General Health

Oral Cancer Diagnosis and Treatment Strategies for Doctors

Oral cancer is the 6th most common type of cancer with India contributing to 1/3rd of the global burden and is expected to become the world capital for oral cancer by 2025. Oral cancer is any form of cancer that occurs in the buccal cavity. Several risk factors and insufficient exposure to the necessary diagnostic amenities contribute to the varied incidence of oral cancer in the population. Oral squamous cell carcinoma is the most common and aggressive type of oral malignant cancer. 

Oral cancer can be easily managed by early detection and surgery. Oral and maxillofacial Surgery is a branch of Dentistry and Medicine that encompasses management of oral cancer, fractures of the face due to trauma, fixing the temporo mandibular joint, treating painful ulcers and aesthetic corrections. 

MedPiper Technologies and JournoMed along with the Association of Oral and Maxillofacial Surgeons of India (AOMSI), Tamilnadu & Puducherry Branch had conducted a webinar on 3rd October, 2021 where oral cancer and the possible treatment strategies were extensively discussed. The speakers were Dr. Pradeep Jeevadhas, Oral, Maxillofacial and Oncology Surgeon at Holy Cross Hospital, Nagercoil and Dr. Senthil Murugan, Professor of Oral and Maxillofacial Surgery at Saveetha Dental College & Hospital, Chennai. The event was moderated by Dr. Jimson S, Consultant, Oral and Maxillofacial Surgeon, Hon. State Secretary AOMSI Tamilnadu and Puducherry Branch, Head of the Department of Oral Maxillofacial Surgery, Tagore Dental College and Hospital, Chennai. 

The speakers discussed the different types of oral cancers, etiology and treatment approaches through various case studies. Both Dr. Murugan and Dr. Jeevadhas stressed on the early detection of cancer. The respective dentists, oral and maxillofacial surgeons and general practitioners are to collect information such as family history, diet, habits, nutrition, occurrence of previous illnesses such as tuberculosis, lifestyle etc. Based on this information the doctors are to determine the next steps of treatment. The doctors are also to educate the patients and alleviate their fears so as to enable smooth diagnosis and successful treatments. 

Proper blood investigation should be done for the suspected patients and their serum should be tested for tumor markers such as the CEA or carcinoembryonic antigen. The masses or lesions found in the oral cavity of these patients are to be excised and sent for biopsy to confirm malignancy and stage of progression. Based on the aggressive nature and stage of the tumour, surgery, chemotherapy, radiation therapy, targeted therapy (eg: EGFR) or a combination of any of these treatments can be done. 

Dr. Murugan suggests that the patients should consult a dental practitioner or an oral surgeon if there is any burning sensation, restricted mouth opening due to a painful swelling, or if an ulcer is taking 7-14 days to heal. Any kind of precancerous oral lesions or have the predisposition of 4S namely Smoking or Spirit, Spicy food, Syphilis or Sharp teeth. Constantly biting an area with sharp teeth, due to stress or habits, can give rise to ulcers and cause cancer of the tongue and even floor of the mouth. Sustained increase in the consumption of spicy food can also precipitate oral cancer. 

Cancers of the hard palate and the roof of the mouth have an easy prognosis and cure. Cancers of the tongue and the floor of the mouth are to be considered carefully as they metastasize faster and advanced treatments like radical intersections or elective neck dissection are to be done. 

Dr. Jeevadhas explained the various kinds of lesions seen in the oral cavity. Oral submucous fibrosis (OSF) is commonly seen among those who work at rubber estates and occurs in the form of red or white lesions on both sides of the cheek. Such cases require proper clinical examination. OSF can manifest itself as a burning sensation that is aggravated by spicy food consumption and lead to restricted mouth opening. In such cases, multiple biopsies of the masses on both the cheeks should be performed to understand the stage of progression.

In the case of severe submucous fibrosis (SMF), there is difficulty in opening the mouth (the mouth will only be open up to 20mm), restricting tongue protrusion and it will also be hard to pinch the cheeks of these patients. Ulceroproliferative growth is another common type of oral cancer that is seen in the gingiva and buccal mucosal regions. If these lesions infiltrate into the periosteum and affect the bones, it indicates that the cancer is aggressive and a complete mandibular resection needs to be done. 

The speakers also discussed how sometimes oral cancers can have its primary roots elsewhere such as the liver and the gastrointestinal tract which can be determined by PET scans. They also stated that any kind of malnutrition can spur the development of oral lesions. Anemia and excessive collagen accumulation can precipitate OSF. Presence of reddish white lesions such as erythroleukoplakia or lichen planus, anywhere in the mouth (eg: retromolar trigone area) is indicative of a precancerous condition. These lesions should be excised and sent for biopsy. 

Advancements in modern medicine have enabled the easy management of cancers including oral cancers at various stages. Early detection, patient responsibility with continuous checkups and proper diagnosis are of paramount significance. Thus it is necessary to spread awareness and educate people about the various kinds of oral cancer and the preventative measures to be taken. 

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