This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
An Aphthous Ulcer on the Lip(Mouse over to zoom in)
‘When was the last time you had your mouth examined - I mean, thoroughly checked ?’
Just like anywhere else in the rest of the body, cancer can also form in any part of the mouth or throat. Oral cancers most commonly are found at the lip especially the lower lip, sides of the tongue and in the floor of the mouth. The commonest histology is squamous cell carcinoma (SCC).It is also more commonly found among those with the following risk/predisposing factors:Cigarette smoking (risk = 6X)Pipe smokingbetel nut (‘kapur sirih’), tobacco chewing alcohol (risk = 6X)dental infections, poor hygienetrauma (dental – dentures, sharp teeth)Human papilloma virus (HPV) the same group of virus that causes genital warts, here it is transmitted through oral-genital route UV/sunlight, radiation (lip)chronic erosive skin diseases, e.g. lichen planus Syphilis Immunosuppression. nutritional deficiencies (riboflavin, Plummer-Vinson, sideropenic dysphagia)
A Non-healing Ulcer on the Lip(Mouse over to zoom in)
What are the symptoms ?Common symptoms may include:•A mouth ulcer/sore that won't heal with common over-the-counter medication especially if the ulcers are painless.Common mouth ulcers are called ‘aphthous ulcers’ –these are usually painful but heals within a week or two with or without medication. Most of us would have had it one time or another before.•White or red patches in your mouth –leukoplakia (white patches) or red patches (erythroplakia) can means high probability of cells transforming into cancer later (considered a pre-cancerous lesion)•Bleeding in your mouth, easy bleeding even with minor trauma, blood-stained sputum•Loose teeth or denture not fitting well anymore•Problems or pain with swallowing•A lump in your neck, commonly due to an enlarged lymph node•An earache, as a result of pain transmission through the common nerve root supply between the ear and oral cavity•Foul smell in the mouth of recent onset•Difficulty in mouth opening –‘my mouth feels tight’
Diagnosis of oral cancerA thorough check of the oral cavity is important - the doctor or dentist checks your mouth and throat for red or white patches, lumps, swelling, or other problems. This exam includes looking carefully at the roof of the mouth, back of the throat, and insides of the cheeks and lips. Nowadays with the advent of flexible endoscopes, the inner recesses of your throat and opening to the food passage can be closely examined in the clinic to exclude other contributing factors to the symptoms. The floor of your mouth and lymph nodes in your neck also are checked.At any region that shows changes suspicious of cancer, a small sample of tissue may be removed for biopsy, usually done with local anaesthesia. Sometimes, general anaesthesia maybe required for harder-to-reach areas where special instruments are used. The specimen would be sent to the laboratory for a pathologist who will examine the tissue under a microscope to confirm or exclude cancer cells. A biopsy is the only definitive way to know if the abnormal area is cancerous.
TreatmentOnce the cancer is confirmed and before treatment can be commenced, it is important to ‘stage’ the cancer i.e to delineate the local, regional and distant involvement of the cancer. This may require other investigative modalities like CT scan, MRI, ultrasound etc. Oral cancer treatments may include surgery, radiation therapy or chemotherapy. Some patients require a combination of treatments to achieve the best outcome. Surgical treatment can be as simple as excising the pre-cancerous lesion to major removal of the cancer and its draining lymph nodes (neck dissection surgery) with reconstructive surgery of the defect.Prognostic factors in oral carcinoma are very much dependant on:•Tumour site •Tumour depth (how much deeper it has invaded the surrounding tissue)•Type of histology of the cancer•Degree of differentiation of the cancer•Presence of perineural spread (i.e spread along the adjacent nerves)•Level and size of metastatic/secondary lymph nodes •Mandibular invasion
DR. VINCENT TANConsultant Ear, Nose and Throat, Head and Neck Surgeon,MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Cert.in Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore)Fellowship in Head and Neck Oncology & Surgery (Amsterdam)