Symptoms of oral cancer in the early stages. Mucosal cancer: prognosis and how it looks
Cancer of the oral mucosa is a disease that is characterized by the occurrence of malignant tumors of the oral cavity.
Tumors can affect the gums, cheeks and even the tongue of the patient.
Despite the disappointing prognosis, oncological diseases are treated in the initial stages. Timely medical examinations will help to identify cancer in the bud and restore its former health.
Causes of Cancer
Each of these causes causes concern, but the combination of several of them is more likely to cause cancer.
Smoking
The danger of smoking is that it has an extremely imperceptible negative effect on the body. After the first cigarette, this influence cannot be noticed, but after a few years this bad habit will significantly undermine health.
Mechanical trauma of the oral cavity
This includes the traumatic edges of the filling or prosthesis.
The sharp edges of the filling will cause non-healing wounds in the oral cavity.
Always pay attention to whether you are comfortable with a new filling, otherwise ordinary caries can end with oncology.
An uncomfortable prosthesis also presses and rubs the mucous membranes, which leads to injuries.
Poor immunity
This category also includes human papillomavirus and lichen in the oral cavity. Human immunodeficiency diseases or immunity simply weakened by bad habits can lead to the occurrence of malignant tumors.
The cause of the formation of cancer of the oral mucosa can also be: vitamin A deficiency, constant contact with asbestos, decayed teeth and lack of oral hygiene.
Cancer of the oral mucosa: symptoms
Among the main symptoms of the disease are:
- loss of sensation of the tongue;
- the occurrence of thickening and swelling;
- the appearance of strange formations in the form of red or, ulcers, growths;
- causeless loss of teeth;
- sharp weight loss;
- an increase in the size of the lymph nodes;
- swelling of the jaw;
- difficulty speaking and eating.
Do not think that every single symptom necessarily indicates the presence of cancer. The symptom speaks, first of all, of the presence of malfunctions in the body, which can lead to oncology if ignored for a long time.
The course of the disease
- Initial period. At the initial stage of the development of the disease, the patient only begins to notice oddities and feel discomfort. Small sores or spots appear in the mouth, which respond with painful sensations when touched;
- The period of tumor development. The sores become larger and in shape they resemble cracks. The pain is felt not only in the place of ulcers - it is given in different parts of the head;
- Running period. The advanced period of the course of the disease is characterized by large-scale lesions of the tissues of the oral cavity.
Photo
In the photographs of cancer of the oral mucosa, neoplasms are clearly visible, which are the main symptoms of the disease. Neoplasms can differ both in appearance and in the nature of painful sensations.
Most often, the inner surfaces of the cheeks are affected, especially at the level of the mouth line.
Leukoplakia of the oral cavity is one of the causes of cancer
Cancer of the oral mucosa: photo of a benign tumor
Types of oral cancer
Any parts of the mucous membranes of the oral cavity are susceptible to cancer.The inner surfaces of the cheeks, the tongue (including the back of the tongue) and the palate are most commonly affected.
Cancer is terrible with metastases, therefore, if one part of the oral cavity is affected, there is a high risk of infection and neighboring tissues.
With cheek cancer, neoplasms most often appear on the line of the mouth or in its corners. The development of the disease begins with the appearance of a small sore, which gradually increases in size. When eating and talking, the patient experiences discomfort.
The floor of the mouth is also prone to cancer. Malignant tumors are deployed in the lower part of the tongue or are located near the salivary glands. Acute pain in the tongue accompanied by profuse salivation.
The first signs of tongue cancer are.
The neoplasm can be located on any surface of the tongue, but more often it is located on the side.
Cancer of the palate is divided into different types depending on which tissue is affected by the disease - soft or hard. The soft tissues of the palate are more prone to tumors, the cancer that occurs on them is called squamous cell.
The disease of the hard palate is called cylindrom or adenocarcinoma. The first signs of the disease, as in many other cases, are the discomfort and pain that the patient experiences while eating, swallowing or using the speech apparatus.
Cancer of the alveolar processes can affect both the upper and lower jaw of the patient. In addition to the alveolar processes themselves, teeth are often affected, which causes bleeding.
Cancer of the oral mucosa can metastasize to organs that at first glance are not associated with the focus of the disease. So in patients, the lungs, liver and even the brain can suffer.
Forms of mucosal cancer
The disease has several forms:
- Knotted shape. It is characterized by the appearance of a seal with clear edges. The mucosa near it does not change, and the seal itself rapidly increases in diameter.
- Ulcerative form. During the ulcerative form of the disease, the mucous membrane is affected by numerous ulcers. The ulcerative form of the disease occurs most often in patients.
- papillary form. It is a hanging tumor.
When diagnosing, you should be extremely careful, because the initial stages of cancer often try to disguise themselves as other, harmless diseases. Therefore, before making a final diagnosis, it is necessary to undergo the following examinations: magnetic resonance imaging (MRI), biopsy, radiography.
Treatment Methods
Among the most popular treatments are:
- chemotherapy;
- radiation therapy;
- surgical removal of the tumor.
Chemotherapy is often not prescribed as a standalone treatment. According to doctors, chemotherapy is more effective in combination with radiation therapy and surgery.
In this type of treatment, the patient takes drugs that prevent tumor growth. Due to their effects, cancer cells stop spreading throughout the body and die.
Radiation therapy is the effect of ionized radiation that destroys a malignant tumor.
Cancer cells themselves do not disappear, but their cellular structure undergoes major changes.
Radiation therapy can be used in combination with other treatments or on its own.
Surgery is the most effective and radical method of fighting cancer. A malignant formation is simply removed by surgeons. In case of damage to the appearance of the patient, plastic surgery can be performed.
The use of any of these methods depends on the stage of the disease, the nature of its course, the age of the patient, his state of health and many other factors.
Prevention
It is easier to prevent cancer than to treat them, so it is necessary to follow preventive measures and regularly appear at scheduled medical examinations. Prevention does not guarantee a 100% cure for the disease, but it makes the chances of getting sick minimal.
The main measures to prevent the disease:
- oral hygiene;
- treatment of diseases of the oral cavity;
- timely reaction on cheeks, tongue and palate;
- healthy eating, no food additives in the diet;
- avoidance of ultraviolet rays;
- no bad habits.
Related videos
Release of the TV show “Life is great!” with Elena Malysheva about cancer of the oral mucosa:
None of these rules are overly strict or difficult to enforce. The patient is required, first of all, to take care of their health and love for their body. A reverent attitude towards your body will help eliminate the possibility of a disease even before it occurs.
- a malignant neoplasm originating from the epithelium and soft tissues of the oral cavity. In the early stages, it is asymptomatic, it is a nodule or sore. Subsequently, the oral cancer increases in diameter, pain appears, first local, then radiating to the head and ears. Increased salivation. When decay occurs, bad breath occurs. Secondary infections are often associated. With lymphogenous metastasis, there is an increase in regional lymph nodes. Diagnosis is based on examination and biopsy data. Treatment - radiotherapy, surgical removal, chemotherapy.
General information
Oral cancer is a malignant tumor localized in the area of the tongue, buccal mucosa, gums, floor, palate or alveolar processes of the jaws. The incidence rate depends on the region, the disease more often affects residents of Asian countries. In Russia, oral cancer accounts for 2-4% of the total number of oncological diseases, in the USA - 8% (probably due to the large number of emigrants from Asian countries), in India - 52%. Usually found in patients over 60 years of age. Rarely diagnosed in children. There is a marked predominance of males.
65% of oral cancer is represented by neoplasms of the tongue, 13% - buccal mucosa, 11% - floor of the mouth, 9% - hard palate and mucous membrane of the alveolar processes of the upper jaw, 6.2% - soft palate, 6% - mucosa of the alveolar processes of the lower jaw , 1.5% - uvula, 1.3% - palatine arches. Epithelial tumors are detected more often than sarcomas. Oral cancer often develops against the background of precancerous processes, usually occurring at the age of 40-45 years. Treatment is carried out by specialists in the field of oncology and maxillofacial surgery, sometimes with the participation of otolaryngologists.
Causes of oral cancer
The causes of oral cavity tumors have not been precisely established, however, experts have been able to identify a number of factors contributing to the development of this pathology. The leading role in the occurrence of oral cancer is played by bad habits, especially the combination of smoking and alcohol abuse. The chewing of betel and the use of nas are of great importance among the inhabitants of Asian countries. As the second most important factor that provokes oral cancer, oncologists consider repetitive mechanical injuries: the use of low-quality dentures, wounds that occur when in contact with the sharp edge of a filling or a tooth fragment.
Less often, in the anamnesis of patients with oral cancer, single mechanical damage is detected: maxillofacial injuries or wounds with dental instruments during the extraction or treatment of teeth. Oncologists and dentists point out the importance of oral hygiene, removal of tartar, treatment of caries and periodontitis, and the inadmissibility of installing dentures made from different materials (this causes galvanic currents and contributes to the development of oral diseases).
Recent studies by American oncologists indicate a connection between neoplasms of the mouth and nasopharynx and the human papillomavirus, sexually transmitted, with kisses or (less often) with household contacts. The virus does not always provoke tumors, but increases the risk of their occurrence. In some patients with oral cancer, there is a connection with occupational hazards: work in heavily polluted rooms, contact with carcinogens, prolonged exposure to high humidity, high or low temperature. In addition, the development of oral cancer is promoted by the use of spicy or too hot food and vitamin A deficiency, in which the processes of keratinization of the epithelium are disturbed. Neoplasms often appear against the background of chronic inflammatory and precancerous lesions.
Classification of oral cancer
Taking into account the characteristics of the histological structure, the following types of squamous cell carcinoma are distinguished:
- Oral cancer in situ. Rarely found.
- Keratinizing squamous cell carcinoma. The presence of large areas of keratinized epithelium (“cancer pearls”) is revealed. Characterized by rapid aggressive local growth. It is diagnosed in 95% of cases.
- Non-keratinizing squamous cell carcinoma of the oral cavity with the growth of atypical epithelium without accumulations of keratinized cells.
- Poorly differentiated cancer whose cells resemble sarcomatous. It proceeds most malignantly.
Taking into account the characteristics of tumor growth, three forms of oral cancer are distinguished: ulcerative, nodular and papillary. The ulcerative form is the most common, manifested by the formation of slowly or rapidly growing ulcers. Knotty oral cancer in appearance is a dense knot covered with whitish spots. With papillary neoplasms, rapidly growing dense outgrowths appear in the oral cavity.
To determine the tactics of treating the disease, a four-stage classification of oral cancer is used:
- 1 stage- the diameter of the tumor does not exceed 1 cm, the neoplasm does not extend beyond the mucous and submucosal layers. Lymph nodes are not changed.
- 2A stage- a neoplasm with a diameter of less than 2 cm is detected, germinating tissues to a depth of no more than 1 cm. Regional lymph nodes are intact.
- 2B stage- there is a picture of stage 2A oral cavity cancer and a lesion of one regional lymph node.
- 3A stage– tumor diameter does not exceed 3 cm. Regional lymph nodes are not involved.
- 3B stage- Numerous metastases are detected in regional lymph nodes.
- 4A stage Oral cancer has spread to the bones and soft tissues of the face. There are no regional metastases.
- 4B stage- a tumor of any size is detected, there are distant metastases or motionless affected lymph nodes.
Symptoms of oral cancer
In the early stages, the disease is asymptomatic or manifests itself with poor clinical symptoms. Patients may notice unusual sensations in the mouth. An external examination reveals an ulcer, a crack, or an area of compaction. A quarter of patients with oral cancer complain of local pain, explaining the appearance of pain syndrome with various inflammatory diseases of the nasopharynx, teeth and gums. With the progression of the oncological process, the symptoms become more pronounced. The pains intensify, radiate to the forehead, ear, zygomatic or temporal regions.
There is an increase in salivation due to irritation of the mucosa by the decay products of oral cancer. Due to the decay and infection of the neoplasm, a putrid odor from the mouth appears. Over time, the tumor invades neighboring anatomical structures, causing facial deformities. An increase in one or more regional lymph nodes is detected. Initially, the lymph nodes are mobile, then they are soldered to the surrounding tissues, sometimes with decay phenomena. Hematogenous metastases are found in 1.5% of patients, usually affecting the brain, lungs, liver, and bones.
Certain types of oral cancer
Cancer of the tongue usually occurs on its lateral surface, less often located in the root zone, on the lower surface, back or tip. Already at the initial stages, oral cancer causes chewing, swallowing and speech disorders, which facilitates timely diagnosis. Subsequently, pain occurs along the trigeminal nerve. If the root is damaged, breathing difficulties are possible. Early formation of secondary foci in regional lymph nodes is characteristic.
Cancer of the floor of the mouth in the early stages is asymptomatic. Patients turn to the dentist after a tumor-like formation is detected, which is felt as a painless growth. Oral cancer grows early in nearby tissues. With progression, regional lymph nodes are affected, pain and increased salivation occur. Bleeding is possible.
Cancer of the buccal mucosa is usually localized at the level of the mouth line. In the early stages, patients with oral cancer may not see a specialist, mistaking the tumor for an aphthous ulcer. Subsequently, the ulcer increases in diameter, patients report pain when chewing, swallowing and speaking. With the germination of chewing muscles, restrictions are observed when trying to open the mouth.
Cancer of the palate is usually accompanied by an early onset of pain. In the region of the sky, an ulcer or a growing, rapidly ulcerating node is revealed. Sometimes, at first, oral cancer is asymptomatic, and pain occurs when the process spreads to nearby tissues and infection joins.
Cancer of the mucous membrane of the alveolar processes early provokes toothache, loosening and loss of teeth. Accompanied by frequent bleeding. Brachytherapy. Most specialists prefer this method, since it excludes the formation of functional and cosmetic defects and is quite easily tolerated by patients. At the same time, the technique does not allow to achieve long-term remission in case of distally located neoplasms and stage 3-4 tumors.
The volume of surgery for oral cancer is determined by the prevalence of the neoplasm. The node is excised along with unchanged tissues. In the process of radical removal of oral cancer, muscle excision or bone resection may be required. In the event of gross cosmetic defects, plastic surgery is performed. If breathing is difficult, a temporary tracheostomy may be placed until the obstruction to air movement is removed. Chemotherapy for oral cancer is less effective. The technique makes it possible to reduce the volume of the tumor by 50 percent or more, but does not provide a complete cure, therefore it is usually used in combination with operations and radiotherapy.
Oral cancer prognosis
The prognosis for oral cancer is determined by the location and stage of the process, the degree of damage to certain anatomical structures, the age and condition of the patient. Tumors of the posterior parts of the oral cavity are more malignant. The five-year relapse-free period for neoplasms of the tongue of stage 1-2 after a course of isolated radiotherapy is 70-85%. With tumors of the floor of the mouth, this figure is 46-66%, with cancer of the cheek - 61-81%. With stage 3 oral cancer, the absence of recurrence for 5 years is observed in 15-25% of patients.
Oral cancer is a malignant neoplasm that develops from the mucous membranes of the oral cavity. Differences of this group of oncology in the early diagnosis of the disease, which allows timely identification and treatment of the disease. But, despite this, not all people pay attention to the first signs and symptoms of the disease, which often leads to disastrous results.
Factors that affect the prognosis include:
- the duration of the process;
- size of education;
- the presence or absence of metastases.
It is very important to determine the prognosis to obtain the degree of differentiation of a malignant neoplasm.
There are three degrees of differentiation:
- high;
- moderate;
- low.
The prognosis is more favorable with high and medium differentiation, since such tumor processes are less malignant, metastasize later and respond better to therapy. To increase the survival rate, special attention should be paid to the diagnosis of early forms of cancer. Modern treatments have improved over the past few years, increasing the five-year survival rate.
Informative video: oral cancer
Oral cancer is a fairly common occurrence. A malignant tumor is curable at its initial stage of formation, which is why it is necessary to know the general symptoms of the disease and its first signs.
Squamous cell carcinoma of the mucosa is a malignant formation of oral tissues. This type of tumor is most common in the age category of patients who are over 40 years old.
Causes
Statistical data indicate that a tumor of this localization occurs more often in men than in women.
The main factors that contribute to the development of malignant neoplasms of the mouth include:
- smoking, this process destroys healthy mucosal cells, as a result of which changes occur in healthy tissues at the cellular level;
- consumption of alcoholic beverages affects the structure of the mucosa, gradually destroying it;
- various mechanical damage mucous tissues of the oral cavity, which over time can lead to irreversible processes in their internal structure;
- eating too spicy, hot or cold food also adversely affects the mucous membranes of the mouth;
- papilloma virus (HPV) also contributes to malignant formations.
There are precancerous diseases that contribute to the development of a tumor. Among them:
- Bowen's disease. Promotes growing nodular tissues. These heterogeneous structural growths can join together to form smooth plaques. This disease is essentially intraepithelial cancer.
- Leukoplakia. The disease is characterized by increased keratinization of specific areas of the oral mucosa. The disease spreads in the form of whitish patches on the mucosa. Subsequently, squamous cell carcinoma can also develop from the affected areas.
- Papillomatosis is an overgrowth of tissue on the skin. These areas have a slightly whitish color and are prone to keratinization.
All of the above circumstances and factors increase the percentage of the disease.
Clinical picture
The overall clinical picture of this disease is quite diverse. Almost 95% of cases of the disease manifest erythroplakia, which in 65% has a leukoplakic component in its structure.
You can learn about the malignancy of a neoplasm by certain external signs and additional factors. For example, a saturated whitish or reddish color of a neoplasm indicates a rather high malignancy.
In the initial stages, the tumor is almost asymptomatic. As the malignant formation of the oral cavity grows and develops, the boundaries of the affected areas of the mucosa are slightly erased, its structure noticeably thickens and has uneven edges. With the ongoing processes of ulceration, pain is present.
Over time, the patient there is a feeling of numbness or burning at the site of the tumor.
Kinds
Squamous cell carcinoma of the oral mucosa is characterized by the presence of differentiated cells in its structure. A malignant formation consists of a peculiar structure, which is called "pearl", because of the whitish color.
This cancer progresses relatively slowly. It can be considered relatively favorable. The degree of differentiation of cancer cells varies. There are several varieties of them:
- highly differentiated;
- moderately differentiated;
- poorly differentiated.
It should be borne in mind that the higher the differential degree of neoplasm cells, the slower the development of pathology proceeds. This circumstance also affects the prognosis.
By localization
Education is distinguished depending on its location:
- The mucous membrane of the cheeks. A frequent site of tumor localization, which is located on the line of the mouth approximately at the level of the corner of the lips. At first, the neoplasm resembles a small sore. Over time, there is a certain discomfort when opening the mouth, smiling, talking or eating.
- Floor of the mouth. Malignant formation is localized on the muscles of the bottom. The tumor can affect nearby areas, which include: the salivary glands and the bottom of the tongue. The patient complains of increased salivation and pain.
- Mucous palate. Squamous cell carcinoma develops only in soft areas of the palatine tissues. As a rule, the problem is detected during meals. This process is accompanied by painful sensations.
- Anterior palatine arches. Has a high tendency to metastasize. It occurs in people of the age category of 60-70 years, mainly in men. The process of development of the disease is accompanied by unpleasant and painful sensations in the throat, aggravated by swallowing saliva or food.
- In the zone of the alveolar processes of the lower and upper jaws. In most cases, it has the structure of a squamous malignant formation. Shows up very early. Teeth are involved in the development of the tumor, which contributes to the appearance of acute toothache. The initial period of neoplasm development is accompanied by light bleeding.
The general symptoms of the development of the disease depend on the location of the malignant tumor.
stages
From the degree of the size of the formation, its development and additional factors, doctors can determine the stage of the disease:
- 1 - a neoplasm no larger than 1 cm. The tumor is located within the submucosal layer. Metastasis at the initial stage is absent;
- 2 - the diameter of the neoplasm is about 2 cm. Also, the disease grows deep into the tissues. The defeat of regional lymph nodes by metastases is not observed;
- 3 - the diameter of the tumor is about 3 cm. This stage is characterized by the appearance of many metastases.
Symptoms
The following symptoms indicate the development of pathology in the oral cavity, after which you should immediately contact an oncologist:
- the tongue increases significantly in size, which makes it difficult to talk, speech is distorted;
- numbness of the tissues of the tongue;
- loss of sensation in teeth and gums;
- for no apparent reason, healthy teeth begin to fall out;
- swollen jaws;
- pain in the mouth, intermittent or constant;
- enlarged lymph nodes in the neck;
- as the disease progresses, the voice changes;
- weight loss occurs for no apparent reason;
- various formations on the lips and in the mouth that do not go away for a sufficiently long time. It can be: a white or red spot, a seal, a growth, an ulcer.
Diagnostics
At the initial stage, the specialist visually determines the tumor, after which he performs procedures, thanks to which an accurate diagnosis can be made:
- Differential Diagnosis. In the initial stage, differentiation is carried out with syphilitic sclerosis and herpetic cheilitis. In later stages, with ulcerative tuberculosis and syphilitic gumma. This method is based on screening out similar symptoms of diseases.
- Biopsy. A standard procedure in which tumor tissue is taken for examination by superficial scraping, needle puncture, or by surgical removal of part of the tumor.
- Palpation. At the first symptoms and suspicions of squamous cell carcinoma of the oral cavity, regional lymphs close to the tumor are palpated (palpated).
- X-ray. With the help of x-rays, you can determine the location of the tumor and the presence of metastases.
In most cases, various diagnostic methods are combined, due to which a more complete and clear clinical picture can be obtained.
Therapy
The choice of therapy depends on factors, which include: the location of the tumor, its degree, the presence of metastases. The oncologist prescribes a specific type of treatment.
- Hemiglosectomy. This method of treatment is possible at the first and second stages of squamous neoplasm. This operation has one significant drawback - a high degree of trauma. Depending on the location of the tumor, one or another part of the oral cavity can be removed surgically.
Chemotherapy. Chemotherapeutic drugs are prescribed, which provide regression of tumor tissues. The technique allows to reduce the malignant neoplasm in size.
Squamous cell carcinoma is most sensitive to several drugs that are used in chemotherapy: Bleomycin and Methotrexate. Often, this therapy is combined with radiation, which allows you to achieve better results.
More about the treatment in this video:
Forecasts
The effectiveness of treatment depends on the location of the malignant tumor in the oral cavity and on the stage.
At 1, provided therapy is started promptly, the survival rate is 98%. from all clinical cases. At 2, the survival rate is 75%. At stage 3, with the presence of metastases in regional nodes, a positive prognosis is only 5%.
Other factors also influence the prognosis, which include: the degree of differentiation, the location of the formation, the presence of metastases and the immunity of the patient.
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Among malignant tumors of the head and neck oral cancer ranks second in frequency after cancer of the larynx. Malignant tumors diagnosed in the oral cavity are mainly various types of squamous cell carcinoma. According to the International Classification, malignant tumors originating from stratified epithelium are divided into:
- Intraepithelial carcinoma (carcinoma in situ).
- Squamous cell carcinoma.
- Varieties of squamous cell carcinoma:
- verrucous carcinoma;
- spindle cell carcinoma;
- lymphoepithelioma.
When describing cancer of the mucous membranes of the oral cavity, three anatomical forms of the most common tumor growth are distinguished: exophytic, or papillary; infiltrative and ulcerative-infiltrative.
Regardless of the anatomical form of the tumor and its localization, three periods of development of cancer of the oral mucosa are distinguished: initial, advanced, and the period of neglect.
Initial period. During this period, most often, patients complain about the feeling of having a foreign body, discomfort in the oral cavity. A number of patients complain of a burning sensation, moderate pain when eating. When examining the oral cavity, erosions, small ulcers without pronounced infiltration, seals located on the mucous membrane of the cavity or in the submucosal layer, areas of hyperkeratosis, presented in the form of whitish spots, outgrowths of the mucous membrane with a whitish surface, can be detected. Despite the diversity of the clinical picture in the initial period, the main symptom that makes you see a doctor is pain.
Developed period. The main symptom in the advanced period of cancer of the mucous membranes of the oral cavity is pain of varying degrees of intensity. The pain may be local or radiate most often to the ear, the temporal part of the corresponding side. During this period, the oral mucosa cancer is subdivided into anatomical forms.
Papillary cancer can develop against the background of papillomatosis, verrucous leukoplakia. With this form, the tumor has the appearance of compacted tissues, towering above the surrounding tissues. The formation may look like an elevated hemisphere or have a base in the form of a wide leg. In the thickness of the tissues, according to the projection of the tumor, an infiltrate without clear boundaries is palpated. The surface of the tumor may be bumpy, covered with areas of keratinized epithelium, in some cases it is represented by a fine-grained surface that bleeds easily with minor trauma.
Infiltrative form of cancer It is quite rare, but it is it that presents the greatest difficulties in diagnosis. The disease begins with the appearance of a mildly painful infiltrate in the thickness of the tissues, the mucosa covering it is most often hyperemic. Over time, there is an increase in infiltration, which limits the function of the organs of the oral cavity.
Patients complain of pain, difficulty in eating, talking. With the further course of the disease, the infiltrate ulcerates, complaints of pain intensify, and bleeding may occur.
Ulcerative infiltrative form of cancer occurs more often than others, its share among other clinical manifestations of oral mucosal cancer is about 65%. The tumor is presented in the form of a cancerous ulcer, the shape and size of which vary significantly and depend on the location and stage of the process. The edges of the ulcer are raised like a roller above the surrounding tissues. The bottom is presented either in the form of necrotic tissues, or is covered with fibrinous plaque, after the removal of which the bottom of the ulcer is crater-shaped, made of fine-grained tissue that bleeds easily with minor trauma. At the base of the ulcer, a dense infiltrate is palpated, which, as a rule, exceeds the size of the tumor ulcer in size and often extends to neighboring anatomical formations.
The period of neglect. Depending on the localization of the tumor, it spreads to the muscles of the floor of the oral cavity, the muscles of the cheek, and grows into the skin.
Cancer of the mucous membrane of the alveolar part of the upper or lower jaw extends to the bone tissue. When the tumor is localized in the region of the posterior parts of the oral cavity - on the palatine arches, lateral parts of the pharynx. Based on clinical observations, it should be noted that cancer of the posterior oral cavity is more malignant and metastasizes to regional lymph nodes at an earlier date. On histological examination, cancer of the posterior parts of the oral cavity usually has a low differentiation of tumor cells.
Cancer of the mucous membrane of the tongue
Most often, the tumor process affects the middle and posterior third of the lateral surface of the tongue.
The most common symptom in this localization is pain, which is often associated with trauma to the tumor on the existing teeth. In earlier terms, functional disorders occur (chewing, swallowing, speech), which is associated both with pain syndrome and with limited mobility of the tongue with a pronounced infiltrative component of the tumor. The ulcer on the lateral surface of the tongue has a rounded or oval shape, at the base of which an infiltrate is determined. On palpation, as a rule, there is a discrepancy between the size of the tumor (ulcer) and the infiltrate, which exceeds its size and can spread both to the tissues of the floor of the oral cavity and to the muscles with a transition beyond the midline, to the root, up to a total lesion of the entire tongue.
Cancer of the oral mucosa
In the area of the bottom of the oral cavity, the ulcerative-infiltrative form of the tumor is more common. In the anterior sections of the floor of the mouth, the ulcer has a rounded shape, in the middle and posterior thirds it is slit-like, and in some cases of observation, one part of the tumor is located in the region of the floor of the mouth, and the other is on the lateral or anterior surface of the tongue.
In the initial period, patients complain of a feeling of a foreign body. A pain symptom appears when a secondary infection is attached and at a later date. The topographic and anatomical features of this localization determine the early spread to the tissues of the tongue, the mucous membrane of the alveolar part of the lower jaw. During the period of neglect, the tumor infiltrates the muscles of the floor of the mouth, the submandibular salivary gland, destroys the alveolar part and the body of the lower jaw.
Cancer of the buccal mucosa
Most often, the tumor process manifests itself in the form of an ulcerative-infiltrative form. A typical localization of a tumor ulcer is the mucous membrane along the line of teeth closure, the retromolar region, the corners of the mouth, i.e. those anatomical regions of the cheek that are most often traumatized. In the initial period, patients complain of discomfort, feeling of a foreign body. More than half of the patients note that the disease began with the appearance of pain when eating, talking. With the progression of the disease, the tumor process spreads to the muscles of the cheek, skin, mucous membrane of the transitional fold, the alveolar part of the upper or lower jaw. When the tumor is localized in the distal sections and the process spreads to the masticatory or internal pterygoid muscle, it leads to a restriction in the opening of the mouth. For tumors of the retromolar region, metastasis is characteristic at an earlier date and involvement of the tonsils and palatine arches in the process.
Cancer of the mucous membrane of the palate
The most common site for squamous cell carcinoma is the soft palate. On the hard palate, tumors from the small salivary glands are more often observed: malignant - adenocystic carcinoma, adenocarcinoma; benign - polymorphic adenomas. For squamous cell carcinoma of the mucous membrane of the palate, the ulcerative-infiltrative form is more characteristic. With this location of the tumor, one of the early symptoms is the appearance of pain, which makes patients see a doctor.
Cancer of the mucous membrane of the alveolar process
The tumor with the same frequency is located both on the lingual and on the buccal side. In the upper jaw, the predominant lesion of any of the sides of the alveolar process (palatine or buccal) is also not determined. The ulcerative-infiltrative form is more common. The bottom of the tumor ulcer in the developed period is the bone tissue of a dirty gray color, although bone-destructive changes may not be determined radiographically. During the period of neglect, bone destruction occurs and the process spreads to the body of the lower jaw, surrounding soft tissues. In the upper jaw, the process destroys the bone tissue of the alveolar process, followed by tumor growth into the maxillary sinus. The tumor process manifests itself quite early and the main symptom is often pain, which is aggravated by eating.
Regional metastasis of oral mucosal cancer
The frequency of metastasis and the localization of metastases depend on the location of the tumor in the oral cavity, its differentiation, and the characteristics of the lymphatic circulation. In cancer of the mucous membrane of the lateral surface of the anterior and middle third of the tongue, metastasis occurs in the submandibular, middle and deep cervical lymph nodes. The frequency of metastasis in the defeat of the tumor process in these areas is 35-45%.
When the tumor is localized in the posterior third and the root of the tongue, metastasis occurs much more often in the upper deep cervical lymph nodes and is about 75%.
When the tumor process affects the anterior parts of the floor of the mouth, the mucous membrane of the anterior part of the alveolar part of the lower jaw, the mucous membrane of the cheek, metastasis occurs in the submandibular and submental lymph nodes. Cancer of the posterior sections of the floor of the oral cavity, the retromolar region metastasizes mainly to the upper and middle jugular lymph nodes.
Tumors of the mucous membrane of the palate and the alveolar process of the upper jaw metastasize to the submandibular and retropharyngeal lymph nodes, sometimes metastases are determined in the anterior nodes.
In cancer of the mucous membranes of the oral cavity, there are cases of contralateral and bilateral metastases on the neck.
In some cases, when diagnosing regional metastases, palpation studies alone are not enough; cases of both hyper- and underdiagnosis are possible. Of great importance for the presence of enlarged lymph nodes and their possible damage by the tumor process is attached to the methods of radiation diagnostics: computed tomography, ultrasound. The cytological method for examining punctate from enlarged lymph nodes is important for the diagnosis of regional metastases; the reliability of this method is 70-80%.
TNM clinical classification. The classification is only applicable to cancer of the oral mucosa:
- TX - Insufficient data to assess the primary tumor.
- T0 - Primary tumor is not determined.
- Tis - Preinvasive carcinoma.
- T1 - Tumor up to 2 cm in greatest dimension.
- T2 - Tumor up to 4 cm in greatest dimension.
- T3 Tumor more than 4 cm in greatest dimension.
- T4 - Oral cavity: the tumor spreads to neighboring anatomical formations - the cortical layer of the bone, the deep muscles of the tongue, the maxillary sinus, the skin.
- NX Insufficient data to evaluate regional lymph nodes.
- N0 - No evidence of metastatic involvement of regional lymph nodes.
- N1 - Metastases in one lymph node on the side of the lesion up to 3 cm in the largest dimension.
- N2 - Metastases in one lymph node on the side of the lesion up to 6 cm in greatest dimension, or metastases in several lymph nodes on the side of the lesion up to 6 cm in greatest dimension, or metastases in the lymph nodes of the neck on both sides or on the opposite side up to 6 cm in largest dimension.
- N2a - Metastases in one lymph node on the side of the lesion up to 6 cm in greatest dimension.
- N2b- Metastases in several lymph nodes on the side of the lesion up to 6 cm in the largest dimension.
- N2c - Metastases in the lymph nodes on both sides or on the opposite side up to 6 cm in the greatest dimension.
- N3 - Metastases in the lymph nodes more than 6 cm in the greatest dimension.
- MX - Insufficient data to determine distant metastases.
- M0 - No evidence of distant metastases.
- M1 - There are distant metastases.
Grouping by stages
| Stage | Grouping by stages | ||
| 0 | Tis | N0 | М0 |
| I | T1 | N0 | М0 |
| II | T2 | N0 | М0 |
| III | T3 | N0 | М0 |
| T1 | N1 | М0 | |
| T2 | N1 | М0 | |
| T3 | N1 | М0 | |
| IVA | T4 | N0 | М0 |
| T4 | N1 | М0 | |
| Any T | N2 | М0 | |
| IVB | Any T | N3 | М0 |
| IVC | Any T | Any N | M1 |
Treatment of cancer of the oral mucosa
The main methods of treatment are radiation, chemotherapy and surgery, as well as their combination with each other. Cancer of the mucous membranes of the oral cavity is a moderately radiosensitive tumor, but despite this, the radiation method is the most common. It is used in almost 90% of patients. The most widely used in the treatment of this group of patients is remote gamma therapy, which is carried out both as an independent method of treatment and in combination with other antitumor methods.
As an independent method of treatment in patients with cancer of the mucous membranes of the oral cavity, it is often used for palliative purposes. In some cases, especially with low differentiation of tumor cells, with the prevalence of the tumor process T1-T2, it is possible to obtain complete regression of the tumor. However, the clinical observations of many authors and their own allow us to conclude that radiation treatment as an independent method of treatment does not give a stable result. The best results are achieved with combined treatment, when the plan of antitumor methods includes an operation that can be performed both after preoperative radiation treatment (the second stage of combined treatment) and before radiation treatment (the first stage of combined treatment).
Surgical treatment of patients with cancer of the mucous membranes of the oral cavity is an important stage, the features of which depend on the prevalence of the process and localization. Surgical intervention is performed according to all the rules accepted in oncology, i.e., the removal of the tumor should be carried out within healthy tissues, deviating from the determined boundaries of 2.5-3.5 cm. As an independent method, the operation is practically not performed in this group of patients, due to the high risk of recurrence. With T1 tumors, after radiation therapy, it is possible to remove the tumor within the organ. An example is the operation of a half resection of the tongue. Locally advanced tumors require combined operations, when adjacent anatomical formations are included in the block of tissues to be removed.
Combined operations in the maxillofacial region lead to disfigurement of the patient, significantly disrupt such important body functions as the ability to eat, breathe, speak, etc. In this regard, an important component of surgical intervention is the restoration of lost organs and partial or complete restoration of function . Restoration of organs and functions can be performed during the operation in full, if this is not possible due to various circumstances, then the restorative part should be preparatory in nature for subsequent interventions to restore lost organs and tissues and impaired functions.
Chemotherapy for patients with tumors of the mucous membranes of the oral cavity is indicated for a widespread process, the presence of metastases or relapses. Antitumor combination regimens of drugs with different mechanisms of action significantly increase the effectiveness of treatment. The use of chemotherapy before radiation treatment has a radiosensitizing effect - hypoxia decreases, blood supply to the tumor tissue improves, and the size of the tumor decreases.
The most rational approach to the treatment of patients with cancer of the oral mucosa is the use of a combination of chemotherapy - radiation treatment - surgery.
"Diseases, injuries and tumors of the maxillofacial region"
ed. A.K. Jordanishvili