diease

Oral and Throat Cancer


Oral and Throat Cancer overview and Definition

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.


Epidemiology

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


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.


Clinical signs & 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


Differential Diagnosis

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


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.


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