Oral cancer is a general term for malignant tumors occurring in the oral cavity, with complex pathological types. 90% of them are squamous epithelial cell carcinoma, which is the so-called squamous epithelial carcinoma of oral mucosa. In clinical practice, oral cancer includes tongue cancer, gum cancer, cheek cancer, soft palate and hard palate cancer, maxillary and mandibular cancer, floor of mouth cancer, large and small salivary adenocarcinoma, lip cancer, etc. Despite the improvement of surgical skills and diversification of treatment methods, the overall five-year survival rate of oral cancer in the United States is only about 50%-60% at the highest, in other words, only about 5-6 out of 10 oral cancer patients can survive for more than 5 years, why? In other words, only about 6 out of 10 oral cancer patients can survive for more than 5 years. Why is it that in such an anatomical area as the oral cavity, where lesions can be easily detected, people cannot get a good treatment result when they have tumors?
Sometimes, as a doctor, I feel very sad. Once an oral cancer patient called me and begged “doctor help me” on the phone, but I could not do anything because all the treatments that should be done in other hospitals have been done, and the best time for treatment has been lost because of the recurrence. Here I will talk about the etiology and treatment of oral cancer with my experience in oral cancer treatment for 10 years.
Causes of oral cancer
All tumors are caused by genetic mutation, there are many oncogenes in human body, but normally they are very important for our normal physiological functions and are monitored by immune system throughout the whole process, so for most normal people, they will not suffer from tumors throughout their life, we can think that the occurrence of tumors is caused by the mutation of normal cellular genes in the body, which lose the recognition by the body’s immune system. We can think that the tumor is caused by the mutation of normal cell genes in the body, which is lost to be recognized by the immune system.
As a simple example, why do we wear leather shoes made of cowhide for a year or two and then they will break down, but in cattle they will not be worn out? Because the living tissue has a metabolism! The surface of the dead skin off will have a new skin grow out. Oral mucosa is the same. The normal oral mucosa cells have a life span of only a few days, and after a few days of growth, they will be recognized by the body’s immune cells and start the cellular aging mechanism, aging off. The dead cells will be replaced by the differentiation of the stem cells under the mucosa, thus completing the metabolism. When the damn cells are genetically mutated for various reasons, the immune cells in the body cannot recognize these senescent cells and will relax the monitoring of them, thus always considering them as newborn cells and causing such cells to proliferate indefinitely to form solid tumors. This is the basic mechanism of malignant tumor development.
There are many causes of cell mutation and each tumor is different from the other. Currently, the factors related to oral cancer are: chronic injury, ultraviolet ray, X-ray and other radioactive material irradiation, long-term chronic stimulation by root remnants, sharp tooth tips, bad restorations, long-term smoking and drinking, betel chewing and other irritants, HPV virus infection, long-term mental stress and genetic factors.
Combined with my own clinic experience the following points are more important.
1, rotten teeth for a long time without treatment, sharp edge like a knife blade, long-term friction oral mucosa;
2.Denture repair in unregulated places, such as the marketplace, which has been encountered many times;
3.Almost all male oral cancer patients have a long-term history of smoking and drinking alcohol;
4, oral hygiene is extremely poor, and a large amount of dental calculus, tea stains and tobacco stains can often be seen attached to the tooth surface, which is a good medium for bacteria to cause chronic inflammatory stimulation;
Although the mechanism is not clear, it seems that the strong immunity will promote the occurrence of tumor, could it be caused by the fatigue of immune system due to strong work? It is to be further studied by science.
6, oral mucosa leukoplakia erythema and other precancerous lesions for a long time conservative treatment, a considerable number of patients with oral precancerous lesions after conservative treatment inevitably progress to oral cancer, for oral mucosa precancerous lesions I have a positive attitude, early surgical excision can be considered, with the exception of individual lesions with a large scope of postoperative function.
7. Age factor: the younger the patient is, the worse the treatment effect of oral cancer, and the treatment effect of patients over 70 years old is relatively better, probably the tumor growth and metabolism will slow down with age; 8. lack of knowledge of oral cancer diagnosis in primary hospitals causes failure of early treatment, if oral cancer patients can be seen when the tumor grows less than 2 cm, the treatment effect will be very good, which requires primary hospitals to A simple way to judge is that if an ulcer does not heal in 2 weeks but has a tendency to expand, please go to a regular specialized hospital for treatment in time, of course, it is possible to find me.
Treatment of oral cancer
The treatment of oral cancer is more complicated, and I suggest that it is better to go to a provincial specialized hospital for the following reasons.
1. Oral cancer requires comprehensive treatment, preoperative neoadjuvant chemotherapy (targeted therapy) + radical surgery + postoperative supplemental radiotherapy is often missing, even so, the treatment effect is sometimes unsatisfactory.
2.Oral cancer surgery requires high requirements, often requiring cervical lymphatic dissection + enlarged resection of primary foci + partial resection of jaw bone, which requires high surgical skills, and repair of defects often requires flap repair to maintain function, which involves microsurgical vascular anastomosis and is difficult to be achieved by general primary hospitals.
3.Postoperative radiotherapy requires not only precise treatment effect but also minimizing complications such as radiation reaction, which requires world-class radiotherapy machines and is difficult to be achieved by primary hospitals.
To sum up, I personally suggest that oral cancer patients should go to higher-level specialized hospitals for consultation. The above views cannot be used as the basis for patients to diagnose and treat the disease on their own, and if they have relevant needs, they should go to regular hospitals. A word of advice: it is not terrible to have a tumor, what is terrible is to lose the best treatment opportunity.