Mouth Tumors | Dental Procedures
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    The oral cavity and the pharynx have major roles in breathing, talking, chewing and swallowing. The mouth and upper throat are sometimes referred to as the oropharynx. Many different cell types make up the different structures in the mouth. Cancer occurs when normal cells undergo a transformation whereby they grow and multiply without normal controls. As the cells multiply, they form small abnormalities called lesions. Eventually, they form a mass called a tumor. Tumors are cancerous only if they are malignant which means that they grow uncontrollably. These could spread to the neighbouring tissues by direct invasion through the lymph nodes. Benign tumors, although they may grow and penetrate below the surface layer of tissue, do not spread by metastasis to other parts of the body.

    The 2 most common kinds of premalignant lesions in the oropharynx are leukoplakia and erythroplakia.

    Leukoplakia is a white or whitish area. This area can often be easily scraped off without bleeding. About 5% of leukoplakias can turn out to be cancerous at diagnosis or will nomally become cancerous within 10 years if not treated.

    Erythroplakia is a raised area usually in a red color, if scraped, it may bleed. Erythroplakia is generally more severe than leukoplakia and has a higher chance of becoming cancerous over time.

    Several types of malignant cancers occur in the mouth and throat.

    • Squamous cell carcinoma is by far the most common type, accounting for more than 90% of all cancers. These cancers start in the squamous cells, which form the surface of much of the lining of the mouth and pharynx. They can invade deeper layers below the squamous layer
    • Other less common cancers of the mouth and throat include minor salivary gland tumors and lymphoma

    Tobacco use is by far the most common risk factor for cancers of the mouth and throat. Both smoking and "smokeless" tobacco (snuff and chewing tobacco) increase the risk of developing cancer in the mouth or throat.

    Symptoms

    Any of the following symptoms may be noted for oropharyngeal cancer:

    • A painless lump on the lip, in the mouth, or in the throat
    • A sore on the lip or inside the mouth that does not heal
    • A painless white or red patch on the gums, tongue or lining of the mouth
    • Unexplained pain, bleeding, or numbness inside the mouth
    • A persistant sore throat
    • Pain or difficulty with chewing or swallowing
    • Swelling of the jaw
    • Hoarseness or other change in the voice

    No blood tests can identify or even suggest the presence of a cancer of the mouth or throat. The most appropriate method is a biopsy of the lesion. Biopsy can be done by simply scraping a portion from the lesion, removal with a scalpel, or withdrawn with a needle. Any other mass in the neck or surrounding areas are sampled by fine-needle aspiration.

    This is then examined by a pathologist who will identify the type of cancer if present. The doctor would then suggest the recommended mode of treatment. The cancer may be treated Surgically or through supportive treatment.

    BRIEF ABOUT THE PROCEDURE

    In Surgical treatment the tumor is removed, along with surrounding tissues, including but not limited to the lymph nodes, blood vessels, nerves and muscles that are affected.

    Radiation therapy involves the use of a high-energy beam to kill cancer cells and is used instead of surgery for many stage I and II cancers, because surgery and radiation have equivalent survival rates in these tumors. In stage II cancers, tumor location determines the best treatment. The treatment that will have the fewest side effects is usually chosen. Stage III and IV cancers are most often treated with both surgery and radiation. The radiation is typically given after surgery. Radiation after surgery kills any remaining cancer cells.

    The tumor is treated with external radiation by using a beam that is precisely targeted at the infected site. The beam penetrates the healthy skin and tissues to reach the tumor. These treatments are usually given at a cancer center.

    Radiation affects both healthy as well as cancer cells. Damage to healthy cells accounts for the side effects of radiation therapy. These include sore throat, dry mouth, cracked and peeling lips and a sunburn-like effect on the skin. Problems are seen with eating, swallowing and speaking.

    These side effects can be overcome by using Internal radiation. In this procedure, tiny radioactive seeds are inserted directly into the tumor or the surrounding tissue. These seeds emit radiations that destroy the tumor cells. This can take several days and a hospital stay would be required.

    Chemotherapy is the use of powerful drugs to kill cancer cells.

    • Chemotherapy alone may shrink these tumors, but the effect does not last for long
    • In head and neck cancers, chemotherapy is used in combination with radiation therapy and surgery for large or extensive cancers and in combination with radiation therapy in other head and neck cancers depending on the site. Common side effects are nausea and vomiting, severe heartburn-type pain, diarrhea, hair loss, mouth sores, loss of appetite, fatigue or weakness and increased risk of infection are also noted

    Treatment for recurrent tumors like that of primary tumors varies by the size and location of the tumor. Previous treatments that were given are also taken into consideration. If an infected site was already treated with external radiation, it would be difficult to repeat the treatment.

    People with head and neck cancers usually tend to loose a lot of weight. Discomfort from the tumor as well as the after effects of therapy affect their chewing and swallowing and the digestive tract which prevent them from eating. Other side effects like nausea, dry mouth, mouth sores and heartburn can be treated by medication. A speech therapist can help you with slurred speech. The speech therapist helps you learn to cope with the changes in your mouth and throat after treatment so that you can eat, swallow and talk.

    Surgery

    Oral surgery for cancer may be simple or very complicated. This depends on how far the cancer has spread from where it started.

    • Cancers that have not spread can often be removed quite easily, with minimal scarring or change in appearance
    • If the cancer has spread to other structures, those structures must also be removed. This may include small muscles in the neck, lymph nodes in the neck, salivary glands and nerves and blood vessels that supply the face. Structures of the jaw, chin and face, as well as teeth and gums, may also be affected

    If any of these structures are removed, your facial appearance will change. The surgery will also leave visible scars. You can consult a plastic surgeon while planning in order to minimize these changes. One option to restore tissues that were removed or altered would be Reconstructive surgery.

    Treatment for tumors that result in removal of tissues can leave back visible scars and can cause problems with the normal functions of your mouth and throat. These changes can be temporary or permanent. Functions like chewing, swallowing and speaking will be affected. You will have to follow-up with your surgeon, oncologist and radiation oncologist after your surgery.

    There would be series of tests to confirm the effectiveness of the treatment and to see if you have any residual cancer. At regular intervals you will undergo physical examination and testing to make sure the cancer has not reappeared.

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