level of the mouth line. In the early stages, patients with oral cancer may not see a specialist, mistaking the tumor for an aphthous ulcer. Subsequently, the ulcer increases in diameter, patients report pain when chewing, swallowing and speaking. With the germination of chewing muscles, restrictions are observed when trying to open the mouth.
Cancer of the palate is usually accompanied by an early onset of pain. In the region of the sky, an ulcer or a growing, rapidly ulcerating node is revealed. Sometimes, at first, oral cancer is asymptomatic, and pain occurs when the process spreads to nearby tissues and infection joins.
Cancer of the mucous membrane of the alveolar processes early provokes toothache, loosening and loss of teeth. Accompanied by frequent bleeding. Brachytherapy. Most specialists prefer this method, since it excludes the formation of functional and cosmetic defects and is quite easily tolerated by patients. At the same time, the technique does not allow to achieve long-term remission in case of distally located neoplasms and stage 3-4 tumors.
The volume of surgery for oral cancer is determined by the prevalence of the neoplasm. The node is excised along with unchanged tissues. In the process of radical removal of oral cancer, muscle excision or bone resection may be required. In the event of gross cosmetic defects, plastic surgery is performed. If breathing is difficult, a temporary tracheostomy may be placed until the obstruction to air movement is removed. Chemotherapy for oral cancer is less effective. The technique makes it possible to reduce the volume of the tumor by 50 percent or more, but does not provide a complete cure, therefore it is usually used in combination with operations and radiotherapy.
The prognosis for oral cancer is determined by the location and stage of the process, the degree of damage to certain anatomical structures, the age and condition of the patient. Tumors of the posterior parts of the oral cavity are more malignant. The five-year relapse-free period for neoplasms of the tongue of stage 1-2 after a course of isolated radiotherapy is 70-85%. With tumors of the floor of the mouth, this figure is 46-66%, with cancer of the cheek - 61-81%. With stage 3 oral cancer, the absence of recurrence for 5 years is observed in 15-25% of patients.
is a tumor that is malignant.
Cancer of the oral cavity initial stage may affect any part of the mucous membrane or other parts of the mouth: cheeks, throat, lips, jaw, gums.
It was found that 10% of all cancer cases are associated with tumors of the oral cavity. At the same time, the male part of the world's population is more susceptible to this type of disease. The ratio is about 4:1.
Cancer in the mouth has three phases of development:
The initial phase is characterized by the appearance of unusual sensations at the site of tumor formation.
On examination, doctors may observe tissue thickening, white or red spots,. Oral cancer in general can develop quite slowly and manifests itself after 40 years. Average age patients is exactly 40 years old.
If you have any doubts about your health, you should immediately consult a doctor. Practice shows that 10% of diseases were untimely detected due to the fact that patients did not pay due attention to the first signs of cancer.
Pain in the oral cavity may also appear, about 25% of patients note that in the initial period they felt pain, while 50% of those surveyed associated them with tonsillitis and other diseases, such as toothache.
The initial stage of oral cancer has three anatomical forms:The ulcerative form is the most common, while in 50% it develops very quickly, in the second half, on the contrary, slowly.
The knotted form is less common. You can see spots white color, which are surrounded around the perimeter by a seal in the mucous membrane. The growth of such cancerous neoplasms proceeds much lower than in the ulcerative form.
The papillary form is characterized by the appearance of dense growths over the mucous membrane, while the latter on them, as a rule, is not damaged. Such formations develop very quickly.
Cancer of the oral cavity can be as follows: cancer of the floor of the mouth, tumor of the tongue, cancer in the sky, tumor in the region of the alveolar processes (upper and lower jaw, teeth), cancer of the cheek.
To this day, doctors around the world cannot determine the exact causes of oral cancer, but there are a number of factors that can affect the onset of the disease:
In order to avoid the development of the disease, it is worth limiting alcohol consumption and quitting smoking, since together these two addictions often provoke a tumor and contribute to its rapid development.
It has been established that in European countries, as well as America this disease less common than in Southeast Asia. This can be explained by the fact that in the Asian region there is a widespread tradition of chewing betel - a mixture of tobacco and lime. A similar reason is very relevant for India, a country in which the percentage of cancer patients with affected oral cavity is the highest.
In addition to the above causes of oral cancer, the following can be noted:
In most cases, oral cancer looks like a slowly growing formation or induration on the mucous membrane.
As a rule, formations of small sizes do not cause any particular inconvenience and begin to respond painful sensations after a significant increase in size or when irritated by food, drink or a toothbrush.
The main symptoms associated with cancer are:
Each of these symptoms individually, and especially when they appear together, can signal the development of oral cancer.
There are 5 stages of cancer in total:
With the development of a tumor in the mouth area, an initial visual examination is performed. In order to determine the degree of penetration of the tumor into the soft tissues, palpation is performed. X-rays are used to determine if the cancer cells have affected the bones.
The human oral cavity is lined with a mucous membrane formed by epithelial cells that can transform into malignant ones - this is how cancer of the oral mucosa develops. AT overall structure Oncological diseases, this pathology ranges from 2% (in Europe and Russia) to 40–50% (in Asian countries and India). It predominantly affects male patients over 60 years of age; it is extremely rare in children.
The exact cause leading to the appearance of neoplasms in the mouth has not been established. Researchers have only identified a number of factors that greatly increase the likelihood of developing this disease. Key among them are bad habits - smoking, chewing nasvay or betel, as well as alcohol abuse.
Additional factors are:
According to the latest research in virology and medicine, a certain role in the development of oncology of the oral cavity belongs to human papillomaviruses, which can be transmitted by kissing.
An increased frequency of development of this pathology was noted in people working in difficult and harmful conditions: in constant contact with harmful substances, in conditions with elevated or excessively low temperatures and high humidity.
Exposure to spicy and hot foods also contributes to the formation of tumors on the oral mucosa. The situation is aggravated by a dietary deficiency of vitamin A and the presence of inflammation or precancerous disease in the oral cavity.
Photo: this is what the initial stage of oral cancer looks like
At the very initial stage, cancer of the oral mucosa may not bother anything, only some patients feel some kind of unusual discomfort in the mouth. On examination, you can see a crack in the mucosa, a small tubercle or seal. About a third of cancer patients complain of unexpressed pain, which masquerades as symptoms of inflammatory diseases: glossitis, gingivitis.
The progress of the disease is usually accompanied by an increase in pain, even if the inflammation has already passed. The pain can radiate to the forehead, temple, jaw. Very often, patients associate these pains with toothache.
Photo: this is what oral cancer looks like in an advanced stage
Late diagnosis allows the disease to go into an advanced stage, when the following symptoms of oral cancer develop:
AT advanced cases the symptoms of a tumor of cancer of the oral mucosa are accompanied by a deformity of the face due to the growth of pathological tissue into the surrounding structures: muscles and bones. Symptoms of intoxication are growing: patients complain of general weakness, fatigue, nausea.
Lack of treatment at an advanced stage of cancer leads to the fact that the patient develops metastases. First, regional lymph nodes (cervical, submandibular) are affected. Then the parenchymal organs - the liver and lungs - can be affected. Often there is a metastatic lesion of the bones.
According to its microscopic structure, cancer of the oral mucosa belongs to the squamous cell type. There are several forms of it:
Depending on the characteristics of tumor growth, the following forms are distinguished:
Possible localization of the neoplasm
The diagnosis is made on the basis of the patient's complaints and after examination of the oral mucosa. A tumor biopsy helps confirm the diagnosis. Technological diagnostic methods, such as ultrasound or tomography, are not very informative for these tumors. To identify damage to the bone tissues of the lower and upper jaws, the patient is prescribed an x-ray of the facial skeleton.
To detect metastatic foci, doctors usually prescribe an ultrasound of the organs. abdominal cavity and chest x-ray. Perhaps the appointment of a computer or magnetic resonance imaging.
Most often, the first neoplasms in the oral cavity are noticed by dentists due to the peculiarities of their profession. When the first signs of oncology in the mouth are detected, the patient is necessarily sent for a consultation with an oncologist.
In the treatment of tumors of the oral mucosa, doctors use the entire arsenal of available means:
Depending on the stage of the cancer process, both monomethods and combined cancer treatment are used. At stages 1 and 2 of the disease, radiotherapy gives a good effect. The advantage of this method is that after it the appearance of cosmetic or functional defects is almost completely excluded. In addition, it is relatively easy to accept by patients and has a minimum of side effects. However, at stages 3 and 4 of the disease, the effectiveness of this treatment method is very low.
Surgical operations are in demand for stages 3 and 4 of oral cavity cancer. The volume of the operation depends on the prevalence of the process. It is important to excise the tumor completely (within healthy tissue) to eliminate the risk of recurrence. Radical surgery often requires muscle excision or bone resection, leading to significant cosmetic defects.
After operations for the treatment of tumors of the oral cavity, in some cases, plastic surgery is required. If breathing is difficult, the patient may have a tracheostomy (hole in the throat).
Among all the methods of treatment, chemotherapy for oral cancer is the least effective, but it can reduce the volume of the neoplasm by more than 50%, which greatly facilitates the surgical operation. Since chemotherapy does not cure this type of cancer, it is used only as one of the stages of complex treatment.
In cases where a patient with an advanced degree of oncology has very little time left to live due to metastases or cancer intoxication, palliative care comes to the fore in treatment. This treatment is aimed at combating associated complications (bleeding, pain) and is to provide a hopeless patient with a normal quality of life. Pain medications are used in palliative care.
The use of rather aggressive methods in the treatment (radiation and chemotherapy) affects the patient's health. During the course of treatment, the following may occur: side effects from drugs:
During the treatment of oncopathology of the oral mucosa, patients need to fully eat - the diet should be rich in protein and animal, and plant origin. If oral nutrition (through the mouth) is not possible, food can be administered through a pre-installed tube or intravenously (using special mixtures for parenteral nutrition).
The main preventive value in the fight against cancer of the oral mucosa is the rejection of bad habits. Be sure to quit smoking, chew betel, use nasvay. It is recommended to give up alcohol.
Reducing trauma to the cheeks, tongue, gums also reduces the risk of tumors of the described localization. All teeth must be cured, the installed fillings must be processed. If you need prosthetics, you should carefully select the prosthesis so that it is easy to use and does not cause discomfort.
Foods with an irritating effect should be excluded from the diet; very hot foods should not be eaten. When the first signs and symptoms of oncology of the oral cavity appear, you should immediately contact a specialist.
To reduce the likelihood of oncology, people employed in hazardous industries should actively use personal protective equipment - overalls, respirators.
With regularity at least once a year, and if precancerous conditions are detected every quarter, it is necessary to undergo preventive examinations at the dentist and oncologist.
In the treatment of cancer at an early stage, with a slight degree of damage to surrounding tissues, the prognosis is very favorable - after recovery, you can live without much concern for your health. In 80% of people with a tumor of the tongue who have undergone isolated radiotherapy, no recurrence is recorded within 5 years. Tumors of the floor of the mouth and cheeks are more unfavorable in this regard - for them, a five-year relapse-free period is noted in 60 and 70% of cases, respectively.
The larger the tumor, and the more surrounding tissues it affects, the sadder the prognosis. Some stage 4 patients have several months to live, especially if distant metastases have developed. In surgical treatment, the prognosis may depend on the fact that there are no malignant cells left in the body after the operation, the re-growth of which will give a relapse.
Most often, formations develop on the lips, lateral surfaces of the tongue, soft palate, and also in the oral cavity. Some formations cause pain or irritation. The formations may be noticed by the patient or they can only be detected during a routine examination.
Squamous cell carcinoma of the oral cavity is prevalent throughout the world, and its incidence in the UK has increased by 19% since the mid-1990s. Mortality in this disease is about 50%, mainly as a result of late diagnosis. The main risk factors are malnutrition, alcohol abuse and tobacco smoking or chewing. In parts of Asia, the disease is common among people chewing betel fruit wrapped in betel leaves (“betel nuts”). Oral cancer can present in a variety of ways and therefore high vigilance is needed. In patients with suspicious lesions, use all possible ways treatment of local injuries or infections, and after 2 weeks they must be re-examined. In the absence of positive dynamics of the pathological process, a biopsy is recommended. A small tumor can be removed, in some cases, transcervical removal of the involved lymph nodes is indicated. For some patients, only radical excision is indicated, followed by radiation therapy performed in the postoperative period to eliminate microscopic foci of cancer cells. Some tumors are sensitive to photodynamic therapy (PDT), which eliminates the need for surgery.
Formations in the oral cavity can be:
Most oral lesions are benign; distinguish many types.
Chronic irritation can cause permanent hardening or a raised area on the gum. Benign growths in response to irritation are quite common and, if necessary, can be removed with surgery. In 10-40% of people, benign growths on the gums reappear because the irritant persists. Sometimes such irritation, especially if it persists for a long time, can lead to cancerous changes.
Warts can develop in the mouth. Common warts (vulgar warts) can develop in the mouth if a person sucks or chews on a wart that has grown on a finger. Genital warts caused by papillomavirus infection (HPV) can also occur in the oral cavity when the pathogen is transmitted during oral sex.
Oral candidiasis often appears as white, cheesy plaques that adhere tightly to mucous membranes and leave red erosions when abraded. Thrush is most common among patients with diabetes or immunocompromised and among those taking antibiotics.
The palatine torus is a slowly growing, round projection of the bone that forms along middle line hard palate or on the inside of the lower jaw. This severe neoplasm is quite common and harmless. Even a large neoplasm can be left alone, unless it is injured while eating or the patient needs a prosthesis that affects the area of the formation. Several bony growths in the mouth may be indicative of familial adenomatous polyposis, an inherited disorder gastrointestinal tract involving multiple polyps.
Keratoacanthomas are benign growths that form on the lips and other areas exposed to sunlight, such as the face, forearms, and hands. The keratoacanthoma usually reaches a final size of 1–3 cm or more in 1–2 months, then begins to decrease after months and may eventually disappear without treatment.
Many types of cysts cause pain and swelling of the jaws. They are often associated with an affected wisdom tooth and can destroy large areas of the mandible as they develop. Some types of cysts are more likely to recur after surgical removal. Various types of cysts can also occur in the floor of the mouth. Often these cysts are removed surgically because they are difficult to swallow or because they are unattractive.
Odontomas are an overgrowth of cells that form teeth and look like small, misshapen extra teeth. In children, they may be located in the path of eruption of a normal tooth. In adults, they can push the teeth out of alignment. Odontomas are usually removed surgically.
Tumors of the salivary glands are mostly (7580%) benign, slow growing and painless. As a rule, they appear as a single soft mobile lump under the skin of a normal appearance or under the mucous membrane of the oral cavity. Sometimes these tumors are hollow and filled with fluid, when they are solid. The most common type is pleomorphic adenoma, occurring mainly in women >40 years of age. Pleomorphic adenomas can become cancerous and are removed surgically. If not completely removed, this type of tumor may reappear. Other types of benign tumors are also removed surgically, but they are much less likely to become cancerous or reappear.
White, red, or mixed white-red areas that are not easily erased, persist for >2 weeks, and are not diagnosed as some other conditions may be dysplastic. For dysplastic changes, there are the same risk factors as for malignant neoplasms. In addition, dysplastic changes can become malignant if they are not removed.
Erythroplakia is a red and flat or erased area that occurs when the oral mucosa thins. The area appears red because the underlying capillaries are more visible. Erythroplakia is a much more ominous predictor of oral cancer than leukoplakia.
People who use tobacco, alcohol, or both have a much higher risk (up to 15 times) of developing oral cancer. Among those who use chewing and snuffing tobacco, the inner surfaces of the cheeks and lips are common places for its localization. In other patients, the most common cancer sites include the lateral borders of the tongue, floor of the mouth, and oropharynx. Rarely, cancer found in the oral region is the result of metastasis from the lung, breast, or prostate.
Oral cancer can have many different appearances, but usually resembles dysplastic lesions (eg, white, red, or mixed white-red areas).
Anamnesis. History of current illness includes questions about how long the tumor has been growing, whether there is pain, and whether there has been any trauma to the area (eg, cheek bite, scraping with a sharp edge of a tooth, or dental restorations). Patients are asked about symptoms of systemic diseases, in particular weight loss and general malaise.
In the medical history, one should strive to identify risk factors for the development of candidiasis, incl. recent use of antibiotics, diabetes, and HIV infection (or risk factors for HIV infection). Note the amount and duration of alcohol and tobacco consumption.
Physical examination. Physical examination focuses on the mouth and neck, checking and palpating all areas of the mouth and throat, incl. under the tongue. The neck is palpated for lymphadenopathy, which suggests possible cancer or chronic infection.
Warning signs. The following signs are of particular concern:
Interpretation of results. The main concern is not to confuse oral cancer or dysplastic lesions with benign disorders. Clinicians should maintain a high degree of suspicion and refer the patient for biopsy if the lesion does not resolve within a few weeks.
Testing. Suspected candidiasis can be confirmed by detection of yeast and pseudohyphae in KOH-stained scrapings from the affected area. Other acute lesions may occur, especially those associated with local trauma or irritation. However, most lesions are present for several weeks, and lesions of unknown duration should be biopsied because cancer is difficult to rule out clinically.
Treatment depends on the nature of the neoplasm.
