Best Oral, Mouth, and Tongue Cancer Specialist in Delhi

Introduction to Mouth Cancer

Mouth Cancer is the no 1 cancer in males in India, and India has the world’s highest number of mouth cancers. To know all about mouth cancers, read below.

Types of Mouth Cancer

Squamous Cell Carcinoma

Verrucous Carcinoma

Mucoepidermoid Carcinoma

Adenocarcinoma

Melanoma

What are the risk factors for oral cancer?

Oral cancer is a serious condition, and understanding its risk factors is crucial for prevention and early detection. Here are the key risk factors associated with oral cavity and oropharyngeal cancers:

1. Tobacco and Alcohol Use:
   • Tobacco: Smoking cigarettes, pipes, or cigars significantly increases the risk. Smokeless tobacco products (such as snuff, dip, or chew) are also linked to oral cancer.
   • Alcohol: Heavy alcohol consumption raises the risk, especially when combined with tobacco use.
2. Age and Gender:
   • The risk of developing oral cancer increases with age, especially after 45 years.
   • Men, particularly those of African descent, are more susceptible than women.
3. Human Papillomavirus (HPV):
   • Certain strains of HPV are associated with oral cancer. HPV-related oral cancers often occur in the oropharynx.
   • Practicing safe sex and getting vaccinated against HPV can reduce the risk.
4. Chronic Sun Exposure:
   • Long-term exposure to sunlight on the lips can contribute to lip cancer.
5. Poor Nutrition:
   • A diet lacking essential nutrients may increase susceptibility to oral cancer.
6. Weakened Immune System:
   • Conditions that weaken the immune system (such as HIV/AIDS or immunosuppressive medications) elevate the risk.
7. Genetic Syndromes:
   • Certain genetic conditions, such as Fanconi anemia, are associated with a higher risk of oral cancer.

What are the warning signs and symptoms of oral cancer?

Oral cancer is a serious condition that affects various parts of the mouth. Here are the warning signs to watch out for:

1. Mouth Sores: If you have a sore in your mouth that doesn’t heal, it could be a sign of oral cancer.
2. White or Red Patches: Pay attention to any white or reddish patches on the inside of your mouth, especially on the tongue or inner cheeks. These patches should not scrape away.
3. Lumps or Bumps: If you notice any growths or lumps inside your mouth, seek medical attention promptly.
4. Loose Teeth: Unexplained tooth mobility can be a symptom.
5. Mouth Pain: Persistent pain in the mouth, throat, or ear should not be ignored.
6. Difficulty Swallowing: If swallowing becomes painful or challenging, consult a doctor.
7. Ear Pain: Sometimes, oral cancer can cause referred pain in the ear.
8. Hoarseness or Voice Changes: Changes in your voice, chronic sore throat, or hoarseness may indicate a problem.
9. Unexplained Bleeding: Any unexplained bleeding in the mouth warrants investigation.
10. Weight Loss: Sudden weight loss without an apparent reason should raise concern.

How is oral cancer diagnosed?

Oral cancer diagnosis involves several steps to determine if a person has cancer and to understand its extent. Here are the common methods used:

1. Physical Examination: The doctor examines your mouth, throat, and neck for any abnormalities, such as lumps, sores, or discolored patches.
2. Biopsy: A biopsy is crucial for a definitive diagnosis. During this procedure, the doctor removes a small tissue sample from the suspicious area. The sample is then sent to a laboratory for analysis. There are different types of biopsies:
   • Incisional Biopsy: Only a portion of the abnormal tissue is removed.
   • Excisional Biopsy: The entire lesion is removed.
   • Fine Needle Aspiration (FNA): A thin needle is used to extract cells from a lump or swollen lymph node.
3. Imaging Tests:
   • X-rays: These help visualize the bones and detect any abnormalities.
   • CT (Computed Tomography) Scan: Provides detailed cross-sectional images of the head and neck.
   • MRI (Magnetic Resonance Imaging): Offers high-resolution images to assess tumor size and spread.
   • PET (Positron Emission Tomography) Scan: Detects cancer cells based on their metabolic activity.
4. Endoscopy:
   • Flexible Endoscopy: A thin, flexible tube with a camera is inserted through the mouth or nose to examine the throat, esophagus, and stomach.
   • Nasopharyngoscopy: Specifically examines the nasopharynx (the upper part of the throat behind the nose).
5. HPV Testing: If oral cancer is suspected, testing for human papillomavirus (HPV) may be done. Certain strains of HPV are associated with oral cancer.
6. Blood Tests: These help evaluate overall health and detect any abnormalities.
7. Biological Markers: Researchers are studying specific markers that may indicate the presence of oral cancer.

What are the mouth cancer stages?

Mouth cancer like most of cancers is staged according to American Joint Committee on Cancer (AJCC) staging system, currently eighth edition. T, N, and M scores are assigned which are further combined to assign a stage. Staging is done clinically by the surgical oncologist and pathologically after the surgery. Following is the clinical staging.

T (Tumor)

Tis: Carcinoma in situ; cancerous cells are found in epithelial layer

This stage includes all the precancerous mouth cancers.

T1: Tumor is 2 cm or less with DOI (Depth of invasion) 5 mm or less

T2: Tumor is either 2-4 cm or DOI 5-10 mm

T3: Tumor is either more than 4 cm or DOI more than10 mm

T4a: Moderately advanced local disease:

Tumor is more than 4 cm with DOI more than 10 mm or invades nearby dispensible structures like bone or skin.

T4b: Very advanced local disease:

Tumor has involved mastication muscle space, bones called pterygoid plates or skull base or encases major Internal carotid artery.

N (Node)

N0: No regional lymph node metastasis

N1: One lymph node with metastasis 3 cm or smaller on same side

N2: One lymph node with metastasis 3 cm-6 cm on same side (N2a), or Multiple lymph nodes with metastasis on same side 6 cm or smaller (N2b), or lymph nodes with metastasis on opposite or both sides 6 cm or smaller (N2c)

N3: Lymph node with metastasis larger than 6 cm (N3a) or Cancer found outside the lymph node i.e ExtraNodal Extension (ENE+)(N3b)

M (Metastasis)

M0: No distant spread

M1: Cancer that has spread through blood to distant organs like lungs and bones.

The T, N and M stages are used to group into following stage groups.

Stage Groups

What are the treatment options for oral cancer?

Oral cancer treatment options depend on several factors, including the location of the tumor, the stage of the disease, and the patient’s overall health. Let’s explore the available treatments:

1. Surgery:
   • Tumor Removal: Surgeons may remove the tumor along with a margin of healthy tissue to ensure all cancer cells are eliminated. Smaller tumors may be removed through minor surgery, while larger ones might require more extensive procedures (such as removing a section of the jawbone or a portion of the tongue).
   • Neck Dissection: If cancer has spread to the lymph nodes in the neck or if there’s a high risk of spread, surgeons may recommend removing lymph nodes and related tissue in a procedure called neck dissection.
2. Radiation Therapy:
   • High-Energy Beams: Radiation therapy uses high-energy beams to target and kill cancer cells. It can be effective for localized tumors or as an adjuvant treatment after surgery.
   • Side Effects: Side effects may include fatigue, skin changes, and difficulty swallowing.
3. Chemotherapy:
   • Systemic Treatment: Chemotherapy aims to stop cancer cell growth or kill cancerous cells throughout the body. It is often used in combination with other treatments.
   • Side Effects: Common side effects include nausea, hair loss, and fatigue.
4. Targeted Therapy:
   • Precision Medicine: Targeted therapies focus on specific molecules involved in cancer growth. They are tailored to the patient’s unique genetic makeup.
   • Examples: Drugs like cetuximab or imatinib may be used.
5. Immunotherapy:
   • Boosting Immune Response: Immunotherapy helps the immune system recognize and attack cancer cells.
   • Checkpoint Inhibitors: Drugs like pembrolizumab or nivolumab are used to block certain proteins that inhibit immune responses.
6. Palliative Care:
   • Symptom Management: Palliative care focuses on improving the patient’s quality of life by managing symptoms such as pain, difficulty swallowing, and weight loss.

What are the survival rates for oral cancer?

The 5-year relative survival rates for oral cavity and oropharyngeal cancers are as follows:

1. Lip:
   • Localized: 94% survival rate.
   • Regional: 63% survival rate.
   • Distant: 38% survival rate.
   • All stages combined: 91% survival rate.
2. Tongue:
   • Localized: 84% survival rate.
   • Regional: 70% survival rate.
   • Distant: 41% survival rate.
   • All stages combined: 69% survival rate.
3. Floor of the mouth:
   • Localized: 73% survival rate.
   • Regional: 42% survival rate.
   • Distant: 23% survival rate.
   • All stages combined: 53% survival rate.
4. Oropharynx:
   • Localized: 59% survival rate.
   • Regional: 62% survival rate.
   • Distant: 29% survival rate.
   • All stages combined: 52% survival rate.

Please note that these statistics are based on people diagnosed with oral cavity (mouth) or oropharynx (the part of the throat behind the mouth) cancers between 2012 and 2018. Survival rates can vary based on individual factors and geographic location, so it’s essential to consult with our healthcare professional for personalized information regarding your specific case.

How can I reduce my risk of developing oral cancer?

Certainly! Taking proactive steps can help reduce your risk of developing oral cancer. Here are some important measures to consider:

1. Avoid Tobacco Products:
   • Quit smoking if you currently smoke. Smoking is a significant risk factor for oral cancer.
   • Avoid smokeless tobacco products, such as snuff or chewing tobacco.
2. Limit Alcohol Consumption:
   • Moderate alcohol intake: If you drink alcohol, do so in moderation. Excessive alcohol consumption increases the risk of oral cancer, especially when combined with tobacco use.
3. Practice Safe Sex and Get Vaccinated:
   • HPV (Human Papillomavirus) is a major risk factor for oropharyngeal cancer. Practice safe sex to reduce exposure.
   • Consider getting vaccinated against HPV. The vaccine is recommended for both males and females.
4. Protect Your Lips from Sun Exposure:
   • Prolonged sun exposure to the lips can increase the risk of lip cancer. Use lip balm with SPF and wear a wide-brimmed hat when outdoors.
5. Maintain Good Oral Hygiene:
   • Regular dental check-ups are essential. Dentists can detect any abnormalities early.
   • Brush your teeth twice a day and floss regularly.
   • Use mouthwash if recommended by your dentist.
6. Be Aware of Symptoms:
   • Pay attention to any changes in your mouth, throat, or neck.
   • Seek medical evaluation if you experience persistent symptoms like mouth sores, white or red patches, difficulty swallowing, or unexplained weight loss.
7. Eat a Balanced Diet:
   • Consume a variety of fruits, vegetables, and whole grains.
   • Limit processed foods and sugary snacks.
8. Avoid Betel Nut and Areca Nut Chewing:
   • These substances are associated with an increased risk of oral cancer.
9. Know Your Family History:
   • Some genetic syndromes increase susceptibility to oral cancer. Be aware of your family’s health history.
10. Stay Hydrated:
    • Proper hydration is essential for overall health, including oral health.

Remember, prevention and early detection are crucial. Regular self-examinations and professional dental visits can help identify any concerning changes in your mouth or throat. If you have specific concerns, consult with our Surgical Oncologist.

Are there any support groups for people with oral cancer?

Here are some oral cancer support groups that can provide valuable information, resources, and emotional support:

1. The Oral Cancer Foundation (OCF):
   • OCF is a national public service organization dedicated to reducing suffering and saving lives through prevention, education, research funding, advocacy, and patient support.
   • They focus on oral and oropharyngeal cancers, including mouth cancer, tongue cancer, tonsil cancer, and throat cancer.
   • OCF maintains the world’s most prominent oral cancer patient and survivor support group online, with over 13,000 registered members and thousands more who view it regularly.
2. Cancer Lifeline’s Oral, Head & Neck Cancers Support Group:
   • Facilitated by Kristin Slotemaker, LICSW.
   • Meetings are held on the 2nd Wednesday of each month via Zoom.
   • To register, download the Zoom app and then click here to register.
3. CancerCare’s Head and Neck, and Oral Cancer Patient Support Group:
   • This 15-week online support group is for people diagnosed with head and neck, and oral cancer who are currently receiving treatment.
   • It covers cancers of the mouth, throat, voicebox, nasal passages, salivary glands, and sinuses.
   • Participants share resources, information, and emotional support. To join, complete the online registration process.

Remember that joining a support group can provide a sense of community, understanding, and encouragement during your journey with oral cancer. Reach out to these organizations to find the support that best suits your needs.

How is HPV linked to oral cancer?

Human papillomavirus (HPV) is a common sexually transmitted infection.

1. HPV and Oropharyngeal Cancer:
   • Oropharyngeal cancer refers to cancers in the back of the throat, including the base of the tongue and tonsils.
   • HPV can infect the mouth and throat, leading to oropharyngeal cancer.
   • Approximately 70% of oropharyngeal cancers in the United States are thought to be caused by HPV.
   • It usually takes years after HPV infection for cancer to develop.
2. Transmission:
   • Oral HPV can be transmitted through oral sex or other routes.
   • Many people are exposed to oral HPV during their lifetime.
   • About 10% of men and 3.6% of women have oral HPV.
   • Infection is more common with older age.
3. Symptoms of Oropharyngeal Cancer:
   • Persistent symptoms may include:
     • Long-lasting sore throat
     • Earaches
     • Hoarseness
     • Swollen lymph nodes
     • Pain when swallowing
     • Unexplained weight loss
   • Some people may have no symptoms.
4. HPV Vaccination:
   • The HPV vaccine was initially developed to prevent cervical cancer and other reproductive system cancers.
   • It also protects against the types of HPV that can cause oropharyngeal cancers.
   • CDC recommends HPV vaccination for 11- to 12-year-olds and everyone through age 26 years (if not vaccinated already).
   • Adults aged 27 to 45 years may consider vaccination after discussing risks and benefits with their doctor.

Remember, early detection and prevention play a crucial role in managing oral cancer risk associated with HPV. Regular check-ups and awareness are essential for maintaining oral health.

What are the latest Advances in Mouth Cancer Research