Formed from mucosal cells, cancer oral cavity affects surrounding tissues, manifesting itself as ulcers and germinations. It must be said that oral cancer includes a number of cancer diseases, including cancer of the lips, soft and hard palate, tongue, throat, and buccal mucosa. In all cases, early diagnosis of the disease gives a chance for a positive treatment outcome.
The five-year survival rate for patients with oral cancer is 41%, the three-year survival rate is 56%, and the average annual survival rate, regardless of the type of oral cancer, is 81%. Generally this type Cancer occupies a small percentage of all human cancers, accounting for 1.5% of all malignant tumors. Most susceptible this disease men aged from 40 to 60 years, while women get sick 4 times less often. Interestingly, this type of cancer ranks 6th among male cancers.
As it develops, oral cancer is divided into three periods: initial, developed and advanced.
Early signs of oral cancer
Cancer at the initial stage of development manifests itself with a feeling of slight discomfort in the area of its formation. During the examination, you can see white spots, compactions in the mucous membrane, papillary neoplasms, and tissue compactions.
Often, patients come for an initial examination due to pain, which, it must be said, begins to bother the patient at the very beginning of the development of cancer only in a quarter of cases. Such pain is often mistaken for a symptom of other diseases, such as tonsillitis.
Oral cancer is usually divided into three main forms: ulcerative, nodular and papillary. Each form of cancer also has its own symptoms.
The most common form of oral cancer is ulcerative form, which manifests itself as characteristic ulcerative formations on mucous tissues.
With the nodular form, specific compactions occur inside the mucosa. This type of cancer develops more rapidly than the previous one and may be accompanied by the appearance of white spots around the lump.
The presence of dense growths above the mucosa indicates a papillary form of cancer. This type of tumor also tends to progress very quickly.
It is worth noting that oral cancer at the initial stage of its development always forms first in the outer layer of the mucosa, and subsequently grows either further outside or inside the tissues.
Oral cancer during development
Along with development cancerous tumor new more appear in the oral cavity clear symptoms. First of all, this is the growing tumor itself, which begins to cause considerable discomfort to the patient. Interestingly, even at an advanced stage, pain may not occur. However, in most cases, pain is still present and becomes quite painful. In addition, they can radiate to other areas of the head, for example, to the ear.
Besides this characteristic symptom advanced stage of oral cancer is bad smell from the mouth, which indicates the disintegration of the neoplasm and its infection.
In addition, in medicine such cancer is divided into two: anatomical forms, each of which is also divided into several types.
The exophytic form is divided into papillary, in which the neoplasm takes on a mushroom- or plaque-shaped form, and ulcerative, when the resulting ulcer develops over time into a kind of crater.
The endophytic form is also divided into two groups, these are ulcerative-infiltrative tumors and infiltrative ones. The first include ulcers localized on a massive infiltrate that grows into the tissue. In this case, the ulcers may look like quite deep cracks. The second group includes tumors that are not ulcers, and there is diffuse damage to the mucous membrane.
Symptoms of advanced oral cancer
First of all, it is worth saying that oral cancer is considered one of the most aggressive and malignant types cancer among other oncological diseases. It grows quite quickly, rapidly destroying the tissues located near it.
The most aggressive behavior is cancer of the root of the tongue, in which the tumor quickly affects the palatine arches and pharynx. However, cancer in the back of the mouth is much more aggressive and difficult to treat than cancer in the front.
Like many other types of cancer, malignant neoplasms in the oral cavity at more advanced stages of development are characterized by the process of metastasis.
Metastases in this type of cancer mostly spread to the lymph nodes of the neck. However, the location of metastases directly depends on the location of the primary malignant tumor. For example, cancer of the tongue, located in its anterior part, most often spreads not only to the lymph nodes of the neck, but also to the submandibular lymph nodes.
It must be said that metastases of oral cancer very rarely reach distant areas of the body.
Most often, patients seek help from a doctor already at fairly advanced stages of the development of the disease, when some kind of infection is attached to the malignant neoplasm itself. Moreover, in a third of patients at the time initial examination The tumor has already metastasized.
In case of cancer of the mucous tissues of the cheek at an advanced stage of the disease, the tumor infiltrates from the skin, tonsils and lips. When the mucous membrane of the palate is affected, quite strong pain and significant discomfort are noted.
If a small tumor appears salivary glands patients seek help for pain in the oral cavity, which are usually caused by the addition of an infection and the formation of an area with ulcerations.
A pathology that is threatening with its complications, oral cancer, can form at any age. A favorable prognosis is only acceptable if early diagnosis tumors. Therefore, experts urge people to apply for timely medical care– at the slightest discomfort in the oral cavity. For example, a long-term non-healing ulcer on the cheek mucosa, the causeless loss of one or more teeth. Complex therapeutic effect will not only fight cancer, but also prevent relapse of the disease.
Forms and types of oral tumors
Malignant neoplasms, based on their morphological characteristics and stages of progression in the oral cavity, can be classified by specialists as the following types:
- Nodular - a kind of local compaction with clear boundaries. The surface of the oral mucosa in a separate area remains practically unchanged or acquires a whitish tint. The tumor tends to grow rapidly.
- Ulcerative is a crater-shaped defect of the mucous membrane. Concerns a person long absence regeneration and soreness, since the bottom of the ulcer affects the nerve endings in the tissues. Diagnosed in 2/3 of cases of cancer of oral structures.
- Papillary - visually resembles a hanging hair or a dense sac on the tissues of the mouth. At the same time, the mucous membrane practically does not lose its usual appearance.
Oral cancer can be of the following types according to its localization:
- cheeks - on the very line of the mouth or its corners, resembles a crater-shaped ulcer, causing constant discomfort when conducting a conversation or eating food;
- fundus cancer - located on the muscle groups of the bottom of the mouth, however, it can also affect the lower region of the tongue, as well as the salivary glands;
- tongue - most often the tumor is detected on its lateral surfaces, but it also occurs on the lower surface, extremely rarely - on the upper part;
- cancer in the area of the alveolar dental processes - with damage to the tissues of the upper or lower jaw, sometimes a tumor forms in the teeth;
- palate tumor - can be diagnosed as a squamous cell form of cancer, or cylindroma, adenocarcinoma.
Modern laboratory and instrumental research methods allow us to clarify the diagnosis - exactly how oral cancer formed in the patient.
Causes and provoking factors
As the practice of oncologists convincingly shows, tumors in the tissues of the oral cavity most often form in already injured areas. Long lasting inflammatory processes prepare the mucous membrane for the appearance of a focus of atypical cells - the risk of a cancer tumor increases several times.
Negative hereditary predisposition also makes a significant contribution to the occurrence of one or another form of malignant tumor of the mouth. Thus, in families where there have already been cases of diagnosed cancer, the risks that in subsequent generations malignant disease will manifest itself much higher.
Predisposing factors:
- prolonged use of tobacco products - nicotine and tar destroy the protective membrane of the mouth;
- papilloma virus, classified as type 16 - most experts are sure that this is the main culprit of oral cancer;
- poorly executed dental procedures– sharpened edges of the filling, incorrectly selected dentures, which constantly injure the tissues of the mouth, are common cause degeneration of cells into a tumor;
- abuse of alcoholic beverages – has an extremely negative effect on the entire human body, including the oral cavity, where drinks enter first;
- malnutrition – low content in the diet of vegetables, fruits, vitamins leads to a weakening of protective barriers, which contributes to the emergence of various inflammatory processes, which are an excellent background for cancer;
- uncontrolled use of medications - their chemical compounds can push the cells of the oral structures to degenerate into cancer.
If there is at least one of the above predisposing factors, it is recommended to be more attentive to your health and visit your dentist more often for a preventive examination.
Symptoms of cancer
Experts call alarming symptoms that may indicate the occurrence of a tumor in the oral cavity discomfort while eating - not just once, which can be easily explained by some acute process, for example, stomatitis, but daily, lasting several weeks. In this case, simultaneous numbness may be observed in one of the areas of the tongue or gums or cheeks. A person can even indicate a certain time interval from which he began to have unpleasant sensations.
The causeless loss of one or more teeth should also be alarming. There were no reasons for this - severe caries, trauma. While dental examination can reveal local weakening of the gums and looseness of nearby teeth, pronounced swelling of the jaw.
Discomfort and even pain when eating can accompany talking and opening the mouth for hygiene procedures. Intensity and character discomfort over time it increases and changes - they intensify, and do not decrease, as in inflammatory processes.
There is also an increase in the immediate submandibular, cervical lymph nodes– this system is one of the first to respond to the appearance of a tumor of the oral tissues, since lymph flows into the nodes and cancer cells. Involvement of the lymphatic system in tumor process indicates the transition of cancer to the second or third stage of the disease.
Gradually, the patient’s voice changes – it becomes hoarse, hoarse, and whispery. Speech loses its clarity, the person seems to have a lisp, protecting himself from additional unpleasant sensations in the mouth. Symptoms of oral cancer, if ignored, will not go away on their own. The tumor requires complex treatment. Otherwise, the person’s condition worsens significantly, up to fatal outcome from cancer intoxication.
Signs of cancer
A careful examination of the entire oral cavity at the time of hygiene procedures is the key good health and early detection dental diseases. Experts urge you to immediately seek medical help if the following warning signs are identified:
- an area of redness on the mucous membrane of the tongue, or gums, cheeks, palate - observed long time, does not decrease, but only increases in size;
- a whitish spot is not a film that can be removed, but a dense flat formation that appears and persists for more than several days;
- a small ulcer resembling stomatitis, however, does not heal, but only increases in size, deepens, causing severe discomfort and pain;
- an incomprehensible, inexplicable growth - a protrusion into the oral cavity, reminiscent of a mushroom or hair, often injured when eating food.
Signs and symptoms of oral cancer may be different - putrefactive, intractable hygiene procedures odor, loss of appetite, constant fatigue, decreased performance, low-grade persistent fever. Only a highly qualified specialist can carry out an adequate differential diagnosis. Therefore, you should not delay consulting a doctor. Early detection tumors and its complex treatment– the key to a quick and successful victory over cancer.
Cancer treatment tactics
After a comprehensive diagnosis - using modern laboratory and instrumental methods, the specialist will select the optimal scheme for treating the tumor.
Having established the type and stage of the neoplasm - oral cancer can have several course options, the oncologist makes a decision on the optimality of a particular method of treating the tumor.
In the early stages of cancer - when the tumor is small, its local location, and the possibility of excision, surgeons prefer the surgical method of fighting cancer. After removal of the main lesion, procedures are subsequently carried out to restore the injured tissue.
Radiation therapy is considered effective - it helps to reduce the volume of the tumor, and after its excision, reduce the severity of pain, and prevent cancer recurrence. According to individual needs, they resort to brachytherapy - internal irradiation of the cancer focus. Rods containing radiation material are inserted directly into the tumor itself.
If it is impossible to resort to surgical or radiation method, oncologists will recommend intravenous or oral administration of special antitumor medications. Chemotherapy can not only reduce the symptoms of cancer intoxication, but also suppress the growth and reproduction of tumor cells in areas of the body remote from the main focus.
Forecast
Early detection of cancer in one of the areas of the oral cavity is a favorable prognosis for the patient. Modern methods Antitumor therapy can effectively fight almost any type of cancer.
Whereas if a person ignores the first “bells” - unpleasant sensations in the mouth, changes in voice, non-healing mucosal defects, the tumor progresses and moves to an inoperable stage of development. The prognosis is much worse if the cancer is diagnosed at stages 3B–4. In this case, the person finds himself palliative care, designed to make his well-being as easy as possible and improve his quality of life.
Each person is the architect of his own happiness and health. In order not to have to fight a disease such as cancer, it is necessary to carefully monitor the condition of the oral cavity and undergo annual preventive medical examinations.
Oral cancer is characterized by the formation of a malignant tumor that is located on the mucous membrane. The group of possible ailments includes cancer of the tongue, floor of the mouth, cheek, gums, hard palate, palato-lingual arch, salivary glands. Pathologies manifest themselves in ulcers that take a long time to heal, and in tissue proliferation.
Etiology
According to doctors, males have a much higher chance of developing oral cancer. The core of the group consists of people over 50 years of age. Provoking factors include the following indicators:
- nicotine;
- use of smokeless tobacco;
- alcoholic drinks;
- heredity;
- prolonged sunbathing.
The disease can also develop when the oral cavity is affected. People with, with weak immunity. The following reasons can provoke the appearance of pathology: unbalanced diet, lack of vitamins, contact with asbestos.
Classification
The disease may manifest itself in various forms depending on the form of development. Thus, doctors have identified three main types of cancer:
- ulcerative – manifests itself in the form of an ulcer, which takes a long time to heal and can increase in volume;
- nodular - seals form on different areas oral cavities, progress rapidly, have clear outlines and shapes, sometimes covered with white spots;
- papillary - outgrowths of a dense formation that hang in the mouth and bring significant discomfort to the patient.
The tumor can also be localized in different places. Based on location, doctors have identified several forms of cancer:
- cheeks;
- floor of the mouth;
- language;
- in the area of the alveolar processes;
- palate.
The disease develops with varying intensity depending on etiological factor. However, in each patient the pathology develops in 5 stages:
- zero – the tumor does not extend beyond the mucosa, the size of the tumor is relatively small;
- first – the tumor is no more than 2 cm in volume, does not grow further along the cavity;
- second – the neoplasm reaches 4 cm in diameter, the progressive disease has not yet affected the lymph nodes;
- third – the tumor is more than four centimeters, the lymph nodes are damaged;
- fourth – metastases spread throughout internal organs, a pathological process develops in the lungs, spreading to the bones of the face and nasal sinuses.
Doctors and patients should take into account that if the disease progresses to stages 3 and 4, then no therapy will help the patient. During this period, the person is prescribed only supportive treatment, which is aimed at minimally improving the patient’s health.
The fourth stage of the disease is characterized by the appearance of metastases, and they, in turn, can spread further with varying strength. Therefore, doctors have identified another classification, which perfectly helps determine the extent of damage by metastases:
- N1 is the only metastasis in the lymph node, the volume is no more than 3 centimeters;
- N2 – foci of inflammation are formed in one or more nodes, the size increases to 6 cm;
- N3 – metastases exceed the mark of six centimeters;
- M – individual metastases appear.
Symptoms
At the initial stage of the pathology, the patient does not feel any significant pain syndromes. At this point, the patient may experience specific symptoms of oral cancer:
- minor pain in the damaged area;
- as the tumor increases in volume, it progresses and pain syndrome;
- attacks of pain can radiate to the ear, temple;
- difficulty swallowing and chewing food;
- the work of the salivary glands increases.
Recognize the disease by last stage possible by characteristic feature- stench from the mouth. This symptom indicates infection and tumor disintegration.
In addition to the above indicators, the appearance malignant formation The following signs may indicate:
- red or white spots on the mucous membrane;
- a feeling of swelling and swelling in some parts of the mouth;
- numbness and bleeding in the mouth;
- slightly swollen neck;
- hoarseness of voice;
- ear pain;
- strong decline weight;
- tooth loss.
Such indicators are typical not only for cancer, but also for other dental problems. Therefore, if you consult a doctor in time, it is possible to avoid complications and eliminate malignant neoplasms.
Diagnostics
After oral cancer has shown its symptoms and the patient has felt significant discomfort, he must definitely seek the help of a doctor. If detected in time initial stage cancer, it is possible to eliminate it without major surgery.
During an examination by a doctor, the patient is prescribed several laboratory and instrumental examination methods:
- nasopharyngoscopy;
- radiography of organs chest and skull bones;
- biopsy;
- blood for tumor markers;
- scintigraphy;
Carrying out research using all possible methods allows you to most accurately determine the disease, the progression of the tumor process and identify the stage of development of the tumor.
Treatment
Cancer treatment involves providing the patient with operational assistance, radiation to the tumor or chemotherapy to reduce the number of cancer cells.
Surgical treatment of a tumor in the oral cavity and oropharynx involves removal of the tumor and nearby lymph nodes.
If a patient is found to have a mobile tumor, he is scheduled for surgery to remove the tumor without excision of bone tissue. Depending on the progressive degree of pathology surgical care It can also involve partial removal of the jaw bones or the affected part of the tongue, with the removal of part of the skin and its restoration with the taken particles in another place.
In some cases, patients are prescribed micrographic surgery, which is based on removing the damaged part of the tissue in a layer-by-layer manner and studying them during surgery.
Radiation treatment is very often given to patients who have small tumors in the mouth or oropharynx. If a tumor of significant size is detected in the patient, then such therapy is carried out together with surgery and is characterized by the same removal of the tumor. Similar treatment It is also prescribed to eliminate certain symptoms - pain, bleeding, difficulty swallowing.
In chemotherapy, doctors select drugs for each patient individually. This treatment helps to completely get rid of cancer cells. Therapy chemicals may be prescribed in conjunction with surgery and radiation treatment.
Chemotherapy is prescribed to the patient after surgical care is provided. This is necessary in order to accurately eliminate all malignant cells.
During therapy similar method the patient may experience several unpleasant side effects– nausea, vomiting, bowel dysfunction, baldness, fatigue. All manifestations that occur to the patient after intravenous administration of drugs must be reported to the doctor so that he can analyze the effect of the drug on the body.
When treating pathology, it is also very important to monitor oral hygiene. To cleanse, dentists recommend following these rules:
- brush your teeth;
- use dental floss;
- reduce the amount of spices and solid foods in the diet;
- eliminate nicotine and alcoholic drinks;
- Chewing gum and candy should be sugar-free.
Prevention
To avoid malignant oral pathology, doctors advise maintaining oral hygiene, brushing your teeth regularly, and remembering to rinse your mouth after every meal. It is also worth giving up all negative habits and balancing your diet. Top tip concerns regular visits to the dentist. Thanks to constant consultations, the doctor will be able to quickly identify even the smallest diseases and the patient will be able to quickly cope with the pathology.
Is everything correct in the article? medical point vision?
Answer only if you have proven medical knowledge
– malignant neoplasms that develop from the mucous membranes of the oral cavity and account for about 1.5% of all tumors in humans.
Most often, the disease occurs in men aged 40-60 years. Experience shows that in most cases tumors develop on pathologically altered tissues. Most often, these are long-term inflammatory processes of various etiologies and dyskeratosis, which belong to the so-called precancer.
Causes of oral cancer
A significant role in the development of pathological processes in the oral cavity is played by such bad habits as smoking, abuse of strong alcoholic drinks, consumption of “nas” among the peoples of Central Asia, and chewing betel leaves among the peoples of India.
There are also factors such as chronic mechanical trauma caused by a damaged tooth crown, a sharp edge of a filling, or a poorly made prosthesis. The nature of nutrition also has a certain significance for the development of precancerous conditions.
Insufficient vitamin A content in food or a violation of its absorption by the body leads to changes in keratinization processes. Undoubtedly and harmful influence systematic consumption of too hot and spicy foods.
Symptoms of Oral Cancer
The clinical course of cancerous tumors of the oral cavity can be divided into three phases or periods: initial, developed and neglected.
Initial period
At this time, patients most often note unusual sensations in the area of the pathological focus.
When examining the oral cavity, various changes may be detected:
- thickening of the mucous membrane;
- tissue compaction;
- superficial ulcers;
- papillary neoplasms;
- white spots, etc.
During this period, it is necessary to carefully examine the organs of the oral cavity, since an analysis of observations shows that almost 10% of cases at the first visit to the doctor local lesions were not detected on the mucous membrane.
Pain, which usually forces you to see a doctor, occurs during the initial period of cancer development in approximately 25% of cases. However, in more than 50% of cases, pain is associated with sore throat, dental disease, etc.
This is especially often observed in cancer localized in the posterior half of the oral cavity and the alveolar edge of the jaw. Doctors' attention is often misdirected.
In the initial period of development of oral cancer, it is advisable to distinguish three anatomical forms:
- ulcerative;
- knotty;
- papillary.
The ulcerative form is observed most often; in approximately 50% of patients, the size of the ulcer increases slowly, in others quickly. Conservative treatment, as a rule, does not lead to a reduction in ulcers. This can be said about the following two forms.
The nodular form is manifested by compaction in the mucous membrane with whitish spots around or hardening in the tissues. In the latter case, the mucous membrane above the hardening may be unchanged. Seals usually have clear boundaries and develop faster than with the ulcerative form.
The papillary form is characterized by the presence of dense growths above the mucous membrane. They develop quickly and are often covered with an intact mucous membrane.
Developed period
At this time, numerous symptoms appear. First of all, almost all patients are bothered by pain of varying intensity, although sometimes, even with large sizes tumors, pain may be absent.
The pain becomes excruciating, is local in nature, or radiates to one or another area of the head, often to the corresponding ear, temporal region. In many patients, salivation increases as a result of irritation of the mucous membrane by tumor decay products.
A typical symptom is foul odor from the mouth - a companion to the decay and infection of the tumor.
In the advanced period of cancer of the oral mucosa, two anatomical forms are distinguished:
Period of neglect
Cancer of the oral mucosa, spreading rapidly, destroys surrounding tissue and should be classified as one of those tumors that are considered exclusively aggressive and malignant.
It should be noted that in general, cancer of the mucous membrane of the posterior half of the oral cavity is more malignant than the anterior one; it is also much more difficult to treat cancer of the organs of the posterior half of the oral cavity.
Descriptions of oral cancer symptoms
Diagnosis of oral cancer
Clinical recognition squamous cell carcinoma of the oral mucosa is based on knowledge of the development features of this form of malignant tumor and does not cause great difficulties.
This requires an assessment of the location of the tumor, its size, extent of spread and clinical form growth. Until now, the extent of tumor spread is determined visually and by palpation.
Secondary tumor damage to the bones of the facial skeleton is determined using X-ray method research and scintigraphy. However, tumor infiltration of the periosteum cannot be established in this way, and therefore one has to be content with a clinical assessment of its involvement in the tumor process.
The task morphological method research is to determine tumor identity biopsy material, histological structure malignant neoplasm, differentiation of squamous cell carcinoma, the prevalence of tumor infiltration into surrounding tissues and blood vessels.
All these signs are important for predicting the course of the disease and choosing a treatment method. The cytological method has a special important For differential diagnosis small tumors and pre-tumor diseases.
Diagnosis of regional metastases is usually not difficult. To predict the course of the disease and select the most rational method of treatment, it is necessary to assess the number of regional metastases and their localization in the corresponding groups of lymph nodes of the neck, which is determined by palpation and ultrasound scanning.
Cytological examination of punctures from a metastatic node allows a correct diagnosis to be made in 80% of cases.
Diagnosis of distant metastases requires examination of the organs most often affected by squamous cell carcinoma, for this purpose the following is carried out:
- chest x-ray;
- functional study of the liver;
- Ultrasound examination of the liver.
Oral cancer treatment
Treatment of patients with cancer of the oral mucosa can be divided into two stages: treatment of the primary lesion and treatment of regional metastases.
Stage I - treatment of the primary lesion
For the treatment of primary neoplasms, radiation, combined and surgical method s.
Radiation treatment for oral cancer
One of the most common methods of treating cancer of the oral mucosa and oropharynx. It is used in 88.7% of patients with tumors of the oral cavity, and in 72.4% - as an independent method. It is recognized as the main one in the treatment of early stages tumor development.
Most often, remote gamma therapy is used, less often intracavitary and a combination of both. As for the results, according to domestic and foreign authors for primary cancer of the mobile part of the tongue, corresponding to stages I and II (T1 and T2), the use of various techniques radiation therapy allowed to cure, respectively, 70-85% and 38-56% of patients within 5 years.
With stage I cancer of the floor of the mouth, 53-66% of patients are cured within 5 years, and stage II - 43-46%, with cheek cancer - 81 and 61%, respectively. Results radiation treatment Stage III oral mucosa cancer is much worse - 16-25%.
Combined method for treating oral cancer
Currently, a combined method of treating cancer of the oral mucosa, the main component of which is surgery, is widely used in our country.
Most specialists recommend remote gamma therapy at the first stage of treatment, and at the second stage surgery. Preoperative radiation doses are 35-45 Gy.
Favorable results of 5-year combined treatment of stage I and II tongue cancer are comparable to the results of only radiation exposure to the tumor and amount to 80-94% and 39-65%, respectively.
For tumors of other locations of stages I and II, long-term cure was achieved in 30-53% of patients with cancer of the floor of the mouth, in 42.8% - of the alveolar process of the mandible, and, respectively, in 94 and 65% of patients with cancer of the cheek.
For stage III disease, the results of combined treatment for cancer of any location in the oral cavity amounted to up to 37% of cures within 5 years. This method is used as a leading method for locally advanced cancer.
The main component is surgery; its volume must correspond to the extent of spread of the primary tumor, the form of its development and its histological structure.
Surgical method for treating oral cancer
In tongue surgery, half-electroresection of the tongue is still widely used. This operation is performed both for stage I-II cancer and for large tumors as part of combined interventions (on 2 or more organs). The boundaries of excision are at least 2-4 cm of healthy tissue.
For locally advanced cancer of the movable part of the tongue and floor of the mouth, a combined half-electroresection of the tongue with resection of the floor of the mouth (if indicated and resection of the lower jaw) is performed with simultaneous plastic surgery with musculocutaneous flaps of tissue defects of the tongue and floor of the mouth.
Stage II - tactics of influencing areas of regional metastasis
Regional metastases of cancer of the oral mucosa of all localizations are observed in 23-40% of cases.
The highest percentage of metastases in the lymph nodes of the neck is observed with a primary tumor measuring 4 cm or more. The influence of regional metastases on the fate of patients is evidenced by the following data from domestic and foreign authors.
With a primary tumor of 4 cm or more with morphologically confirmed metastases, only 17-20% of patients are alive for 5 years without relapses or metastases. Regardless of the size of the primary tumor with regional metastases, 9-33% of patients are alive, and in their absence - 50-70%.
The leading method of treating regional metastases is surgery. For this purpose, fascial-sheath excision of the tissue of the neck and Krail's operation are performed. In order to prevent the development of regional metastases, a number of radiologists use elective irradiation of areas of regional lymphatic drainage.
Questions and answers on the topic "Oral cancer"
Question:Good afternoon. Please tell me how necessary the operation is for my 37-year-old brother, who in August of this year was diagnosed with cancer of the oral mucosa in the anterior part of the right with mts in the submandibular, cervical lymph nodes on the right, T3N2 in M0. Since that time, three courses of chemotherapy have been carried out, but it was still decided to have surgery. Latest ultrasound: to the right anterior to the PSG, a hypoechoic infilstrate of 3.1x2.6 cm is determined, without clear contours, and single lymph nodes No. 3, 1 cm in diameter. Along the sternocleidomastoid muscle there is a chain of lymph nodes with a hyperechoic center, maximum 2.0x0.7 cm. The salivary glands are not changed, on the left lymph nodes of a specific nature are not identified, thyroid gland no changes.
Answer: The operation is necessary - without it, the chances of prolonging life, much less recovery, are extremely small.
Oral cancer is malignant tumor, which arises from epithelial cells located in the mouth. The cheeks, gums, mucous membranes, palate and even tongue may be affected. The danger of the diagnosis directly depends on the form of the disease and the stage at which it was detected.
The causes of the occurrence and development of cancer are very different. The first factor that stands out is smoking. According to statistics, the vast majority of patients abused cigarettes. In addition, it is believed that a tumor can be provoked by:
- Contact with harmful substances: carcinogens, heavy metals, toxic gases;
- Radioactive radiation;
- Ultraviolet radiation;
- Eating too hot or spicy food;
- Improper or poor nutrition;
- Vitamin A deficiency;
- Alcohol abuse;
- Availability viral diseases in the body. Special attention it is worth paying attention to the human papillomavirus;
- Wounds and ulcers in the mouth for a long period.
The risk group includes middle-aged and elderly people. Moreover, the disease is diagnosed in males 2 times more often than in females.
An interesting fact is that in European countries, oral cancer is not common, in no more than 5% of cases of all possible cancers. At the same time, this figure in Asian countries is much higher. So, in India it reaches more than 50%.
Types of oral cancer
Oral cancer can be classified according to two main criteria. This is the histological appearance and growth pattern. In the first case, accept the following types:
- Oral squamous cell carcinoma;
- Adenocarcinoma;
- Basal cell tumor.
If we talk about appearance and the form of growth of the neoplasm, it can look like: papillary, nodular or ulcerative.
Papillary tumor
This type is expressed in the appearance of dense growths in the oral cavity. Despite the fact that their growth rate is quite high, they pose the least danger, since they do not grow into nearby tissues. They respond well to treatment.
Nodular tumor
This tumor appears as dense nodules with clearly defined boundaries. They are quite different fast speed growth and the presence of white spots.
Ulcerative tumor
This is the most common form of oral cancer. It looks like an ulcer that does not heal long period time. It tends to grow. IN various cases it happens quickly or slowly.
Locations in the oral cavity
A feature of cancer of the oral mucosa is the possibility of affecting its various parts. This can be the tongue, cheeks, palate, as well as the bottom of the cavity and the area of the alveolar processes.
Floor of the mouth
The floor of the mouth is the area between the tongue and the hyoid bone. There are many blood and lymph nodes in this place. The salivary glands also pass through here. All this contributes to the fact that emerging tumors quickly grow into the tissue.
Cancer of the floor of the mouth is accompanied by discomfort, increased salivation, and difficulty swallowing. It accounts for almost 20% of all oral tumors.
Language
Oral cancer, which is localized on the tongue, occurs most often, in approximately 40-50% of cases. The lesion itself usually occurs on the side or in the area of the root of the tongue. Expressed as ulcers or papillomas.
Typical for tongue cancer rapid growth. The neoplasm not only grows into tissue in short terms, but also forms a large number of metastases.
Cheeks
In this case, the neoplasm is usually localized with inside corner of the mouth. Due to the fact that this area is in close proximity to the tooth line, the cause pathological process often become mechanical injuries mucous membrane. This can be caused by chipped teeth or poor-quality crowns.
The main symptoms are pain when chewing and talking.
Sky zone
Palate cancer is considered enough rare form. Signs of the disease depend on which palate was affected: soft or hard. In the first case, as a rule, squamous cell carcinoma is diagnosed, in which the patient feels a thickening and problems with pronunciation. In the second case, the patient most often deals with adenocarcinoma. It is distinguished by its aggressive character, rapid germination in bone tissue and severe painful sensations.
Cancer of the gum mucosa is even less common. Usually its source is inflammatory processes in the teeth.
Alveolar ridge zone
The alveolar process is the edge of the jaw along which the teeth are located. This structure causes the tumor in this area to be accompanied by severe pain. This often leads the patient down the wrong trail, making him think that the causes of his discomfort lie in dental disease.
The most important thing the patient should do in this case is to find a qualified doctor. Otherwise, if the dentist is unable to see the oncological process and removes the tooth, the situation may only get worse. And that’s all, because cancer cells will have a quick path to the bones through the formed hole.
Clinical manifestations of pathology
As in many other cases, the first signs cancer the oral cavity may have mild symptoms. The patient may perceive them as indicators of sore throat, stomatitis, pulpitis or other pathologies. Unfortunately, this can waste valuable time. It is best if during this period the patient falls into the hands of an experienced dentist or ENT specialist, who can determine the onset of the tumor process.
Symptoms of oral cancer include:
- Seals in the mucous membrane. It can often be felt with the tongue;
- Unpleasant sensations in the area of the primary lesion. Without appropriate treatment, they grow and can spread to the ear, temple or forehead;
- The presence of visible ulcers or cracks;
- Spots inside the mouth. They may have a white or red tint;
- Feeling of a lump in the throat;
- Changed voice;
- Feeling of numbness in a certain part of the mouth;
- Poor breathing;
- Difficulty chewing and swallowing;
- Enlarged lymph nodes;
- Swelling of the jaw.
A lump in the throat is one of possible symptoms oral cancer The most visible and at the same time serious sign of the disease is facial deformation. It indicates that the tumor process has begun to spread to neighboring structures.
Stages of the disease
Since the development of a cancerous tumor occurs gradually, it goes through certain stages, which are characterized by certain signs of a pathological condition.
In total, it is customary to distinguish 4 main stages:
- First stage. The neoplasm affects only the mucous and submucosal layers, without going beyond them. Moreover, its size does not exceed 1 centimeter in diameter;
- Second stage. The tumor increases slightly, its diameter reaches 2 centimeters. Lymph nodes at this stage are practically not affected, but germination into the tissue occurs, although not deep, by about 1 centimeter;
- Third stage. Metastasis to regional nodes may occur. There is also an option in which the lymph nodes remain untouched. The size of the neoplasm can reach 3 centimeters;
- Fourth stage. The tumor continues to grow and its size can be quite large. Possible damage to the soft tissues of the face or metastasis to distant organs.
Undoubtedly, the nature of the treatment will depend on the stage at which the disease was discovered.
Diagnostic methods
At the initial examination, the doctor must not only evaluate external condition the patient, but also carefully read his medical history. In addition to the oral cavity itself, the lymph nodes and neck area are subject to examination.
Procedures such as:
- Radiography. This is a simple and accessible examination method. It helps to detect a pathological focus. But, unfortunately, he is unable to determine his character;
- Computed and magnetic resonance imaging. These are two modern and popular ways to detect tumors. Unlike X-rays, they allow not only to detect a tumor, but also to clarify its size, structure, and location. MRI can also determine the extent of its growth into nearby tissues;
- Positron emission tomography. Another modern one diagnostic method, which is especially informative in identifying cancer-affected lymph nodes;
- Biopsy. This is a standard procedure that remains one of the most informative in detecting oncology. Its essence lies in laboratory examination taken sample.
In addition, the patient mandatory takes urine and blood tests so that specialists can study their composition.
Treatment options
Oral cancer treatment can be done various methods or a combination thereof. What exactly needs to be done in each individual case will be determined by the doctor based on the diagnostic results obtained.
Operational
Malignant tumors must be removed. In this case, the method of surgical intervention is selected based on the location of the tumor. Thus, removal may be accompanied by excision of bone or, conversely, only soft tissue.
Often, in addition to resection of the tumor itself, there is a need to remove lymph nodes. This is a very important moment, since a large number of nerve fibers are located in this area. If they are injured, the patient may begin to experience problems with hearing, speech or facial expressions.
Chemotherapy
That's enough known procedure, which involves administering potent drugs to the patient antitumor drugs. Under their influence, atypical cells are destroyed. Therefore, chemotherapy can be prescribed both before and after surgery, and in some cases it can act as the main treatment.
The main disadvantage this method treatment is the presence of side effects. During and after procedures, patients may notice active hair loss, weakness, fatigue, nausea, dizziness, poor health.
It is very important for doctors to monitor the patient’s condition during this period, because if necessary, they can suspend and reschedule therapy.
Radiation therapy
Treatment for mouth cancer may include radiation therapy. It has a similar purpose to chemotherapy. But in this case, it is not the use of drugs that occurs, but the irradiation of the focus itself. The conditions for successful results of the procedure are the small size of the tumor.
Radial curative therapy always follows courses. It usually does not require hospitalization, but can also cause various side effects.
Brachytherapy
Brachytherapy is a type of radiation therapy. Its meaning is that irradiation occurs from the inside. To do this, a special rod containing radioactive material is inserted into the patient's tumor itself. The patient is in a hospital setting under the supervision of medical personnel. Before discharge, the rod is removed.
Brachytherapy is one of the ways to treat oral cancer Prevention
As such preventive measures There are no strategies specifically aimed at preventing oral cancer. But you can reduce the likelihood of risk by following the following tips general:
- Refusal bad habits: cigarettes and alcoholic beverages;
- Use of protective clothing during forced contact with harmful and dangerous substances;
- Limited exposure to direct sunlight;
- Keeping healthy balanced nutrition, rich in all essential minerals and vitamins.
If suspicious lumps, cracks, or ulcers occur in the oral cavity, you should consult a doctor, especially if they not only do not disappear within a few days, but also tend to grow.
Forecast
The prognosis of cancer depends on a large number of different factors, ranging from the type of lesion and stage of the cancer and ending individual characteristics the patient's body.
If the tumor was diagnosed in the early stages, then a positive treatment outcome can be hoped for in 80-85% of cases. At stage 3, this figure already decreases to 20-25%.
There is also a risk of relapse. For this reason, it is very important to register and undergo a preventive examination.
