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What is cancer?
The organs are made of cells. Cancer is a disease of these cells. Although cells in different parts of the body may look and work differently, most repair and reproduce themselves in the same way. In a benign tumour the cells do not spread to other parts of the body and so are not cancerous. If they continue to grow at the original site, however, they may cause a problem by pressing on the surrounding organs. A malignant tumour consists of cancer cells which have the ability to spread beyond the original site. If the tumour is left untreated, it may invade and destroy surrounding tissue. Sometimes cells break away from the original (primary) cancer and spread to other organs in the body through the bloodstream or lymphatic system. When these cells reach a new site they may go on dividing and form a new tumour, often referred to as a secondary or a metastasis. Doctors can tell whether a tumour is benign or malignant by examining a small sample of cells under a microscope. This is called a biopsy. It is important to realize that cancer is not a single disease with a single cause and a single type of treatment. There are more than 200 different kinds of cancer, each with its own name and treatment.  |
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Mouth Cancer
We have tried to bring together an much information as we can about Cancers in the mouth. We have lots of links and these pages are being constantly updated. If you leave here and find a better source please let us know and we will put in new links.
Frequently Asked Questions
The organs
are made of cells.
Cancer is a disease of these
cells. Although cells in different parts of the body may look and work
differently, most repair and reproduce themselves in the same way.
In a benign tumour the
cells do not spread to other parts of the body and so are not cancerous. If they
continue to grow at the original site, however, they may cause a problem by
pressing on the surrounding organs.
A malignant tumour consists of cancer cells which have the ability to spread beyond the original site. If the tumour is left untreated, it may invade and destroy surrounding tissue. Sometimes cells break away from the original (primary) cancer and spread to other organs in the body through the bloodstream or lymphatic system. When these cells reach a new site they may go on dividing and form a new tumour, often referred to as a secondary or a metastasis.
Doctors can tell whether a tumour is benign or malignant by examining a small sample of cells under a microscope. This is called a biopsy.
It is important to realize that cancer is not a single disease with a single cause and a single type of treatment. There are more than 200 different kinds of cancer, each with its own name and treatment.
What causes cancers of the mouth and throat?
Cancers of the mouth and throat are more common in men and older people. In some cases the causes are unknown, but smokers and those who drink alcohol heavily -- especially those who do both -- run an increased risk of developing these cancers. Cancers of the lip and cheek are more common in pipe smokers. In countries where chewing tobacco or betel nuts are common habits, cancers of the mouth and throat are common.
Behind the nose is an area called the nasopharynx. Cancer of this area is very common in southern China and Hong Kong, but rare in the UK. It may be connected with a viral infection known as an Epstein-Barr virus. Although this cancer is commoner in men and elderly people it can occur in adults of all ages as well as children.
As with other forms of cancer, the direct cause of mouth cancer is not yet clear. Research continues on many fronts to find the key to why cells in various organs and tissues of the body begin a pattern of uncontrolled growth (i.e. become cancerous). With mouth cancers, however, we do know that there are several factors that contribute significantly to their development:
Smoking tobacco products - especially pipes and cigars
Chewing tobacco
The use of snuff
Poor oral hygiene
Chronic irritation of the mouth. For example, from dentures that don't fit well or from the broken or rough edges of teeth.
Exposure to sunlight (lips)
(Information provided by the Oral Health Education Foundation)
A causative relationship has been established between oral cancer and the heavy use of alcohol, and evidence indicates that the combination of tobacco and alcohol use raises the risk for oral cancer signficantly more than the use of either substance alone. Studies indicate that cirrhosis of the liver due to alcohol intake may be associated with an increased risk for oral cancer, although the mechanism for this relationship is poorly understood. The fact that most heavy users of alcohol are also smokers may also be indicative of the synergistic relationship between tobacco and alcohol use in terms of raising the risk for oral cancer.
Studies investigating the relationship between alcohol and oral cancer include:
Mashberg A, Garfinkel L, Harris S: Alcohol as a primary risk factor in oral squamous carcinoma. CA 31:146, 1981.
Graham S, Dayal H, Rohrer T et al: Dentition, diet, tobacco and alcohol in the epidemiology of oral cancer. J Natl Cancer Inst 59:1611, 1977.
Johnston WE, Ballantyne AJ: Prognostic effect of tobacco and alcohol use inients with oral tongue cancer. Am J Surg 134:444, 1977.
Schmidt W, Popham RE: The role of drinking and smoking in mortality from cancer and other causes in male alcoholics. Cancer 47:1031, 1981.
Trieger N, Taylor GW, Weisberger D: The significance of liver dysfunction in mouth cancer. Surg Gynecol Obstet 108:230, 1959.
Keller A: Cirrhosis of the liver, alcoholism and heavy smoking associated with cancer of the mouth and pharynx. Cancer 20:1015, 1967.
Rothman K, Keller A: The effect of joint exposure to alcohol and tobacco on risk of cancer of the mouth and pharynx. J Chronic Dis 25:711, 1972.
Kissin B, Kaley M. Su WH et al: Head and neck cancer in alcoholics: The relationship to drinking smoking, and dietary patterns. JAMA 224:1174, 1973.
Keller AZ: Alcohol, tobacco and age factors in the relative frequency of cancer among males with and without liver cirrhosis. Am J Epidemiol 106:194, 1977.
In different parts of the world a variety of substances are introduced into the mouth, and some of these substances may increase the risk for oral cancer. For example, slaked lime, betel nuts and various spices are placed in the mouth in countries such as India, and the incidence of oral cancer is particularly high in this country. In fact, in Asia oropharyngeal cancer is the leading cancer in men, and in Africa and Asia oropharyngeal cancer is the third most frequent cancer site in women. In certain countries, the lit end of rolled tobacco leaves or small cigars is placed in the mouth, and this habit may lead to an increased incidence of palatal cancer.
What are the symptoms of mouth and throat cancers?
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A lump or thickening in the oral soft tissues
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Soreness or feeling that something is caught in the throat
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Difficulty chewing or swallowing
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Ear pain
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Difficulty moving the jaw or tongue
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Hoarseness
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Numbness of the tongue or other areas of the mouth
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Swelling of the jaw that causes dentures to fit poorly or become uncomfortable
If the above problems persist for more than two weeks, a thorough clinical examination and laboratory tests, as necessary, should be performed to obtain a definitive diagnosis. If a diagnosis cannot be obtained, referral to the appropriate specialist is indicated.
To perform the oral cancer self examination, just follow these 7 easy steps.
Look at and feel your:
1. Head and Neck
look at your face and neck in a mirror. Normally, the left and right sides of the face have the same shape. Look for any lumps, bumps, or swellings that are only on one side of your face
2. Face
examine the skin on your face. Do you notice any colour or size changes, sores, moles, or growths?
3. Neck
Press along the sides and front of the neck. Do you feel any tenderness or lumps?
4. Lips
Pull your lower lip down and look inside for any sores or colour changes. Next, use your thumb and forefinger to feel the lip for lumps, bumps, or changes in texture. Repeat this on your upper lip
5. Cheek
Use your fingers to pull out your cheek so you can see inside. look for red, white, or dark patches. Put your index finger on the inside of your cheek and your thumb on the outside. Gently squeeze and roll your cheek between your fingers to check for any lumps or areas of tenderness. Repeat this on the other cheek
6. Roof of the Mouth
Tilt your head back and open your mouth wide to see it there are any lumps or if the colour is different than usual. Run your finger on the roof to feel for lumps
7. Floor of the Mouth and Tongue
Stick out your tongue and look at the top surface for colour and texture. Gently pull your tongue forward to look at one side first and then the other. Look for any swellings or colour changes. Examine the underside of your tongue by placing the tip of the tongue on the roof of your mouth.
Look at the floor of your mouth and the underside of your tongue for colour changes that are very different from what is normal. Gently press your finger along the underside of your tongue to feel for any lumps or swellings
If you find anything out of the ordinary, particularly anything that does not heal or go away in two weeks, or that has recently changed, discuss it with your oral health professional or physician.
Mouth cancer can appear in different forms. It may appear as a painless ulcer or sore that does not clear up. Sometimes it may happen through changes in pre-cancerous conditions such as thickened white patches (leukaplakia) or superficial red patches (erythroplakia) on the surfaces of the mouth. The most common area is the tongue or bottom of the mouth. It is very often painless but pain may be a symptom for some people. Some of these affected areas also bleed at times. Sometimes your dentist may notice it -- before it starts to produce any symptoms -- during a routine dental check-up. Earache is another common symptom. Most often such symptoms are not cancer, but you should have them checked by your dentist or doctor.
The problems caused by the affected area will depend on where it is situated. For example, if it affects the tongue it may cause some slurring of speech. If it affects other parts of the mouth or throat it may cause difficulty and pain when chewing or swallowing, or cause loose teeth.
Lymph glands
Another important symptom of cancers of the mouth and throat is an enlarged lymph gland in the neck. The lymph glands are part of the lymphatic system, which is the body's natural defence against infection. The system is made up of a collection of small lymph glands, found mainly in the neck, under the armpits and in the groin. These glands produce white blood cells which help to fight infections and disease.
The lymph glands in the neck are usually the first place to which cancers of the mouth and throat spread. Sometimes the first symptom of a mouth or throat cancer will be a painless enlargement of one of these glands. Enlarged lymph glands are much more likely to be due to a harmless infection rather than cancer. However, if a lump persists for more than 3-4 weeks in spite of antibiotics, it should be examined by a specialist.
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Early Detection Saves Lives With early detection and timely treatment, deaths from oral cancer could be dramatically reduced. The five-year survival rate for those with localized disease at diagnosis is 76 percent compared with only 19 percent for those whose cancer has spread to other parts of the body. Early detection of oral cancers is often possible. Tissue changes in the mouth that might signal the beginnings of cancer often can be seen and felt easily. |
INCIDENCE OF ORAL CANCER
(source: U.S. Dept of Health and Human Services)
U.S. Statistics:
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The annual age-adjusted incidence of oral cavity and pharyngeal cancers combined was 11.3 cases per 100,000. Incidence in males was almost three times that of females, and blacks had a higher rate than whites. The highest incidence was in black males, at 24.5 cases per 100,000.
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For cancers of the oral cavity alone, incidence was 7.7 cases per 100,000. Males had more than twice the rate of females. Incidence in whites was similar to that of blacks.
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Tongue cancer was the single largest contributor to oral cancer cavity, accounting for almost 30 percent of these cases.
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Over a 15-year study period (1973-1987), cancers of the tongue increased significantly by 1.0 percent per year. A significant increase was noted in all race and gender groups, except black females. Cancers of "other sites," which include the buccal mocosa and vestibule, gingiva, and palate, increased significantly at an annual rate of 0.8 percent. Overall, however, incidence of cancers of the oral cavity decreased by 0.4 percent per year during the 15-year period. Cancers of the lip had a significant annual decline of 4.1 percent, due primarily to the decrease of these cancers in white males. Incidence of pharyngeal cancer increased by 1 percent per year during the 15-year period, primarily as a result of a 6 percent annual increase in black males.
MORTALITY STATISTICS FOR ORAL CANCER
(source: U.S. Dept. of Health and Human Services)
U.S. Statistics:
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For combined oral cavity and pharyngeal sites, the overall mortality rate is 3.2 per 100,000.
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The mortality rate in males is nearly three times greater than that of females. Blacks have almost twice the mortality of whites. The highest mortality rate is for black males (9.5 per 100,000).
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For cancers of the oral cavity, the overall mortality rate is 1.7 deaths per 100,000. Mortality is higher in males than in females, and greater in blacks than in whites.
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For oral cavity sites, there was a significant annual decrease of 1.8 percent in overall mortality during the 15- year period 1973-1987, most notably in males. There were no significant changes in females.
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For blacks in general and black males specifically, there was significant increases in mortality rates of pharyngeal cancer, with annual percent increases of 1.5 and 2.0, respectively.
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The 5-year survival rate for oral cavity and pharyngeal cancer combined was 50.9 percent in the 1981-86 time period. Survival for males was 49.0 percent compared with 54.8 percent for females. The 5-year survival rates for pharyngeal cancer cases were about half of those for cancers of the oral cavity (32.4 vs 59.4 percent).
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Statistically significant differences were found between 5-year relative survival rates (9181-1986) for blacks as compared to whites for oral cavity and pharyngeal cancers combined (31.2 vs 53.4 percent), and survival rates for pharyngeal cancers, likewise were lower for blacks than whites (32.0 vs 33.3 percent).
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5-year relative survival rates for oral cavity and pharyngeal cancer cases were 75 percent for localized cases at time of diagnosis, 41 percent for regionalized cases at time of diagnosis, and 18 percent for cases with distant metastases as time of diagnosis. Oral cavity cancer cases are almost three times as likely to be localized at time of diagnosis than pharyngeal cancers (47 vs 17 percent).
Any mouth sore that persists for more than a week should be examined by your dentist. Leukaplakia is a thick, whitish-colour patch that forms on the cheeks, gums or tongue and is caused by excess cell growth. It is common among tobacco users and can also result from irritations such as ill-filling dentures or a habit of chewing on one's cheek. The danger of leukoplakia is that it can progress to cancer. Your dentist may want to take a biopsy if the leukoplakia appears to be threatening.
How can I help prevent oral cancer?
Eliminate any risk factors such as tobacco and alcohol and regularly visit your dentist. Periodic dental exams allow early detection and appropriate treatment if cancer develops. If at any time you notice any changes in the appearance of your mouth or any of these signs and symptoms, contact your dentist at once:
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A persistent sore or irritation that does not heal
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colour changes such as the development of red and/or white lesions
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Pain, tenderness or numbness anywhere in the mouth or lips
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A lump, thickening, rough spot, crust or small eroded area
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Difficulty in chewing, swallowing, speaking or moving the jaw or tongue
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Change in bite
What to Do:
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stop smoking (this includes cigarettes, cigars and pipes)
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stop the use of chewing tobacco and snuff
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if you drink alcohol, do so only in moderate amounts
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maintain good oral hygiene - this includes regular brushing, flossing and regular checkups and cleanings at the dentist's office.
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if you spend time outside, protect yourself from the damaging rays of the sun. A sun protection factor or SPF of 15 or greater is recommended. Wearing a wide brimmed hat will offer extra protection to your face.
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if you are aware of anything that causes frequent irritation to the inside of your mouth, take measures to prevent this irritation.
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examine the inside of your mouth regularly.
`Will I be in pain?' is a question commonly asked by people diagnosed with cancer. The answer is that one in three cancer patients have no pain at all. A better understanding of the causes of pain, together with new, more effective ways of treating it, mean that there is rarely any need to suffer uncontrolled pain. It is important to know that the amount of pain you have is not related to how severe your cancer is. Having pain does not necessarily mean that the cancer is advanced, or more serious than if you had no pain. And pain does not necessarily get worse as the cancer progresses. Everyone feels pain differently and even people with the same disease have very different experiences. Pain is what you say hurts. And, like any other symptom of cancer, it should be treated according to your own particular needs. And for more information look at http://www.cancerbacup.org.uk/ which is a very good source of information. |
How does the doctor make the diagnosis?
You will probably begin by seeing your family doctor (general practitioner) or dentist, who will examine you and arrange for you to have any further tests that are necessary. If you are seeing the dentist for a routine checkup, be sure to ask him or her about any changes in the mouth you have had for more than a couple of weeks. You will need to be referred to hospital for these tests and for specialist advice and treatment, normally from an oral and maxillofacial surgeon who is qualified as a dentist and a doctor.
At the hospital the specialist will ask you about your medical background before examining your mouth, throat and neck using small mirrors and a bright light if necessary.
Sometimes the doctor will examine the lump or raw area with a gloved finger or a small mirror. This can be uncomfortable and you may be given a local anaesthetic lozenge to suck, which numbs the mouth for a few minutes, or an anaesthetic spray. If you do have a local anaesthetic to your throat you shouldn't eat or drink anything for about an hour afterwards until your throat has lost the numb feeling, otherwise there is a risk of things going down the wrong way when you swallow.
Occasionally the doctor will pass a very thin flexible tube with a light at the end (nasendoscope) into the nose in order to get a better view of the back of the mouth and throat. This may be uncomfortable but only takes a few minutes.
You will probably also have a blood test and a chest X-ray to check your general health.
The doctor can only make a definite diagnosis by looking at a sample of cells from the suspected cancer under a microscope (biopsy). The sample of cells can usually be obtained by first numbing the affected area with some local anaesthetic and then removing a small piece of the suspected cancer.
If there is a strong possibility of cancer, the specialist will want to examine your whole mouth and throat area, so it may be necessary for you to have a general anaesthetic. Usually this is done on a day visit, with no need to spend the night in hospital.
Further tests
If the sample shows you have cancer your doctor may want to do some further tests to find out the extent of the cancer. These results help the doctor decide which is the best type of treatment for you.
X-ray
Sometimes the doctor may want to take X-rays of your mouth and throat to see if
there are any other lumps and swellings, or to check whether any bones in your
face or neck have been affected. If the cancer is at the bottom of the mouth an
X-ray known as an orthopantomogram (OPG) may be needed to look at the jaw and
the teeth.
A chest X-ray will be taken to check whether the cancer has spread to the lungs.
CT (CAT) scan
In this scan, several small X-rays are taken of the area in question and fed
into a computer. This builds up a detailed picture of the size and position of
the cancer.
To increase the detail shown in the pictures, a dye may be injected into a vein, usually in your arm. For a few minutes, this may make you feel hot all over. The scan is painless but it will mean lying still for about 30-40 minutes.
You will probably be able to go home as soon as the scan is over.
Magnetic resonance imaging (MRI or NMR scan)
This test is similar to a CT scan, but uses magnetism instead of X-rays to build
up cross-sectional pictures of your body.
As with CT scans, some people are given an injection of dye into a vein in the arm to improve the image.
During the test you will be asked to lie very still on a couch inside a long chamber for up to an hour. This can be unpleasant if you don't like enclosed spaces: if so, it may help to mention this to the radiographer. The MRI scanning process is also very noisy, but you will be given ear plugs. You can usually take someone with you into the room to keep you company.
The chamber is a very powerful magnet, so before entering the room you should remove any metal belongings. People who have cardiac monitors, pacemakers or surgical clips cannot have an MRI because of the magnetic fields.
Radioisotope bone scan
A radioisotope scan may be done for some tumours, to see if the cancer has
spread into nearby bones such as the jaw bone. For this test a tiny amount of
radioactive dye is injected into a vein, usually in the arm, and the patient is
then scanned by a machine which measures minute amounts of radioactivity.
The doctor can tell if there has been any spread of the cancer, as a larger amount of radioactivity is found in areas of bone affected by cancer cells.
After the dye has been injected, you will have to wait for about an hour before having the scan, so you may want to take a magazine or book with you to pass the time.
The test does not make you radioactive as the amount of radioactivity used is so small. The radioactivity disappears from your body within a few hours.
Most people are able to go home once their scan is over. It will probably take several days for the results of your tests to be ready, and this waiting period will obviously be an anxious time for you. It may help if you can find a close friend or relative with whom to talk things over.
Apart from the lymph glands in the neck, cancers of the mouth and throat do not usually spread to other parts of the body. For this reason, further tests which check whether the cancer has spread beyond the head and neck may not be necessary. Should you need any further tests, your doctor will discuss them with you.
MOUTH AND THROAT CANCER MAY RESULT FROM AGING
April 25, 1995
Media Contact: John Cramer
Phone: (410) 955-1534
E-mail: jcramer@welchlink.welch.jhu.edu
A cancer of the mouth and throat linked in middle-aged people to smoking, drinking or specific genetic mutations is more likely in the elderly to result from random genetic errors accumulated over a lifetime -- in plain language, aging itself -- according to results of a study at The Johns Hopkins Medical Institutions.
The Hopkins scientists report that squamous cell carcinoma in patients over age 75 "more commonly results from accumulated spontaneous mutations rather than through heavy exposure to known carcinogens, and less commonly involves mutation of the p53 gene." Mutation of the p53 gene, a tumor suppressor gene that normally helps to prevent the formation and growth of cancers, is the most common cancer-related genetic mutation. Many independent mutations in different genes are required for a cell to become a cancer cell.
Results published in the March 1995 issue of Archives of Otolaryngology -- Head and Neck Surgery suggest older people may develop cancer because they accumulate genetic mutations that usually occur only in people who have been exposed to carcinogens. The aging process itself may increase the tendency for certain older people to develop cancer, the researchers say.
In support of this view, the study found that older patients who develop cancers besides those in the head and neck were more likely than their younger counterparts to get skin and prostate cancers as well. Both of these cancers are commonly associated with old age. In contrast, when middle-aged people developed other cancers, they were more likely to have lung and colon cancers. These cancers are strongly associated with smoking, drinking and mutations in the p53 gene.
Hopkins scientists say the study's results have two implications for the treatment of patients in their 70s or older:
These patients and their physicians should be alert to the risk of squamous cell carcinoma, the most common type of head and neck cancer, even if the patients have been non-smokers and non-drinkers.
Many patients in their 70s, 80s and 90s who have not smoked or drunk heavily are strong enough to undergo standard cancer-fighting therapies used on younger patients. Major surgery was an integral part of the treatment for most of the older patient group.
"Although stopping smoking would prevent a large number of cases of head and neck cancer each year, this study indicates that a group of older patients would continue to develop the disease spontaneously," says Wayne M. Koch, M.D., the study's lead author and associate professor of otolaryngology. "We believe that aggressive standard therapy should still be considered for older patients. If they are in generally good health, they should get the same types of treatment as younger people."
Aggressive therapy can include major surgery and/or radiation, with treatment determined on an individual patient basis.
For the study, researchers analyzed the medical records of patients with a new onset of squamous cell carcinoma between 1988 and 1993. The study group included 81 patients who developed the carcinoma of the upper respiratory and digestive tracts after age 75. The control group included 102 patients who developed the carcinoma between age 40 and 70. Researchers analyzed the patients' exposure to tobacco and alcohol, family history of cancer, treatment and other factors. This data was a subset of patient data from a recently reported Hopkins study that uncovered the most conclusive molecular evidence to date linking cigarette smoking to cancer.
Cancer of the upper respiratory and digestive tracts accounts for about 5 percent of all cancer cases in the United States annually, or about 70,000 cases. Eighty percent of these are squamous cell carcinoma.
While mutation of the p53 gene is the most common known genetic mutation in head and neck cancer, it is suspected that eight to 10 different mutations in this gene are required to develop this disease, Koch says. The study offers support for the possible involvement of multiple tumor-suppressor genes, which requires further research.
Koch estimated it will be five to 10 years before scientists identify all the head and neck cancer-related genes and their mutations and "someday maybe tailor treatment according to the mutation of the genes."
Other researchers on the study include Himanshu Patel, M.D.; Joseph Brennan, M.D.; Jay O. Boyle, M.D., and David Sidransky, M.D.
For more information look at http://www.cancerbacup.org.uk/ which is a very good source of information
Specialist organisations
British Association of Skin Camouflage
25 Blackhorse Drive, Silkstone Common, Barnsley,
S. Yorks S75 4SD
Tel: 01226 790744
Members are trained in all aspects of camouflage. Services sometimes
available through NHS clinics. Creams can be prescribed by family doctors.
British Red Cross Society
9 Grosvenor Crescent, London SW1X 7EJ
Tel: (020) 7235 5454
Offers a special service providing camouflage make-up and individual teaching
lessons. See telephone directory for your local branch.
Changing Faces
1-2 Junction Mews, London W2 1PN
Tel: 01252 879630 fax: 01252 872633
London office: tel/fax: (020) 8931 2829
Counselling facially disfigured people. Offers advice, rehabilitation.
Let's Face It
14 Fallowfield, Yateley, Hants GU46 6LU
Tel: 01344 774405
Support groups for adults and children with facial disfigurement. Telephone
support.
Masquerade
8 The Heys, Reddish, Stockport, Cheshire
Tel: 0161 947 9117
Support group providing social events, penpal club.
General organisations
