Oral cancer is relatively rare and occurs in 3% of all cancer diagnoses. As a rule, the disease is usually detected in men over the age of sixty, while it is rare in children and young people. However, this fact should not lead people to think that they will never be affected by the disease. If diagnosed, the course of oral cancer, its form, activity of spread and many other factors, depend on the location of the neoplasm, which determines the cancer treatment tactics.
Content
- Risk groups for oral cancer
- Types of oral cancer
- Typical development of oral cancer
- Manifestations of oral cancer
- How is surgery for oral cancer treatment carried out?
- Chemotherapy for oral cancer
- Radiation therapy for oral cancer
- Prognosis and prophylaxis
- Cost of treatment in European hospitals
- How to start oral cancer treatment in Europe?
Risk groups for oral cancer
It’s important to know which people are more susceptible to oral cancer. And even though experts cannot unequivocally answer the question of what causes oral cancer, the factors that facilitate its development are indicated. These include:
- Bad habits. Smoking has a negative impact, especially when combined with the consumption of alcoholic beverages.
- Mechanical trauma to the oral mucosa. Continuous mechanical damage arising from improper dentures, wounding of the mucosa with fillings or splinters of tooth enamel, increase the risk of oral inflammation.
- Oral trauma or damage caused by dental procedures.
- Faulty oral hygiene (poor brushing, untimely treatment for oral diseases).
- Working environment with exposure to carcinogenic compounds.
- Consumption of hot or spicy foods.
- Vitamin A deficiency.
In the last few decades, experts have also conducted trials that demonstrate a connection between the development of malignant pathology and the detection of the papillomavirus (HPV) in people. The virus is often transmitted through kissing and less often it is transmitted through household contacts.
Types of oral cancer
There are three forms of oral cancer: nodular, ulcerous and papillary. The first looks like papillary tumors. Their surface may be either unchanged or covered with whitish spots. The size of these masses gradually increases.
The ulcerous form is the most common. It is characterized by the formation of small ulcers on the mucous membranes. They do not heal for a long time and cause discomfort. Papillary cancer is a structural formation that penetrates tissues of the oral cavity.
Oral cancer is also classified according to the site of formation and includes the following types:
- Floor of mouth cancer. The tumor is located on the mouth floor's muscles and affects the salivary glands and the lower part of the tongue.
- Cheek cancer. The tumor looks like a small ulcer and gradually enlarges. This leads to restriction in opening the mouth and interferes with speaking and eating.
- Tongue cancer. Pathological formation begins to develop on the lateral surface of the tongue. Less commonly, the tumor is localized on the lower or upper part of the tongue.
- Cancer of the alveolar processes. A malignant tumor can be located on the upper and lower jaw. It can affect the teeth and is manifested by bleeding and soreness in the places where it appears.
Cancer of the palate. Cancer cells develop in the soft tissues as well as in the hard palate.
Typical development of oral cancer
Often, oral cancer initially appears as a limited ulcer with infiltrated margins. With further growth, the tumor spreads not only in-plane but mainly in-depth, turning into a hard mass, like wood. This causes severe adduction of the jaw, leading to its complete immobility and this makes it very difficult to speak and eat.
Uncontrollably spreading, cancer extends to the bone, sometimes affecting both the upper and the lower jaw, penetrating the palate and the pharynx. It may even grow outward and form ulcerous masses on the skin of the face.
Early on, lymph nodes on the healthy side are also affected. And, as the tumor spreads, the number of involved nodes grows. With it, the cancer prognosis worsens. In general, the prognosis is more unfavorable when the tumor is further from the lips and when neoplasms in the throat accompany it.
Manifestations of oral cancer
As with most cancers, the initial stage of oral cancer is either asymptomatic or it has few clinical manifestations. People usually experience unusual sensations in the mouth or even in the throat area. During an examination, a doctor often discovers a characteristic ulcer, fissure or thickened area.
So, how does oral cancer manifest itself? More than a third of people complain of local pain, which they attribute to inflammation of the throat, dental disease or gum disease. As the malignant process progresses, painful manifestations intensify and the pain turns from barely noticeable, to excruciating and thus irradiates to the cheekbones, forehead, temples and ears. The pathological process steadily spreads to nearby tissues and structures, leading to changes in the shape of the face, a patient’s speech or throat disorders and difficulty swallowing.
At the advanced stages of the disease, signs of oral cancer include enlarged regional lymph nodes, which can be fused to the adjacent tissues.
How is surgery for oral cancer treatment carried out?
In the case of resectable neoplasms and an absence of contraindications for surgery, the volume of surgical treatment of oral cancer and its technique, depend on the localization of a tumor, its stage and the need to perform subsequent reconstructive surgery.
If the tumor is mobile, it is removed without performing bone excision. An X-ray scan is performed before treatment to identify the degree of involvement of the facial skeleton in the pathological process. If the bone is not affected and the tumor has limited mobility, it is removed, together with some jaw tissue. In cases where the X-rays clearly show a lesion in the jawbone, the bone tissue is more widely excised.
If metastases in regional lymph nodes are detected or if there is a high risk of their spreading, a block of lymph nodes is removed during surgery.
The doctor determines the volume of surgery after determining the stage of cancer and its spread. A wedge, partial resection of the jaw, is performed if the cancer cells have penetrated the periosteum and surrounding tissues. If the diagnostics reveal that the cancerous cells have penetrated the bone directly or if the defect is noticed during the surgery, segmental resection of the lower jaw is performed. The doctor basically assesses the lesion on the spot and determines the thickness of the dissected layer.
The next surgery step is a partial or complete excision of the cervical lymph nodes, in order to prevent recurrence if the tumor is more than 4mm thick or if the tumor is located on the floor of the mouth or the tongue. If the tumor is located on the midline, the cervical lymph nodes are excised from both sides. If necessary, the surgery is complemented with replacement of the damaged tissue.
After treatment, the tumor tissue is sent for histological study. Its size and edges are evaluated. Further treatment depends on the detection of cell growth beyond the boundaries of the capsule of the removed lymph nodes and any spreading of cancer cells to neighboring organs.
Chemotherapy for oral cancer
Antitumor drugs are prescribed before surgery or simultaneously with radiation therapy, to reduce the size of the neoplasm. Sometimes chemotherapy treatment complements surgery. It should be noted that chemotherapy should be started no later than six weeks after surgery.
Treatment involves a regimen of fluorouracil combined with cisplatin or other agents. These can cause a number of side effects, such as vomiting or nausea, decreased appetite and bleeding. However, symptoms do disappear after a course of treatment but persistent hearing impairment is sometimes noted after cisplatin administration.
Unresectable tumors are treated with chemotherapy and radiotherapy. If a patient has contraindications to cisplatin, this can be replaced with carboplatin. Another option is to use carboplatin and fluorouracil in a two-component regimen.
In the case of resectable masses, neoadjuvant chemotherapy is usually not used. If there is a high risk of pathology progression after surgery, adjuvant chemotherapy or radiotherapy is indicated. Predispositions for oral cancer recurrence include:
- Spread of metastases beyond the lymph nodes;
- The presence of malignant cells at the resection margins;
- Deep invasion into the lymphatic nodes;
- The last stages of the disease.
Radiation therapy for oral cancer
Radiotherapy plays a leading role in the combined treatment because this method provides efficient damage to malignant cells, reducing the volume of the area which will be subsequently removed.
When deciding how to cure the initial stages of oral malignancy, brachytherapy is highly effective. This treatment method consists of implanting radioactive compounds directly into the tumor tissue. One of the unconditional advantages of this method is the reduction of both irradiation of the surrounding tissues and the occurrence of reactions to the radiation exposure. Brachytherapy is used as an independent therapeutic method or is combined with distant irradiation and chemotherapy. It is often preferred because of its minimal side effects and relatively high tolerance. However, the technique is of low efficacy and does not provide a prolonged remission at advanced stages of cancer or in some tumor localizations.
At the advanced stages of the disease, the question arises as to how to treat the oral cancer because, at this stage, the tumor is inoperable. In a case of stage four oral cancer, radiation therapy is prescribed for palliative purposes.
Prognosis and prophylaxis
The prognosis for people with oral cancer depends on the effectiveness of the treatment and the stage at which the pathology is diagnosed. The outcome of the therapy is influenced by:
- The duration of the course of the disease;
- The size of the tumor and its localization;
- The age of a patient;
- The general state of a patient;
- The absence or presence of metastases.
The prognosis for oral cancer largely depends on the stage at which the disease is detected. If treatment is started at stage zero, the condition is often cured. Patients should keep in mind that smoking provokes recurrence of this oncology, so repeated surgery or radiation may be required. Surgery for patients with the first stage of oral cancer increases the survival rate to 80-85% and a combination of radiotherapy and surgery at the second stage – to 70%. Even with advanced cancer, survival is possible in about 50% of cases when treatment is comprehensive.
Early diagnosis making and precise irradiation can provide a five-year recurrence-free survival rate of 70-85%. This rate is reduced by 20% for people with cancer on the floor of the mouth. If the cancer has affected the cheek area, the five year survival rate is no more than 60-80%. Cancer that has formed on the lips has a high survival rate. Statistically, about 20% of people experience a disease recurrence in two to three years, following treatment.
For this reason, oncologists recommend undergoing preventive examinations every three months for the two years following treatment. After that, for up to five years, such exams are indicated once every six months. To reduce the risk of oral cancer occurrence, it is necessary to give up smoking. The same applies to alcohol addiction. People need to increase the amount of plant-based foods in their diet, whilst regular dental check-ups can help detect the disease early.
Cost of treatment in European hospitals
The cost of treatment in Europe is a rather complicated process due to several factors.
A comprehensive approach is used when treating oncology abroad, depending on the type of cancer. Therefore, the cost of treatment in European hospitals depends on the procedures and methods included in the treatment regimen. In any case, oral cancer treatment in Europe today is the best choice, both in terms of the quality of treatment provided and in terms of price.
And, of course, the cost of treatment in European hospitals will vary from country to country.
So, the average price of diagnostics in European hospitals is around 600 EUR. The cost of treatment with chemoradiotherapy is about 15,500 EUR. The cost of treatment with chemotherapy alone amounts to 1,377 EUR (for one course) and subsequent rehabilitation costs 951 EUR per day.
You can check prices for oral cancer treatment in different countries on the Booking Health website.
How to start oral cancer treatment in Europe?
For starters, you should decide on whether you want to take upon the organization of treatment in Europe yourself or entrust it to a specialized company.
The medical tourism company, Booking Health, has been arranging treatment in Europe for foreigners for over twelve years. Using the Booking Health organizational services is one of the ways to make cancer treatment in Europe cheaper. The company has special lower prices, due to agreements with the hospitals, based on many years of successful cooperation and interaction.
Besides that, you don't have to wait for treatment for long either. With Booking Health, you start your treatment as soon as possible, so that no time is wasted. In this case, you can reduce your expenses and get a cost of treatment guarantee.
To find out what it is and to find answers to all of your questions, visit the Booking Health website and fill in the request form for a medical advisor to contact you.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Vadim Zhiliuk and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
European Society for Medical Oncology
Cancer Research Institute
NORD - National Organization for Rare Disorders
