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Oral and Throat Cancer


OVERVIEW OF Oral and Throat Cancer :

When the cell grows out of control in the oral cavity and throat, it constitutes the cancer in the oral cavity and throat. The throat cancer is also known as the oropharyngeal cancer.


STRUCTURE of Oral and Throat Cancer :

 The oral cavity constitutes the tongue, buccal and lingual vestibule, teeth and palate. The bones present in the oral cavity includes maxilla and mandible. The nasopharynx(the upper part of the pharynx which constitutes the nose) leads to the oropharynx which constitutes the throat. The hypopharynx is located at the lower part of the pharynx. Pharynx leads to the food pipe called oesophagus which leads to the stomach.

Larynx(voice box): the voice box is the short passage which lies beneath the surface of the cartilage of the pharynx. It has a small piece of tissue called epiglottis which closes when food enters the larynx. Hence the food is mediated to enter into the pharynx.

Salivary glands: the salivary that belongs to the oral cavity includes Parotid gland, submandibular gland and sublingual gland. These glands aids in the formation of the saliva. There are many minor salivary glands which are present throught the mucous membrane of the oral cavity and throat.


EPIDEMIOLOGY :

It is common among the people who have crossed 50 years of age. It is the sixth most common type of cancer


CAUSES :

Smoking

Tobacco, pan chewing

Alcohol consumption

Sharp teeth

Spicy foods

Ill fitting dentures

Malnutrition

Genetics

Chronic ulceration

Premalignant conditions such as leukoplakia, lichen planus

Exposure to the sun

Using ciger, pipes, cigarettes

Dietary habits.

Herbs such as sanguis

Xerostomia

Infection with human papilloma virus and Epstein barr virus

Occupational exposure to chemicals


PATHOPHYSIOLOGY :

The most common type of the cancer is the epidermoid cancer which is called the Squamous cell carcinoma. This disease most commonly begins in a leukoplakic lesion which can be smooth or rough, flat or elevated, ulcerated or intact. Histologically it results in the thickening of the mucosa.

Due to the continuous triggering by the above etiologic factors it results in the dysplastic features of the cells.

The cells in the oral cavity replicates rapidly. They are against the apoptosis ( programmed cell death by the individual cells).

Types:

Cancer cells developing from the epithelium:

Squamous cell carcinoma, Basal cell carcinoma, Melanoma

Cancer cells developing from the glands:

Adenocarcinoma,  Adenocystic carcinoma,  Mucoepidermoid carcinoma

Cancer cells developing from the connective tissues:

Sarcoma, Lymphoma.


COMMON CLINICAL SIGNS AND SYMPTOMS :

Swelling or lump in the cancer site

Spontaneous bleeding from the site

Pain in the site of cancer

Unexplained numbness in the site

Hoarseness of voice

Unexplained weight loss

Difficulty in swallowing

Speech difficulties


DIAGNOSTIC :

Biopsy:

  1. Excisional biopsy: when the lesion is small it can be excised fully
  2. Incisional biopsy: It is indicated when complete excision is not possible
  3. Aspiration biopsy: If the lesion is deep seated, cystic and haemorrhagic  then the aspiration biopsy can be used.
  4. Punch biopsy: It is used when the biopsy  is taken from the inaccessible areas such as maxillary sinus, lateral and posterior walls of the pharynx.
  5. Oral Brush biopsy: The brush is used to collect the samples.

 

CTscan:

A CT scan takes three dimensional pictures of the abnormal tissues from different angles.

Magnetic Resonance Imaging:

A MRI scan uses the combination of the magnetic and radiowave frequency to view the abnormal tissues.

An dye is injected in the vein or the patient is asked to swallow the dye and the results are observed.

Ultrasound:

A sound waves to create the picture of the internal organs to find out if the cancer is spread or not.

Ultrasound:  with the patient symptoms it can be used to view the cancer involving lymph nodes.

Endoscope: In this method the doctor uses an ultrasound probe, and with the guidance of endoscope it is passed in to the nose to view the head and neck structures.

X-ray:

If X rays are taken at this time to show the abnormalities in the head and neck.

Positron emission tomography (PET) or PET-CT scan.:

A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body. With the help of the PET scan one can be able to find out the stage of cancer.

 

 

 

Barium swallow or modified barium swallow:

 It is used to check the barium swallowing. During an x-ray exam, the patient is asked to swallow liquid barium.

 

Primary tumor (T)

  • TX: Main tumor cannot be measured.
  • T0: Main tumor cannot be found.
  • T(is), or T in situ: The tumor is still within the confines of the normal glands and cannot metastasize.
  • T1, T2, T3, T4: Refers to the size and/or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has grown into nearby tissues. T's may be further divided to provide more detail, such as T3a and T3b.

Regional lymph nodes (N)

Lymphatic fluid transports immune system cells throughout the body. Lymph nodes are small bean-shaped structures that help move this fluid. Cancer often first spreads to and through nearby lymph nodes.

  • NX: Cancer in nearby lymph nodes cannot be measured.
  • N0: There is no cancer in nearby lymph nodes.
  • N1, N2, N3: Refers to the number and location of lymph nodes that contain cancer. The higher the number after the N, the more lymph nodes that contain cancer.

Distant metastasis (M)

Metastasis is the spread of cancer to other parts of the body.

  • MX: Metastasis cannot be measured.
  • M0: Cancer has not spread to other parts of the body.

M1: Cancer has spread to other parts of the body


TREATMENT AND PROGNOSIS :

The following are the surgeries done:

Primary tumour surgery:

In this surgery the tumour and a margin of the healthy tissues are removed to decrease the chances of recurrences.

Glossectomy:

 This is the partial or complete removal of the tongue.

Mandibulectomy:

If the tumour enters the jawbone (lower bone) then the partial or complete removal of the jawbone is indicated.

Maxillectomy:

This surgery removes the part or complete removal of the hard palate, and also the maxilla bone the upper bone of the oral cavity.

Neck dissection:

 The cancer in the oral cavity or throat often spreads to the lymph nodes.

It is important to remove some or all these lymph nodes using a surgical procedure called neck dissection. A neck dissection is followed by the chemotherapy, radiotherapy and targeted cell therapy.

Micrographic surgery:

This type of surgery reduces the risk of removing the healthy tissue. It often involves the removal of lip cancer.

Reconstruction:

If the removal of the cancer part requires the larger surface area then the reconstruction with the healthy area such as pectoral(chest) muscle or thigh muscle is indicated.

Other Therapy:

  • Chemotherapy:
    • A chemotherapy is after the sugery or before the surgery to shrink the cancer cells. A chemotherapy is nothing but the delivery of drug intravenously.
    • The following are the certain type of drugs which are used in the chemotherapy:
    • It includes:
  • Radiation therapy:
    • It uses powerful x rays or emission of protons to destroy the cells. The radiation therapy also aids  in shrinkage of the cells and also relief the symptoms caused by the cancer.
  • Immunotherapy
    • it is a drug treatment that uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. This immunotherapy boos those cells and helps the body to fight against it.
  • Targeted therapy:
    • This therapy involves targeting the specific organs. It involves the emission of rays.

 


PROGNOSIS :

The 5 year survival rate of oral cancer is 60%


PREVENTION :

Avoid smoking

Avoid smokeless tobacco

Maintain proper oral hygiene

Limit the intake of spicy food

Limit the exposure to the chemicals

Maintain the healthy lifestyle.


Medicines used in the Treatment :

Cisplastin

Carboplantin

5- fluorouracil

Cetuximab- given in targeted therapy

 


REFERENCE :

https://www.cancer.gov/types/head-and-neck/head-neck-fact-she

https://www.cancer.net/cancer-types/oral-and-oropharyngeal-cancer/types-treatment

https://nyulangone.org/conditions/oral-cancer/treatments/medication-for-oral-cancer

https://www.nidcr.nih.gov/health-info/oral-cancer/more-info

https://www.medicalnewstoday.com/articles/16533