Oral Cancers

Oral Cancers - The Mouth's Malignancy

• Malignant neoplasms of oral cavity; >90% are Squamous Cell Carcinoma (SCC).
• India: High burden due to tobacco, areca nut, alcohol.
• Risks (📌 Mnemonic: TAB-H): Tobacco, Alcohol, Betel quid, HPV (16, 18), chronic irritation.
• Signs: Non-healing ulcer, growth, pain, trismus, red/white patches (leukoplakia/erythroplakia).

⭐ In India, buccal mucosa is the most common site for oral SCC, strongly linked to betel quid chewing practices.

Culprits & Causes - Risky Business

• Tobacco: Dominant factor; single most important cause.
  • Smoking (cigarettes, bidis, hookah).
  • Smokeless (khaini, gutkha, pan masala, zarda).
• Alcohol: Potent co-carcinogen, especially with tobacco.

  ⭐ Tobacco + Alcohol = Synergistic effect, dramatically ↑ risk (multiplicative, not additive).

• Areca Nut (Supari): Key independent carcinogen; common in betel quid/pan.
• Human Papillomavirus (HPV): Primarily types 16 & 18; more common in oropharyngeal cancers but also oral.
• Chronic Irritation: Sharp teeth, ill-fitting dentures, poor oral hygiene.
• Dietary Deficiencies: Low intake of fruits/vegetables (↓ Vitamins A, C, E, iron).
• Genetic Predisposition: e.g., Plummer-Vinson syndrome, Fanconi anemia.

Spotting the Signs - Lesion Location Logic

• High-Risk Zones: Tongue (posterolateral), floor of mouth (FOM), retromolar trigone.
• Tongue: Lateral border (most common), ventral. Base of tongue often advanced at diagnosis.
• Floor of Mouth: Anteriorly; common site for midline spread.
• Buccal Mucosa: Along occlusal line; strong tobacco/betel quid association.
• Lip: Lower lip vermilion (sun exposure); generally best prognosis.
• Gingiva: May mimic periodontitis or epulis; check for underlying bone invasion.
• Palate: Hard palate (often minor salivary gland tumors), soft palate.

⭐ Squamous Cell Carcinoma (SCC) of the lower lip vermilion typically carries the best prognosis among oral cavity cancers due to early detection and less aggressive behavior.

Diagnosis & Staging - Sizing Up the Foe

• Biopsy: Gold standard. Incisional (lesion edge); excisional (small lesions <1 cm).
• FNAC: For neck nodes.
• Imaging:
  • CT (Contrast): Bone, neck nodes.
  • MRI: Soft tissue, perineural spread.
  • PET-CT: Distant mets, recurrence.
• Staging: AJCC TNM (8th ed.).
  • T: Size & Depth of Invasion (DOI).
  • N: Nodes (size, number, ENE+).
  • M: Metastasis.

  ⭐ Depth of Invasion (DOI) critically impacts T-stage & prognosis in oral SCC. oka

Treatment Tactics - Battling the Blaze

• Primary Goal: Cure; preserve function & QoL.
• Core Modalities: Surgery (Sx), Radiotherapy (RT), Chemotherapy (CT), Immunotherapy.
• Strategy: Stage-dependent.

• Neck: Elective Neck Dissection (END) if cN0 & >20% occult mets risk.

⭐ Adjuvant RT: 60-66 Gy. CTRT for high-risk (positive margins, ENE).

Prevention & Prognosis - Outlook & Ounce of Prevention

• Prevention:
  • Primary: Avoid tobacco (all forms), betel quid, excessive alcohol.
  • Secondary: Early detection via dental exams, oral self-awareness.
  • Consider HPV vaccination for high-risk groups.
• Prognosis:
  • Strongly linked to TNM stage at diagnosis.
  • 5-year survival rates:
    • Stage I/II: ~70-90%
    • Stage III/IV: ~20-50%
  • Overall 5-year survival: ~60-65%.

  ⭐ Cervical node involvement: most critical adverse prognostic factor.

High‑Yield Points - ⚡ Biggest Takeaways

• Squamous Cell Carcinoma (SCC) is the most common oral cancer, accounting for over 90% of cases.
• Primary risk factors include tobacco (smoked and smokeless), areca nut (betel quid), and alcohol.
• Commonest sites are the lateral border of the tongue and buccal mucosa (especially in India due to chewing habits).
• Key premalignant lesions: leukoplakia, erythroplakia (highest malignant potential), and Oral Submucous Fibrosis (OSMF).
• A non-healing ulcer or an unexplained red/white patch are the most common early symptoms.
• Biopsy is essential for diagnosis; treatment is typically multimodal involving surgery, radiotherapy, and/or chemotherapy.