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Cancer from A to Z

Types of cancer, how to prevent them, diagnosis and treatment.

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Oral Cancer

The incidence of oral cancer in Spain is aproximately of 6 to 13 cases per 100.000 men / year and 1 to 2 cases per 100.000 women / year. Almost all oral cancers occur in squamous cells, which line the mouth and oropharynx. These are called squamous cell carcinomas.

 

Mouth cancer occurs most commonly in the tongue, the floor of the mouth and the lips. It can also begin in the gums, teeth, salivary glands, the lining of the lips and cheeks, the roof of the mouth and behind the wisdom teeth.

 

Oropharynx cancer, also known as oropharyngeal cancer, starts in the area just behind the mouth (oropharynx), but can also occur in the back of the tongue, the back of the mouth and the uvula, the tonsils and the back and side walls of the throat.

 

More than half of patients are diagnosed after the cancer has spread to other areas of the body. The chances of successful treatment of oral cancers are highest when it is found early.

Many of the oral cancer symptoms may be caused by other problems that are not dangerous. But since early detection is important for successful treatment of oral cancer, see your doctor or dentist if you notice abnormal areas in the mouth or throat or other symptoms.

 

Leukoplakia is a white area or spot in the oral cavity. About 25% of leukoplakias are cancerous or precancerous.

 

Erythroplakia is a red, raised area or spot that bleeds if scraped. About 70% of erythroplakias are cancerous or precancerous.

 

Erythroleukoplakia is a spot with both red and white areas.

 

Other oral cancer symptoms include:

  • Sore in the mouth or throat that doesn't heal
  • Loose teeth
  • Lump or thickening in the neck, face, jaw, cheek, tongue or gums
  • Difficulty swallowing or the sensation that something is caught in the throat
  • Earache or sore throat that does not go away
  • Dentures that cause discomfort or do not fit well
  • Difficulty chewing, swallowing or moving the tongue or jaw
  • Persistent bad breath
  • Unexplained weight loss
  • Change in voice
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The meeting will provide an educational venue in which current topics of relevance to practicing pathologists and other physicians, academic and non-academic, are presented and discussed.
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Actualización en el tratamiento de la Leucemia aguda 2018
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Ensayo de fase 1a/2a, abierto y multicéntrico, para investigar la seguridad, tolerabilidad y actividad antitumoral de dosis repetidas de Sym015, una mezcla de anticuerpos monoclonales dirigida frente al receptor MET, en pacientes con tumores malignos sólidos en fase avanzada
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Tumores sólidos. Antiemesis Estudio fase III, multicéntrico, aleatorizado, doble ciego, con control activo para evaluar la seguridad y eficacia de Rolapitant en la prevención de náuseas y vómitos por la quimioterapia (NVIQ) en pacientes que reciben quimioterapia altamente emética (QAE). A phase III, multicenter, randomized, double blind, placebo controlled study of the safety and efficacy of Rolapitant for the treatment of Chemotherapy-induced nausea and vomiting in subjects receiving highly Emetogenic Chemotherapy (HEC)
Ensayo clínico en fase I de determinación de dosis del antiangiogénico multidiana Dovitinib (TKI258) más paclitaxel en pacientes con tumores sólidos
Ensayo clínico en fase I de determinación de dosis del antiangiogénico multidiana Dovitinib (TKI258) más paclitaxel en pacientes con tumores sólidos.

Although the exact causes of oral cancers are unknown, alcohol and tobacco use are major risk factors. Recently, the human papillomavirus has been found to cause cancers of the tonsil and the back portion of the tongue.

 

Tobacco
 

Ninety percent of people with mouth and oropharynx cancer use tobacco in some form. The risk increases with the length of the habit and the amount of tobacco used.

 

Specifically, pipe smoking increases the risk for cancer of the lip and the soft palate. People who use chewing tobacco or snuff are more likely to develop cancer of the gums, cheek and lips. Living with a smoker or working in a smoking environment can cause secondhand or passive smoking, which may also increase risk.

 

Alcohol
 

About 80% of people with oral cancers are heavy drinkers, consuming more than 21 alcoholic drinks each week. People who drink alcohol and smoke are six times as likely to get mouth and oropharynx cancer as people who do not drink. The combination of tobacco and alcohol is particularly dangerous

 

Other risk factors include:

  • Infection with human papillomavirus
  • Gender: About two thirds of patients are men
  • Race: The risk is higher for blacks
  • Age: These cancers are more common in people over 45
  • Prolonged sun exposure (lip cancer)
  • Long-term irritation caused by ill-fitting dentures
  • Poor nutrition, especially a diet low in fruits and vegetables
  • Immunosuppressive drugs
  • Previous head and neck cancer
  • Radiation exposure
  • Lichen planus, a disease that often affects the cells that line the mouth
  • Drinking maté, a beverage made from a type of holly tree common in South America
  • Chewing quids of betel, a stimulant common in Asia

Your doctor or dentist will examine the tongue, roof of the mouth, back of the throat and the insides of the cheeks and lips. The floor of the mouth and the lymph nodes will also be examined.

Should any abnormalities be discovered during the exam, it is typical for a small tissue sample, or biopsy, to be taken. A pathologist will examine the tissue sample under a microscope to check for cancer cells. This biopsy is important, as it is the only sure way to know if the abnormal area is cancerous.

 

Staging
 

If the biopsy indicates the presence of cancer, the next step is to determine the stage (extent) of the disease, in order for the doctor to plan the most suitable treatment. Staging also provides information about the prognosis(expected outcome) of your cancer. Tumor stage is determined by the size of the primary tumor, how much it has invaded the tissues and whether the cancer has spread to lymph nodes.

 

Stage 0: Abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

 

Stage I: Cancer has formed and the tumor is two centimeters or smaller. Cancer has not spread to the lymph nodes.

 

Stage II: The tumor is larger than two centimeters but not larger than four centimeters, and cancer has not spread to the lymph nodes.

 

Stage III: The tumor may be any size and has spread to a single lymph node that is three centimeters or smaller, on the same side of the neck as the cancer. Or, the tumor is larger than four centimeters.

 

Stage IVA: The tumor has spread to nearby tissues in the lip and oral cavity. Or, the cancer has spread to one or more lymph nodes on one or both sides of the neck, and the involved lymph nodes are six centimeters or smaller.

 

Stage IVB: The tumor may be any size and has spread to one or more lymph nodes that are larger than six centimeters. Or, the tumor has spread to the muscles or bones in the oral cavity, or to the base of the skull and/or the carotid artery. Cancer may have spread to one or more lymph nodes on one or both sides of the neck.

 

Stage IVC: The tumor has spread beyond the lip and oral cavity to other parts of the body. The tumor may be any size and may have spread to the lymph nodes.

Because the mouth and throat are crucial components of eating, breathing and talking, oral cancer treatment and rehabilitation requires a team of healthcare professionals, led by a doctor who specializes in treating oral cancers. Team members may include speech pathologists, dieticians and plastic surgeons, working together to restore physical function as much as possible.

 

Surgery
 

Surgery is the most common treatment for oral cancer. The type of surgery depends on the type and stage of the tumor. Multiple surgeries may be necessary to treat the cancer and restore physical function and appearance. Even if the surgeon removes all the cancer, some patients may need additional treatment to increase the chance of successful outcomes, which may include chemotherapy or radiation therapy.

There are several surgical techniques to treat mouth and oropharynx cancer:

 

  • Removal of the tumor or a wider local incision to remove the tumor and surrounding healthy tissue
  • Removal of part or all of the jaw
  • Maxillectomy (removal of bone in the roof of the mouth)
  • Neck dissection or removal of lymph nodes and other tissue in the neck
  • Plastic surgery, including skin grafts, tissue flaps or dental implants to restore tissues removed from the mouth, throat or neck
  • Tracheotomy, or placing a hole in the windpipe, to assist in breathing for patients with very large tumors or after surgical removal of the tumor
  • Dental surgery to remove teeth or assist with reconstruction

Radiation Therapy
 

In cancer of the mouth and oropharynx, radiation therapy may be used alone to treat small to intermediate-stage tumors or to kill remaining cancer cells after surgery, or it may be combined with chemotherapy for advanced tumors. The method of radiation treatment used depends on the type and stage of cancer.

 

External radiation therapy is the most common procedure to treat cancers of the mouth and oropharynx. Known as intensity-modulated radiotherapy(IMRT), these highly focused beams treat the tumor while sparing salivary gland tissue, with the goal of sparing saliva production.

 

Internal radiation or brachytherapy delivers radiation with tiny seeds, needles or tubes that are implanted into the tumor. After the implants are in place, patients remain in the hospital for several days with limited human contact. The implants will be removed before the patient leaves the hospital.

 

Chemotherapy
 

Chemotherapy may be used to shrink the cancer before surgery or radiation, or it may be combined with radiation to increase the effectiveness of both treatments. Chemotherapy may also be used to shrink tumors that cannot be surgically removed. The most commonly used drugs in mouth and oropharynx cancer are cisplatin and 5-fluorouracil. Carboplatin and paclitaxel are also used in combination.

 

Tumor Growth Factors
 

New research on growth factors shows promise in the treatment of mouth and oropharynx cancer. Growth factors are hormone-like substances that occur naturally in the body and cause cell growth. An epidermal growth factor (EGF) receptor on the surface of some mouth and oropharynx cancer cells can bind to certain substances that stimulate tumor growth. New drugs are being tested that target EGF receptors and may stop cancer cells from growing.