Lip and oral cavity cancer
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What is that
The diagnosis
The stage of the disease
How to cure
Treatment based on the stadium
What is that
Lip and mouth cancer is a disease characterized by the presence of tumor cells in the mucous membrane of the lips or mouth. The oral cavity includes the front two thirds of the tongue, the upper and lower gums, the inner surface of the cheek and lips, the lower part of the mouth under the tongue (oral floor), the upper bony end of the mouth (hard palate) and the small area beyond the wisdom teeth (retromolar trigon).
Head and neck cancers are more common in subjects over 45 years of age. Oral tumors are more common among men than women, although in recent years the relationship has dropped significantly, given the change in habits in alcohol consumption and smoking by women. The risk of developing lip cancer is higher among fair-skinned people who have spent much time in the sun.
It is essential to go to the family doctor in the presence of a small protuberance on the lip, in the mouth or in the gums; or if you have in your mouth a small lesion that does not heal or a reddish-white stain that does not resolve or if your mouth is bleeding or hurts. People who wear dentures must go to the doctor if the prosthesis does not adhere more well. Lip and mouth cancers are often diagnosed during a dental check-up.
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The diagnosis
In the presence of these symptoms, the doctor examines the mouth using a lamp and a mirror and, if necessary, addresses by an otolaryngologist specialist who prescribes radiological examinations (computized axial tomography, CT scan, or magnetic resonance imaging) nuclear, RMN). If the radiological investigations detect the presence of abnormal tissue, the doctor proceeds to biopsy, that is, he removes a small sample of tissue that he sends to the laboratory for examination under a microscope, in order to assess whether there are cancer cells. The biopsy is performed under local anesthesia to avoid the slightest discomfort.
The chances of recovery (prognosis) and the choice of treatment depend on the location and stage of the tumor (if it is circumscribed to the lip or the mouth or if it has spread to the lymph nodes or other organs), as well as from the general health conditions of the patient .
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The stage of the disease
Once the presence of the tumor is confirmed, further investigations must be carried out to check if the cancer cells have spread to other parts of the organism (staging). Staging is important for choosing the most appropriate treatment. Cancer of the lip and the oral cavity is classified in the following stages:
- stage I: the tumor has a maximum diameter of 2 cm and has not extended to the regional lymph nodes;
- stage II: the tumor has a diameter that measures more than 2 cm, but less than 4 cm, and has not spread to the regional lymph nodes;
- stage III: two situations are possible:
- the tumor has a diameter greater than 4 cm (it is longer than 4 cm); or
- the tumor, regardless of size, has invaded a single lymph node located in the same part of the neck where the tumor is located and the affected lymph node does not measure more than 3 cm;
- stage IV: three situations are possible:
- the tumor has spread to the tissues surrounding the lips and the oral cavity; the lymph nodes can be harmless or compromised; or
- the tumor, regardless of size, has invaded more than one lymph node located in the same part of the neck where the tumor is located, the lymph nodes of one or both sides of the neck, or a lymph node measuring more than 6 cm of diameter; or
- the tumor has spread to other organs;
Return to topHow to cure
The treatment options currently available for the treatment of lip and mouth cancer are:
surgery;
radiotherapy;
chemotherapy;
Surgery is a common treatment for lip and oral cavity cancer. The surgeon can remove the tumor with a margin of surrounding healthy tissue. In some cases it also removes the lymph nodes of the neck with a lymph node dissection.
Radiation therapy (also called radiation therapy) uses high frequency radiation to destroy neoplastic cells and reduce tumor size. Radiation can be delivered from a machine external to the organism (external radiotherapy) or the radioactive substance (radioisotope) can be introduced directly into the lesion by means of plastic tubes (internal or intracavitary radiotherapy or brachytherapy). Its exclusive use is indicated only in selected cases for small tumors. If smokers stop smoking before being given radiotherapy, the chances of survival increase.
To learn more: see Radiotherapy
Chemotherapy is the therapeutic modality that destroys cancer cells through the administration of drugs, which can be taken by mouth in the form of tablets, or injected intravenously or intramuscularly. Chemotherapy is defined as systemic treatment, because the drug enters the bloodstream, spreads in the body and in this way can reach and destroy the cancer cells that have spread at a distance. In the treatment of lip and mouth cancer, chemotherapy is rarely given by mouth. Usually in the treatment of oral cancers the chemotherapy is administered together with radiotherapy.
If the surgeon removes all visible tumor, it is possible to undergo postoperative chemotherapy in order to destroy any residual tumor cells. The chemotherapy performed after the operation, when there are apparently no more tumor cells, is defined as an adjuvant. Chemotherapy performed before surgery in order to reduce the size of the tumor, to be able to remove it more easily, is called neoadjuvant.
To learn more: see Chemotherapy
Because lips and mouth are essential for eating and talking, the patient may need help getting used to the side effects of the disease or treatment. The oncologist will consult with various specialists, who will be able to help him decide which treatment is best suited to the individual case. If the treatment has required the removal of an extended portion of the lip or oral cavity, plastic surgery may be required. Qualified medical personnel will follow the patient to help him recover from treatment and get used to a new way of eating and talking.
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Treatment based on the stadium
The choice of therapy depends on the location and stage of the tumor, the age and the general condition of the patient.
The specialist may propose standard treatment for its proven efficacy, confirmed by previous experience, or participation in a clinical trial. Standard therapy does not necessarily work for all patients and sometimes involves more side effects than you think. For this reason, clinical trials are conducted in order to identify more effective treatment methods, based on the most up-to-date information currently available.
Stadium I
The choice of treatment depends on the location of the tumor. In summary, the therapeutic options are as follows:
Tumor localization
Therapeutic options
Lip:
- surgery; or
- radiotherapy
Tongue:
- surgery; or
- surgery followed by radiotherapy on the neck;
Inner surface of cheek and lip:
- surgery; or
- radiotherapy
Oral floor:
- surgery;
Lower gingiva:
- surgery; or surgery followed by radiotherapy
Retromolar trine:
- surgery with partial removal of the maxillary bone; or
- radiotherapy followed (if necessary) by surgery
Superior gingiva and hard palate:
- surgery; or
- surgery followed by radiotherapy
Stage II
The choice of treatment depends on the location of the tumor. In summary, the therapeutic options are as follows:
Tumor localization
Therapeutic options
Lip:
- surgery; or
- external radiotherapy and / or brachytherapy
Tongue:
- radiotherapy; or
- surgery plus radiotherapy
Inner surface of cheek and lip:
- radiotherapy; or
- surgery; or
- surgery plus radiotherapy
Oral floor:
- surgery; or
- radiotherapy;
- surgery followed by external radiotherapy or brachytherapy
Lower gingiva:
- surgery; or
- radiotherapyRetromolar trine:
- surgery with partial removal of the maxillary bone; or
- radiotherapy followed (if necessary) by surgery
Superior gingiva and hard palate:
- surgery followed by radiotherapy
Stage III
The choice of treatment depends on the location of the tumor. In addition to the therapies listed below, radiotherapy of the neck with or lymph node dissection is also possible. In summary, the therapeutic options are as follows:
Tumor localization
Therapeutic options
Lip:
- surgery plus external radiotherapy or brachytherapy; or
- radiotherapy; or
- surgery on tumor and lymph nodes followed by chemotherapy and radiotherapy, or a second surgery if tumor cells are still present in the margins of resection
Tongue:
- external radiotherapy with or without brachytherapy; or
- surgery plus radiotherapy; or
- surgery on tumor and lymph nodes followed by chemotherapy and radiotherapy, or a second surgery if tumor cells are still present in the margins of resection
Inner surface of cheek and lip:
- surgery with removal of the tumor with a healthy tissue resection margin; or
- radiotherapy;
- surgery plus radiotherapy
Oral floor:
- surgery with lymph node dissection and, if necessary, partial removal of the maxillary bone; or
- external radiotherapy with or without brachytherapy
Lower gingiva:
- pre- or post-operative radiotherapy
Retromolar trine:
- surgery followed by radiotherapy
Superior gingiva and hard palate:
- radiotherapy; or
- surgery plus radiotherapy
For all stage III lip and mouth cancers, some clinical trials are currently underway to test the effects of combination chemotherapy plus radiotherapy.
Stage IV
The choice of treatment depends on the location of the tumor. In addition to the therapies listed below, radiotherapy of the neck with or lymph node dissection is also possible. In summary, the therapeutic options are as follows:
Tumor localization
Therapeutic options
Lip:
- surgery plus intracavitary or external radiotherapy; or
- radiotherapy in association with targeted therapy
Tongue:
- surgery with removal of the tumor and the underlying larynx followed by radiotherapy; or
- palliative radiotherapy, ie aimed at relieving symptoms; or
- radiotherapy in association with targeted therapyInner surface of cheek and lip:
- surgery with removal of the tumor with a healthy tissue resection margin; or
- radiotherapy; or
- surgery plus radiotherapy; or
- radiotherapy in association with targeted therapy
Oral floor:
- surgery to remove the tumor plus radiotherapy; or
- radiotherapy followed by surgery; or
- radiotherapy in association with targeted therapy
Lower gingiva:
- surgery, radiotherapy or both; or
- radiotherapy in association with targeted therapy
Retromolar trine:
- surgery followed by radiotherapy; or
- radiotherapy in association with targeted therapy
Superior gingiva and hard palate:
- surgery plus radiotherapy; or
- radiotherapy in association with targeted therapy
Cancer of the lip and relapsing oral cavity
Therapeutic options depend on the treatment already received, on the conditions of operability and on the spread of the disease. In summary, the therapeutic options are as follows:
operable tumor:
- surgery, if the patient has already undergone radiotherapy; or
- second-instance surgery or radiotherapy or both, if the patient has already undergone surgery;
inoperable tumor:
- systemic chemotherapy, combined treatment of chemotherapy, radiotherapy and targeted therapy.
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