Tumors of lips and oral cavity

Cancer of the oral cavity develops every year in 30,000 Americans and causes 8,000 deaths, mostly in people over 40 years old. This makes about 2.5% of cancer cases and 1.5% of all deaths due to some type of cancer-a high percentage if small oral cavity size is taken into account relative to the rest of the body. In addition to lung and skin cancer, oral cavity cancer can be more often prevented than many other types of cancer.

Non-cancerous (benign) and cancerous (malignant) neoplasm may arise from every type of tissue in and around the mouth, including bones, muscles and nerves. Cancer derived from the oral mucosa or surface tissue is called cancer; Cancer that arises from deeper tissues is called sarcoma. Rarely in the mouth area there are forms of cancer that have spread from other parts of the body, most often lungs, breast and prostate.

Busting (screening or searching) for the purpose of early diagnosis of oral cavity cancer should be an integral part of the review of the doctor and dentist, since it the early detection is essential. Cancer of less than 1 centimeter in diameter can be easily cured. Unfortunately, most cancers of oral cavity are not diagnosed until they penetrate into the lymph nodes of the jaw and neck. Due to the late diagnosis, 25% of cases of oral cavity cancer end up fatal.

Symptoms and diagnosis
Cancer of the oral cavity appears usually on the lateral sides of the tongue, the bottom of the oral cavity and the back of the roof of the mouth (soft palate). Cancer in the tongue and the bottom of the oral cavity is usually platelet cancer (squamous cell carcinomas). Kaposi’s sarcoma is a cancer of blood vessels near the skin. It appears in the oral cavity – usually on the roof of the oral cavity (palate) – in people with AIDS.
The common cancer of those who chew or snuff tobacco is the inside of the cheeks and lips. This cancer is often slowly growing verrucous (VC) carcinoma.
Melanoma, a cancer that usually occurs on the skin, rarely appears in the mouth. The area in the mouth that has become brown or dark colored recently may be melanoma, and the doctor or dentist should examine it. Melanoma should be distinguished from normally pigmented areas in the mouth that appear in some families, and are particularly common in dark-skinned people in the Mediterranean.

Tongue
Cancer of the tongue is painless in early stages and is usually detected during a routine examination of teeth.
Cancer usually appears on the lateral sides of the tongue. It almost never occurs at the top of the tongue except in someone who has had untreated syphilis for many years. Platelet cell cancer of the tongue often looks like open cracks and is prone to growing into the tissues that lie beneath. The red area in the mouth (erythroplakia) is the forerunner of cancer. Anyone with a red area on the lateral sides of the tongue should visit a doctor or dentist.

The bottom of the oral cavity
Cancer of the bottom of the cavity is regularly painless in early stage and is usually detected during a routine examination of the teeth. As with cancer of the tongue, oral cavity cancer is usually platelet cell carcinoma (squamous cell carcinoma) that looks like open crack and is prone to growing into the tissues below. Anyone with red area (erythroplacia) at the bottom of the cavity should visit a doctor or dentist, as this may indicate cancer.

Soft palate
Cancer of soft palate can be a cancer of plate cells or cancer that begins in small salivary glands in the soft palate. Platelet cell cancer often looks like ulcer. Cancer that starts in small salivary glands usually looks like a little swelling.

Oral mucosa
When the moist inner lining of the oral cavity (mucous membrane of the oral cavity) irritates for a long time, a shallow white stain that cannot be scratched (leukoplakia) can develop. The damaged spot looks white, because it is a thick layer of keratin-the same material that covers most of the skin and normally there is less of it on the lining of the oral cavity. Unlike other white areas that occur in the mouth – usually from food accumulation, bacteria or fungus-leukoplakia cannot be cleansed. Most leukoplakia occurs as a normal protective reaction against further injury. However, in the process of making this protective cover, some cells can become cancerous.

On the contrary, the red area in the mouth (erythroplakia) is due to the thinning of the oral mucosa. The area looks red, because the capillaries below are better seen. Erythroplakia is a significantly more dangerous cancer than leukoplakia. A person with any red area in the mouth should consult a doctor or dentist.

Ulcers of the oral cavity often arise as a result of tissue injury or irritation – for example, when someone accidentally bites or scratches the inside of the cheek. Other causes are wounds from an ulcer or irritating substances, such as acetylsalicylic acid (aspirin), which revolves around the gums. Non-cancerous ulcers are regularly painful. An ulcer that does not hurt but lasts more than 10 days can be precancerous or cancerous and should be checked by a doctor or dentist.

A person who chews tobacco or sniffs it can develop white peeling on the inside of the chhek. These clumps can develop in verrucous carcinoma.

Gums
Sharp bulge or elevated area on gums (gingiva) should not be the cause of an alert. If such bulge is not caused by a periodontal abscess or a tooth filled with pus, this may be a non-cancerous neoplasm induced by irritation. Non-cancerous neoplasm is relatively common and, if necessary, can be easily removed by surgical procedure. In 10% to 40% of people non-cancerous neoplasm is returned, because the cause is not removed, that is the thing that irritates. If a badly fitted denture causes the appearance of non-cancerous neoplasm, it should be properly adjusted or replaced.

Lips
Lips – most commonly lower lip – are the object of sun damage (actinic cheilitis), which makes them cracked and red, or blended red and white. A doctor or dentist may make a biopsy to determine if these rough spots on the lips are carcinogenic. Cancer on the outside of the lip is more common in areas where there is more sunshine. Cancer of the lip and other parts of the oral cavity is often firm on the touch and is held firmly to a tissue that lies beneath it (fixed to the base), while most of the non-cancerous lumps (knobs) in these areas are not tied to the substrate, and are movable. Abnormalities of the upper lip are less common than those on the lower lip, but are more likely to be carcinogenic and require medical attention. A person who chews tobacco or sniffs it can develop white peeling on the inside of the lips. These accumulations can develop in verrucous carcinoma.

Salivary glands
Tumors of salivary glands can be carcinogenic or non-cancerous. They can occur in any of the three pairs of large salivary glands: a parotid gland (on the face in front of the ear), a submandibular gland (under the jaw), or a sublingual gland (at the bottom of oral cavity in front of the tongue). Tumors can also occur in small salivary glands scattered over most of the part of oral saliva. Early growth of tumors of the salivary glands may or may not be painful. Carcinogenic tumors tend to grow rapidly, and they are firm when touched.

Prevention and treatment
Hiding from the sun reduces the risk of lip cancer. Avoiding excessive use of alcohol and tobacco can help prevent most cases of oral cavity cancer. The smoothening of the rough edges of broken teeth or their restoration is another preventive measure. There is evidence that antioxidant vitamins, such as vitamins C and E, and beta-carotene can additionally contribute to protection, but further research is needed. If the damage of the sun involves a large surface area of the lip, the scraping of the lip, removing the entire outer surface, whether surgical or laser, can prevent cancer progression.

The success of treating cancer of the oral cavity and lips largely depends on how far cancer has advanced. Cancer of the oral cavity rarely spreads to distant places of the body, but it is prone to catch the head and neck. The healing rate is high if the entire cancer and surrounding normal tissue is removed before it has spread to the lymph nodes. If the cancer has spread to the lymph nodes, healing is much less likely. During surgery, the nodes are removed under and behind the jaw and along the neck, as well as cancer in the oral cavity. Surgery for oral cavity cancer can be distorting and psychologically traumatic.

A person with mouth or neck cancer can be directed to radiation therapy and surgery or just radiation. Radiation therapy (radiotherapy) often destroys the salivary glands and leaves people’s mouth dry, which can lead to teeth bleeding and other problems. As the jawbones exposed to radiation do not heal well, problems with teeth should be treated before radiation is applied. Every tooth that appears to be problematic is removed and time to heal is enabled.

To people who perform radiation therapy due to cancer of the oral cavity is important good dental hygiene. Such hygiene includes regular checkups and good home care with daily fluoride use. If a person finally takes out a tooth, a wound in the jaw can heal better with help of oxygen treatment at elevated pressure (hyperbaric chamber).
For oral cavity cancer, chemotherapy has limited success. The main areas of treatment are surgery and radiation (radiotherapy).

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PhD Milica Čelebić

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