Oral Cancers

Oral cancers are more commonly seen in the middle-aged group and elderly, affecting men more than women.

What are the symptoms of oral cancers?

Patients usually present with non-healing ulcers of more than 3 weeks despite medication. Other complaints include:

1. Persistent presence of blood in saliva
2. Lump/nodule with contact bleeding
3. Numbness of chin or lower lip
4. Pain upon eating/swallowing
5. Persistent earache
6. Lump in the neck (which usually indicates a spread of the cancer to the lymph nodes)

Risk factors of Oral Cancers include:

1. Smoking
2. Heavy alcohol consumption
3. Betel nut chewing
4. Tobacco chewing
5. Chronic irritation from ill-fitting dentures
6. Sun exposure (for lip cancer)
7. Poor immunity states, e.g. patients on immunosuppressants or HIV
8. Human Papilloma Virus (HPV) infection
9. Poor nutrition especially diets low in fruits and vegetable
10. Premalignant oral lesions:
    • Leukoplakia, which is a persistent white patch in the oral cavity
    • Erythroplakia, which is a persistent brightly coloured smooth area in the oral cavity (erythroplakia has higher risks of turning cancerous than leukoplakia)

How do we diagnose oral cancers?

A thorough head and neck examination is performed which includes examination of the oral cavity, the neck and a nasoendoscopy. A biopsy of the oral cavity lesion is then performed under local anesthesia as a clinic procedure. A fine needle aspiration cytology is also performed on any neck node. Either a computed tomography scan or magnetic resonance imaging (CT or MRI) is done to evaluate the extent of the oral cavity lesion and possible neck node involvement. If the biopsy confirmed the diagnosis of cancer, then a CT scan of the thorax and liver are done as part of the staging work-up, looking for distant spread to the lungs or the liver.

How do we treat oral cancers?

All cases will be discussed at the multidisciplinary tumour board where the best recommended treatment options will be detailed. Treatment modality depends on:

1. Age and general health of the patient
2. Extent of the oral cavity lesion infiltration
3. Stage of the cancer
4. Patient’s expectations and preferences

The preferred treatment is surgery of the oral cavity cancer and the associated lymphatic/nodal drainage pathway in the neck. The surgical defect may require reconstruction to ensure a functional and cosmetic outcome (refer to chapter on Head & Neck Reconstruction). Postoperative radiotherapy with or without chemotherapy will be decided based on tumour characteristics.

Even after completing treatment of the cancer, patients often have to undergo months of rehabilitation as surgery can result in altered speech and swallowing. Hence, intensive speech and swallowing therapy as well as regular dietician review is to be expected by our patients.