Dental services

Oral cancer treatment

Regarding the mortality caused by oral cancer in men and women alike, Hungary tops the list in Europe. According to the data in the National Cancer Register of the National Oncology Institute, in 2001 1432 men and 305 women died due to malicious tumours of the oral cavity.

What is even more shocking is the fact that since 1975 mortality caused by oral cancers has increased at an alarming rate, by approximately 500%. The situation is more serious if we consider that in case of oral cancers it is predominantly such tumours that are easy to detect even at the stage preceding the development of cancer, if the oral cavity is carefully checked by a dentist. Patients themselves can realise a great proportion of these cancers.
Oral cancers realised and treated in time can be cured in 80% of the cases.

Oral cancers and their symptoms

Around half of oral cancers form on the tongue, a quarter of them on the lips, while the rest is made up of cancers starting from the inner surface of the cheeks, the floor of the mouth or the gums. The overwhelming majority of oral cancers can be observed in people over 45.
Due to the fact that the oral cavity is easy to examine, oral cancers can be realised at an early stage, often in the pre-cancer state. Unfortunately, though, because the early changes related to cancer do not cause pain, patients often neglect processes of the oral cavity and turn to a doctor too late. This is really unfortunate as the chances of recovery are much higher at an early stage than at a later stage. This is why the American National Cancer Institute suggests the monthly self-examination of the oral cavity for the sake of early realisation of cancer; this examination simply means that, standing in front of a mirror, you observe the surfaces of your oral cavity thoroughly.
Regular check-ups by the dentist and the oral surgeon also serve the early realisation of cancer.

Causes of oral cancers and possibilities of preventing them

Although the causes and formation of oral cancers are not absolutely clear, we know for sure that they are not infectious diseases, so they do not spread from one person to another. The main risk factors are smoking and alcohol consumption. It has been proved in several ways that 80-90% of oral cancers form in connection with smoking cigars, cigarettes or pipe.
According to the surveys, the risk of developing oral cancer is 4-15 times higher in strong smokers, compared to non-smokers. Excessive alcohol consumption also increases the risk around seven times higher. Those who smoke and drink alcohol excessively at the same time bear a particularly high risk of developing oral cancer.
Why are smoking and excessive alcohol consumption such serious risk factors, especially the two combined? Combustion products of the cigarette contain approximately 4000 different compounds and all known carcinogen compound groups are represented by several members among them. These substances are found in the cigarette smoke that the smoker inhales and so these compounds directly contact the epidermic lining of the mouth and the throat, the mucous membrane of the bronchi. Alcohol, on the other hand, constitutes a risk factor as it solves the tar ingredients of the combustion products that contain carcinogen materials, and, depending on the alcoholic strength, has an irritating (stimulating) effect on the mucous membrane of the mouth and causes hyperaemia there, thus promoting the absorption of carcinogen compounds.

Other risk factors

Dust and chemical exposure can also play a role in the formation of oral cancers. Lip cancer develops especially easily if the lips are exposed to ultra-violet radiation, if people smoke a pipe or if they smoke a cigarette without a filter. Neglecting the teeth, broken and carious teeth and badly fitting false teeth also help the development of oral cancers as they permanently irritate the mucous membranes and maintain chronic purulous gingivitis. Nutrition lacking vitamins and minerals also promote the development of these cancers. This may be the explanation of the fact that oral cancers are more frequent in countries where the population is underfed due to poverty.

Prevention of oral cancers

The most effective way of preventing oral cancers is to stop smoking and excessive alcohol consumption.
According to experiences obtained in developed western countries, improving oral hygiene and frequent dental check-ups and treatment can also significantly reduce the occurrence of oral cancers. The oral cavity is easy to access during clinical examinations and by eliminating the bad teeth and the diseases of the gums, dental treatment can also decrease the risk of developing cancer. On the other hand, periodical medical check-ups can often realise the chronic lesions at the time when the pre-malignant lesions develop and they can reduce the risk of developing cancer by treating these cases.
According to several studies, in a significant proportion of oral cancer cases, typical white patches can be observed on the mucous membrane of the mouth before cancer forms, which are called leukoplakias. This, in essence, is the thickening and widening of the epithelium. The exact cause of leukoplakia is not known but it apparently often accompanies strong smoking and excessive alcohol consumption or it frequently develops in areas permanently irritated by a badly fitting denture.
Other changes in the mucous membrane, on which cancer can form easier: erythroplakia, which appears in the form of flat red patches, brownish or smoky grey patches, which can rarely be observed on the mucous membrane of the mouth, as well as papilloma, a seldom developing benign epithelial tumour. It is important that these lesions, which can be regarded as pre-malignant conditions, should be frequently checked by a specialist, who can decide about removing them, if needed.

Diagnostics of oral cancer

If any pathological lesion, suspected to be related to cancer, is observed in any area of the oral cavity, a tissue sample is taken (biopsy is performed) as only the microscopic examination of the material removed through biopsy can provide reliable information and facilitate exact diagnosis about the nature of the lesion.
In case the lesion proves to be cancer during the microscopic examination, the doctor has to know exactly the extension and stage of the tumour in order to be able to prepare the treatment plan. For this purpose, he prepares various supplementing examinations. A part of this is the dental X-ray examination, whereby images of the upper and lower jaws and the teeth are taken, as well as X-rays of the head and the chest, which can provide information about the extension of the tumour. Sometimes it may be necessary to make computer tomography (CT) or, possibly, an ultrasound (US) examination as well. The obtained images provide valuable information about the possible pathological lesions and their extension. Naturally, all these examinations have to be preceded by thorough physical examinations, where the doctor feels the patient's oral cavity by hand.
In order to accurately establish the extension and the borders of the malignant lesions of the oral cavity, the tissue samples are sometimes marked with paint solution. This is based on the fact that cancerous cells are much more permeable for paint than healthy cells, thus they discolour and become visible to the naked eye.

Treatment of oral cancers

Considering the results of the above-listed examinations, the doctor prepares the treatment plan, which is influenced by several factors. Such factors can be the position, size, type, extension or stage of the tumour. Before commencing the treatment, doctors will generally recommend that the possibly necessary dental treatments should be made as during the treatment of the tumour the mucous membrane becomes extremely sensitive and very susceptible to infections.
Several questions and doubts may arise in the patients regarding the recommended treatment. They may want to know what other methods of treatment may be considered, what result those methods may deliver and what consequences the planned operation may have. Will there be lasting scars, permanent changes in the appearance of the face, will they lose teeth during the treatment and to what extent will the treatments change their eating and speaking abilities. Patients are especially curious how the tumour and its treatment will affect their everyday lifestyle, whether their face will be deformed and if it will be necessary and possible to make any plastic surgery afterwards.
All these are very natural and necessary questions and it is desirable that patients should receive satisfactory answers to all these questions before the treatment begins - therefore, they should not hesitate to ask their doctors the questions. The treatment generally involves surgical intervention. Sometimes only radiotherapy is applied but in many cases the two methods have to be combined. In certain cases it may also be necessary to apply chemotherapy using chemicals to kill cancerous cells.

Surgical intervention

In case of smaller tumours, the surgical intervention means the complete removal of the tumour. If it is suspected that the tumour may have spread to the neighbouring lymph nodes, they may also be removed. If the tumour has infiltrated into the cervical muscles, a more extensive operation may be necessary.
Methods of surgical treatment: resection using surgical or electronic knife or laser ray. The doctor takes special care that the line of the cut should not run through a tumorous area and that the edges of the cut after the operation should be free from cancerous cells. If a large size of tissue has to be removed due to the radical removal of the tumorous area, then it may be necessary to perform a tissue replacing, corrective surgical intervention.

Radiotherapy

Radiotherapy is a local treatment method. It is aimed at destroying the tumourus cells in the area and it applies powerful rays. In certain cases radiotherapy is used before the operation in order to reduce the volume of the tumour, while in other cases patients are irradiated following the operation so that the possibly remaining tumourus cells can be destroyed this way. Such treatment is called adjuvant radiotherapy.
Basically, two types of radiotherapy treatment may be applied: external beam radiotherapy (EBR) and brachytherapy.
In case of external beam radiotherapy, the necessary radiation dose is applied on the area to be irradiated from outside, using the appropriate equipment. External irradiation may be performed in outpatient treatment when the patient appears for treatment daily, for the necessary radiation is not applied in one dose but in several smaller doses in order to protect the neighbouring healthy tissues. Thus applying the necessary radiation dose may take up to 5-6 weeks, calculating with five treatments a week.
In case of brachytherapy, radioactive materials of high energy emitting ionising radiation are placed in the tissues to be irradiated. The benefit of this method is that the surrounding healthy tissues are exposed to less radiation and the common general symptoms occurring after irradiation using external radiation source can be avoided. Treatment periods are also much shorter. The disadvantage is that in most cases the patient has to be anaesthetised in order to implant the radiation source in the tumorous tissue and that this method of radiotherapy can only be applied in the hospital.
During the radiotherapy oral hygiene (washing teeth after meals) has to be taken special care of in order to avoid infections and inflammations.

Chemotherapy

Chemotherapy may also be applied in case of oral cancers, especially to treat reoccurring tumours. Treatment may involve one medicine (monotherapy) or the combination of several medicines. Chemotherapy medications may be applied in various ways. Sometimes the patient takes them orally and in other cases they will be injected into the vein of the patient. In both cases the chemotherapy medication will have its effect in the whole body, thus the treatment impacts the whole organism. There are side effects accordingly.

Patient follow-up, aftercare

Treatment does not stop with the surgery or when the radiotherapy and/or chemotherapy ends, for the treatment includes all the interventions that are performed in order to make the patient able to do their daily activities again, in other words, to rehabilitate the patient. This sometimes necessitates plastic surgery or the preparation of a new set of denture. In other cases it is enough to provide dietetic advisory while sometimes treatment has to focus on restoring the speaking ability.
The regular, periodical treatment of patients treated with oral cancer is also extremely important later, when the after-treatment is concluded. It is the basic interest of the patients that they should appear punctually at the check-ups recommended by the doctor. The condition of the patients is generally checked once a month or once in two months in the first year, and half-yearly for the next five years. The doctor or the dentist checks the recovery process and examines if there is a sign that the tumour reoccurs, for there is a higher risk of reoccurring cancer in the oral cavity or the head-neck in those patients who had oral cancer.
In order to reduce the risk of a new tumour forming, it is essential to completely stop smoking and consuming alcohol. Besides, it is necessary to adopt a diet rich in vitamins and minerals and to take the medicine recommended by the doctor.
The information described above mainly applies to so-called epitheliomas starting from the mucous membrane of the oral cavity. These constitute the overwhelming majority of malignant oral cancers but several other rare malignant tumours may occur in the oral cavity. The treatment of these tumours are generally much less successful than that of epitheliomas.

What should you do for the prevention and early diagnosis of oral cancer?

  1. Smoking, excessive alcohol consumption and bad oral hygiene are important aetiological factors regarding the development of most oral cancers. By stopping smoking and alcohol consumption you can significantly reduce the risk of developing oral cancer.
  2. Pay more attention to the hygiene of your oral cavity (e.g. washing teeth after meals) and the maintenance of your teeth!
  3. If you regularly perform self-examination of your mouth, you can notice certain irregular lesions yourselves. When such conditions are observed, you should see your doctor; this way you can significantly increase the chance of diagnosing the tumour at an early stage, thus the successfulness of the therapy.
  4. Regularly see your doctor for health check-ups!

Source: Internet