Oral cancer

Oral cancer . General term in Medicine for any localized malignant growth in the mouth. It can appear as a primary lesion of the same tissue of the oral cavity , or by metastasis from a site of distant origin, or by extension of neighboring anatomical structures, such as the nasal cavity or the maxillary sinus .

Summary

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  • 1 History
  • 2 Causes
  • 3 Symptoms
  • 4 Risk factors
  • 5 Self- scan
  • 6 Causal agents of oral cancer
    • 1 Exogenous or Extrinsic
    • 2 Endogenous or Intrinsic
  • 7 Diseases or health damage
    • 1 Diseases or damage to health are
      • 1.1 Premalignant States
      • 1.2 Premalignant Lesions
    • 8 Diagnosis
    • 9 PDCB Exam
      • 1 Physical exam
        • 1.1 Lip
        • 1.2 Cheek mucosa
        • 1.3 Palate
        • 1.4 Mobile language
        • 1.5 Floor of the mouth
        • 1.6 Root or base of the tongue and oropharynx
        • 1.7 Neck
      • 10 Prevention
        • 1 Other tips
      • 11 Expectations
      • 12 Bibliography
      • 13 Sources

History

Oral cancer is a health problem that affects a significant group of people worldwide, capable of producing notable anatomical and physiological sequelae in those who suffer from it. The incidence, prevalence and severity of this disease vary from country to country.

Numerous studies have shown that cancer is a relatively complex phenomenon in which various factors act or participate and where probably none of them alone is capable of causing a neoplasm . This justifies the universal criterion that cancer is a disease of multifactorial cause, which depends on the simultaneous action of social or behavioral, hereditary and environmental factors.

Cancer appears in the oral cavity can have various histological types: teratoma , I adenocarcinoma derived from one of the salivary glands , lymphoma of the tonsils or any other lymph tissue or melanoma of pigmented cells of the oral mucosa . The most common form of cancer in Boca is the carcinoma of squamous cells , tissues originated in delimiting the mouth and lips .

Oral cancer is usually located in the tissue of the lips or tongue , although it may appear on the floor of the mouth, the lining of the cheeks , the gums or palate roof or mouth. Under a microscope , most cancers that develop in the mouth have similar characteristics and are jointly called squamous cell carcinoma. They are evil in nature and tend to spread very quickly.

The histological variety of the oral complex allows various types of benign and malignant neoplasms to develop , but more than 95% of malignant tumors of the oral cavity have been shown to be of epithelial origin. This justifies that oral squamous cell or squamous cell carcinoma (CEB)It is the most frequent malignant neoplasm of the stomatological system and towards its origins all the etiological and analytical studies of epidemiological profile have been directed. These investigations have established that the oral complex has two well-defined and delimited anatomical regions, with the capacity to suffer from the same type of cancer, but subject to the action of very different risk factors; These locations are: the lips and the oral cavity.

Causes

Most oral cancers look very similar under a microscope , are called squamous cell carcinomas , are malignant, and tend to spread rapidly. Smoking and other uses of tobacco are associated with 70-80% of cases of oral cancer. Smoke and heat from cigarettes , cigars, and pipes irritate the mucous membranes of the Mouth . The use of tobacco for chewing or snuff causes irritation due to direct contact with the mucous membranes. Excessive alcohol consumption is another activity associated with an increased risk of oral cancer.

Other factors that increase the risk of oral cancer are, among others: poor oral and dental hygiene and chronic irritation (due to, for example, rough teeth, false teeth or fillings). Some cases of oral cancer start as white plaque ( leukoplakia ) or as a cold sore . An infection with the human papilloma virus has recently been shown to be a risk factor.

Oral cancer represents approximately 8% of all malignancies. Men get this type of cancer twice as often as women, particularly those over 40 years of age.

symptom

Oral cancer symptoms include:

  • White or red spots inside the mouth
  • A sore in the mouth that won’t heal
  • Bleedingin the mouth
  • Falling teeth
  • Swallowing problems or pain
  • A lump in the neck
  • Sore ear

Additional symptoms that may be associated with this disease are:

  • Abnormal taste in the mouth
  • Mouth ulcer
  • Difficulty swallowing
  • Language problems

Risk factor’s

Tobacco and alcohol use are habits that increase the chance of oral cancer. If these are consumed together, the possibility is much greater than if they are consumed independently. Excessive exposure to the sun’s rays is a risk factor for lip cancer. Special precautions should be taken by people who work in the sun (peasants, sailors), especially if they are fair-skinned people.

Poor or no dental hygiene, factors that erode the mucosa such as broken teeth, poorly positioned or poorly fitted prostheses, are also factors that favor the formation of lesions that can be malignant.

Keeping the mouth in good condition is essential to prevent oral cancer, hence the importance of good dental hygiene and regular visits to the dentist .

It usually appears in elderly people. For this reason, the elderly should visit the dentist more frequently for check-ups. However, this does not happen because on many occasions they no longer have teeth and they do not go to the dentist, unless their false teeth are out of adjustment.

It is also more frequent in black people than in white people.

Self-scan

The patient must know what the normal structures of the mouth are like. When these change, you must go to the dental office for a dentist to perform a review. To do this, the dentist must perform an examination explaining everything to the patient. The latter must learn what the mouth is like under normal conditions and what alterations are not pathological.

To do this, the patient must follow a self-examination method in which they will observe the face, neck, lips, the inside of the cheek, the palate, the gums, the tongue and the floor of the mouth. The dentist could be asked to give us in writing the steps that we must follow so that they are not forgotten.

The patient should carry out this self-examination at home every 5-6 months at least and, before any finding, go to their dentist. Sometimes the odotologist finds it difficult to motivate the patient to carry out the self-examination, but considering that the benefit is life, it is worth doing.

Oral cancer causative agents

Classically, the causal agents of oral cancer have been divided according to their mechanism of action on the human body into two large groups:

Exogenous or Extrinsic

They act by extracorporeal routes, generally known and caused by physical, chemical or biological damage at the tissue level.

Endogenous or Intrinsic

They act by intracorporeal routes, little clarified and justified by genetic bases, endocrine changes, immunological deficit and nutritional disorders that affect the tissues.

Diseases or health damage

The states and / or premalignant lesions of the oral complex are the first sign that the oral tissues are responding to risk factors and, while continuing to harm oral health, they become unmodifiable risk factors that require greater control and clinical follow-up.

Diseases or health damage are

Premalignant States

  • Lichen planus of the oral mucosa.
  • Florida Oral Papillomatosis
  • Oral submucosa fibrosis
  • Actinic cheilitis
  • Atrophic mucosa of the mouth
  • Smoker’s palate.
  • Immune deficiencies
  • Human papillomavirusinfection
  • Infection virus herpes simplex
  • Nevus of the oral mucosa.

Premalignant injuries

  • Leukoplakia of the oral mucosa
  • Erythroplasia of the oral mucosa
  • Inverted smoker’s palate.

Diagnosis

An examination of the mouth by a trained healthcare professional or dentist will show visible and in some cases palpable lesions to one of the lips, tongue, and other areas of the mouth. As the tumor grows, it can become ulcerative and can start bleeding. If cancer progresses on the tongue, the individual may experience difficulties with speech, chewing, or swallowing. The only method to determine if a lesion is cancerous is through a biopsy and microscopic evaluation of the cells removed from the lesion.

PDCB Exam

The examination of the PDCB to a subject who comes to the consultation of a stomatological service in search of dental care must start from the same moment that he sits in the stomatological chair .

We conducted an interrogation of patients and families. Specifying type of symptoms emphasizing the sequence and time of appearance of the same.

Physical exam

To identify any morphological alteration and according to what is exposed in the Oral Cancer Detection Program. The exam has been streamlined into seven steps, taking full advantage of the examiner’s skill. In them the examination is directed to topographic areas that have anatomical continuity:

  • Have the patient seated in front of the examiner and ask them to remove any prostheses before starting the exam.
  • Carry out a general inspection of the patient’s face, detailing any alteration of his physiognomy.

Lip

Exploration of the lip from the skin to the mucosa, from one commissure to the other, and the height to the vestibular sulcus , which is explored together with the vestibular or labial gingiva to the canine area, begins.

Bimanual palpation will show us any sign of alteration in the accessory salivary glands , the insertion of the braces and the normal consistency of the gum and lip .

Cheek mucosa

It begins on the right side, from the corner to the retromolar space, which is thoroughly explored; also the rest of the vestibular sulcus and the labial gum.

The normal structures such as the termination of the parotid duct , the alba line , the ectopic sebaceous glands , the occasional dark spots of ethnic origin and the other usual structures in the area should be remembered ; the maneuver is repeated on the left side. When xerostomia or volume increase of some of the salivary glands is noticed , the quality, quantity and consistency of the saliva should be extracted and evaluated . To milk the parotid gland, place a finger in the preauricular area and move the finger forward following the path of the canal.

Palate

In this case we include in a block of exploration the hard palate, the soft palate with the uvula and the anterior pillars, as well as the palatal gingiva . The palatine papilla , the median raphe, the palatine roughness, the mouth of the ducts of the accessory mucous glands and, occasionally, the palatine torus should be remembered .

Mobile language

Explore the dorsal aspect, edges and apex of the tongue. Check lingual mobility by instructing the patient to project the tongue and move it in all directions. Perform bidigital palpation of the dorsal aspect and edges, looking for nodules or indurations. For this you can take the lingual vertex with gauze. In this region filiform, fungiform, fenced and foliaceous papillae can normally be identified; rhomboid glossitis media and crack and lingual grooves.

Soil of the mouth

With the help of a depressor or oral mirror, examine the floor of the mouth, the ventral aspect of the tongue and the lingual gum. For inspection of these sites instruct the patient to place the apex of the tongue on the hard palate.

For bidigital palpation of the floor of the mouth, the index finger of one hand is placed under the chin and the finger of the other hand palpates the anterior floor of the mouth on each side.

The anatomical formations of these sites include: the outlet of the ducts of the sublingual and submandibular salivary glands, lingual frenulum , prominent sublingual glands, mandibular torus , internal oblique line and genis process (insertion line of the muscles of the floor of the mouth) . The accessory salivary glands can be found on the ventral side of the tongue.

The submaxillary gland is milked by placing a finger on the submandibular triangle of the neck with a movement toward the chin. Saliva from the submandibular glands is drained by the Wharton’s Duct located behind the lower incisors. Normally functioning salivary glands will produce at least one drop of clear, watery saliva.

Root or base of the tongue and oropharyngeal

Inspect the root or base of the tongue and the rest of the oropharynx, using the oral or laryngeal mirror, previously heated above body temperature , while pulling with a gauze pad from the lingual apex forward and down. With your index finger, feel the base of the tongue and the rest of the oropharynx with a U-motion. The following structures should be identified here: palatine, lingual, and pharyngeal tonsils, lymphoid vegetations of the base of the tongue, and vallecules .

Neck

Inspection of the face and neck will detect pigmentation changes or increases in volume, asymmetries or other alterations. For palpation starting on the left side, tilt the patient’s head towards that side with the help of his left hand, while palpation is performed with the right, repeat the maneuver on the right side, inverting his hands. Carefully palpate the areas of the submandibular, internal jugular, accessory cervical, transverse and spinal ganglion chains and the submental, parotid, preauricular, retroauricular, and occipital groups. Palpate the parotid, submandibular, and sublingual salivary glands and the temporomandibular joint.

To complete the neck examination, stand behind the patient and, using both hands, palpate the entire neck, detecting possible differences between the contralateral structures. Even in the absence of symptoms, a unilateral cervical nodule in a middle-aged patient is suspected of malignancy.

Prevention

Many oral cancers are discovered through routine dental exams.

Other tips

  • Have dental problems corrected.
  • Minimize or avoid alcohol consumption.
  • Minimize or avoid smoking or other tobacco use.
  • Practice good oral hygiene.

Expectations

About half of people with oral cancer will live more than five years after diagnosis and treatment. If the cancer is caught early, before it has spread to other tissues, the cure rate is almost 75%. Unfortunately, more than half of oral cancer cases are at an advanced stage when they are detected and most have spread to the throat or neck. Approximately 25% of people with oral cancer die from delay in diagnosis. and treatment.

 

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