Oral cancer is one of the more common malignant tumors of the head and neck, which is a general term for malignant tumors occurring in the oral cavity, most of which belong to squamous epithelial cell carcinoma, the so-called mucosal variant, accounting for about 80% of oral cancer. Secondly, there are adenogenic carcinomas. In clinical practice, depending on the site of occurrence, oral cancer includes tongue cancer, lip cancer, buccal mucosa cancer, gum cancer, floor of mouth cancer, hard and soft palate cancer, central jaw cancer, oropharyngeal cancer, salivary adenocarcinoma, malignant lymphoma, malignant melanoma and maxillary sinus cancer, as well as cancers occurring in the skin and mucosa of face and face.
Etiology.
1.Endogenous factors: genetic factors mainly affect the susceptibility of the body, neuropsychiatric factors affect the resistance of the body, immune status of the body, gene mutation
2, exogenous factors.
a, bad diet, such as cooking process due to gas combustion produced nitrosamines, barbecue produced polycyclic hydrocarbons, sugar heat generated by glyoxal and furan.
b. Long-term addiction to tobacco and alcohol, which contain strong carcinogens such as benzopyrene, N C nitrosoquatidine, etc. Chewing tobacco is more harmful than smoking in causing oral cancer, and the likelihood of oral cancer increases 30 times for both smokers and alcoholics.
c, poor oral hygiene, long-term stimulation by foreign bodies, residual crowns, over-sharp tooth tips and bad restorations, as well as long-term sun exposure and exposure to radiation.
d. Bad habits in individual regions, such as the preference for betel nut in some regions, is one of the reasons for the high incidence of oral cancer.
e, malnutrition Vitamin A deficiency can cause thickening and hyperkeratosis of oral mucosa epithelium and is related to the occurrence of oral cancer. Zinc is an indispensable element for animal tissue growth, and zinc deficiency may lead to mucosal epithelial damage, which creates favorable conditions for the occurrence of oral cancer. In addition, insufficient intake of total protein and animal protein may be related to oral cancer.
Clinical manifestations
1.The presence of lumps and nodules.
2.The presence of white, smooth, squamous plaque-like appearance.
3.Persons with symptoms such as red plaques, ulcers, inflammatory areas and cannot be cured for a longer period of time
4, recurrent bleeding in the mouth without obvious cause.
5, numbness, burning or dryness in the oral cavity with no apparent cause.
6.Difficulty or abnormality when speaking or swallowing.
［Lip cancer]
Prevalent in men, most patients are over 40 years old, and it is easy to occur in outdoor workers.
It can occur in both upper and lower lip, most commonly in the lower lip, and most commonly in the outer 1/3 of the red lip. The growth is slow and the lesion is superficial in the early stage, but it can be accompanied by proliferation and ulceration as the disease progresses, and can be complicated by infection. There are often blood crusts and inflammatory exudates on the surface of the tumor, and the whole lip and the surrounding tissues can be accumulated in the advanced stage.
［Tongue cancer]
There are slightly more males than females, and the age of the disease tends to be younger in recent years. The most frequently affected area is the middle third of the lateral margin of the tongue, followed by the ventral and dorsal parts of the tongue, and less frequently the tip of the tongue.
It can be presented as ulcerative, exophytic and infiltrative types. The exophytic and ulcerative types are easily detected; the ulcerative type presents as a crater-like ulcer with elevated margins; the exophytic type presents as cauliflower-like, often combined with infection and necrosis. Infiltrating type may not have obvious changes on the surface and is not easily detected at an early stage, and may be asymptomatic or only mildly painful. In advanced stage, tongue cancer may involve the floor of mouth, mandible, tongue root and tonsils, etc. The above symptoms are more obvious.
［Gum cancer]
Most commonly seen in 40-60 years old, more males than females, preferably in the premolar and molar areas, and more common in mandibular gingiva than maxillary gingiva.
Most of them are ulcerated and exophytic. If the lower alveolar nerve canal is involved, numbness of the lower lip may appear, and if the posterior molar area and pharynx are involved, mouth opening may be limited.
[Fundus carcinoma]
Mostly occurs on both sides of the tongue ligament, early manifestation is small hard nodules or erythema, and later develops into ulcers. The lesion can easily invade into the contralateral floor of the mouth, gingiva and mandibular bone plate, resulting in destruction of mandibular bone, loosening of mandibular teeth and restriction of tongue movement, with symptoms such as pain, salivation and difficulty in eating.
[Buccal mucosa cancer]
It is mostly of ulcerative type with infiltration in and around the base.
There is no obvious symptom in the early stage, but there may be mild to moderate pain when the lesion continues to develop or secondary infection occurs. When the buccal muscle and masticatory muscle are invaded, mouth opening may be restricted and gradually aggravated. In advanced stage, the cancer may penetrate the skin of the buccal area and form sinus tracts; invasion of upper and lower gums and jaw bone may cause toothache, tooth loosening and jaw bone destruction.
［Palate cancer]
Most of the squamous carcinomas of hard palate develop slowly and the main manifestation is painful ulcers. Palate cancer often invades the bone of palate, causing palate perforation, and upward development can invade the nasal cavity and maxillary sinus; upward development can cause tooth loosening.
［Oropharyngeal cancer]
Oropharyngeal cancer refers to cancerous lesions occurring in the root of tongue, linguopharyngeal-palatal arch, tonsils, soft palate and posterior pharyngeal wall.
Tonsil cancer: early lesions are red, white or red-white changes. In the early stage of the lesion, there is often no obvious symptom, or only mild sore throat and swallowing discomfort, which is aggravated when eating, and the pain is obvious after the development of ulcers, which may spread to the ear-temporal area, and the tumor growth may spread to the palate, posterior molar area, gums and tongue. In late stage, the tumor may involve the inner pterygoid muscle and cause difficulty in opening mouth, and involve the tongue body and cause limitation of tongue movement.
Tongue root cancer: Early symptoms are foreign body sensation or painful swallowing at the root of the tongue, and with the development of the lesion, dysphagia, slurred speech and auriculotemporal pain may appear. In the late stage, the above symptoms are aggravated and manifested as tongue fixation, salivation, bad breath and other symptoms.
Soft palate cancer: early symptoms are mild sore throat, which is aggravated when eating. In the middle and late stages, the patient has difficulty swallowing with slurred speech. Soft palate fixation or destruction of perforation can cause food reflux to the nasal cavity, and tumor spread to surrounding tissues causing symptoms such as restricted mouth opening, temporal pain and tinnitus.
［Facial skin cancer]
Initially, it appears as dark gray pigmentation with dilated capillaries around it. Further growth of the tumor indicates that vesicles and crusts may occur, and then develop into ulcers with raised and turned-out edges in the shape of cauliflower, indicating that necrotic tissues are often overlaid with bleeding, and the base and surrounding area are obvious, often invading deeper and adjacent tissues.
[Maxillary sinus cancer].
In the early stage, when the tumor grows in the sinus and has not yet destroyed the basal layer of mucosa, there are often no obvious conscious symptoms. As the tumor develops and invades different walls, different symptoms appear. If the tumor occurs in the lower wall, there are often numbness of gums, tooth pain, loosening of teeth and swelling of gingival-cheek sulcus, and if the tumor is mistakenly extracted, abnormal secretion can be seen in the alveolar fossa or tumor protrusion, and the extraction wound does not heal. If it occurs in the inner wall, there may be nasal congestion, abnormal discharge, nasal bleeding and tearing due to obstruction of nasolacrimal duct; if it occurs in the upper wall, there may be bleeding with protrusion and upward displacement of the eyeball, restriction of eye movement, etc., and numbness in the infraorbital area; if it occurs in the posterior wall of maxillary sinus, there may be bleeding with restricted opening, opening to the affected side, and tinnitus and deafness.
In clinical diagnosis and treatment of maxillary sinus cancer, not one wall is invaded and has corresponding symptoms and signs, but mostly one wall is mainly or more than one wall is invaded.
Treatment
Early oral cancer without lymphatic metastasis in the neck can be effectively treated by surgery or radiation alone.
1.Surgical treatment
Surgical resection and radiotherapy are still the two most effective methods to treat oral cancer. Chemotherapy is still an adjuvant treatment, which is used before or after surgery in combination with radiotherapy. To choose the treatment method, a multidisciplinary consultation should be adopted to decide the treatment plan based on an objective assessment of the patient’s condition. The success or failure of oral cancer treatment is largely determined by whether the first treatment is correct.
Surgery can be used if the following conditions are met: primary foci and metastatic lymph nodes can be radically treated; malignant tumors that are not sensitive to radiotherapy and chemotherapy; tissue defects can be repaired after resection of advanced tumors; surgical removal of large hypoxic or ischemic necrotic lesions can create conditions for radiotherapy or chemotherapy; radical surgery cannot be performed, but palliative surgery is feasible due to certain complications, such as respiratory distress caused by tumors; radical Some lesions remaining after radiotherapy.
For those who have metastasis in lymph nodes or are estimated to have large metastasis according to the characteristics of the primary lesion, cervical lymphatic dissection should be performed to remove the lymph nodes in the neck where cancer cells may metastasize. The specific scope of cervical lymphatic dissection should be decided according to the size of the tumor and the metastatic characteristics of different parts of the tumor.
2.Radiotherapy
Radiation therapy plays an important role in the treatment of oral cancer, whether used alone or in combination with surgery. For early stage lesions, external irradiation can maintain cosmetic, normal chewing, swallowing and pronunciation functions and improve patients’ survival quality. For intermediate and advanced lesions, especially when cervical lymph node metastasis is present, the efficacy of radiotherapy alone is poor. The ideal treatment plan should be formulated by radiologists and surgeons in cooperation with each other according to the anatomical location of the lesion, the extent of infiltration, the degree of cervical lymph node metastasis and the patient’s general condition.
3.Chemical drug treatment
The main treatment means of oral cancer are still surgery and radiotherapy, but chemotherapy can play an auxiliary role. The trend of oral cancer chemotherapy is to consider adjuvant chemotherapy before and after surgery or radiotherapy as one of the important means of comprehensive treatment. The type of chemotherapy administration has changed from single drug to combined drug; the mode of administration has changed from the original palliative chemotherapy to induction chemotherapy before surgery or radiotherapy, sensitization before radiotherapy, adjuvant chemotherapy after surgery or radiotherapy, etc.; the routes of administration have adopted intravenous injection, oral administration, intramuscular injection, pushing or continuous infusion of temporal artery or other branches of external carotid artery, intravenous infusion of hemiplegia, intra-tumor administration, external application and The newly developed targeted therapy using microspheres as a carrier, dissolving chemotherapeutic drugs into microspheres and embolizing the tumor blood supply artery, etc.
It must be clear that the current chemotherapeutic drugs are moderately sensitive to most oral cancers and their efficacy is not yet satisfactory. Combining local treatment with chemotherapy is the basic principle of applying chemotherapy, except for those with advanced cancer or recurrence and metastasis after local treatment.
Prevention
1.Through various media, learn some knowledge about cancer prevention, understand the danger of cancer tumor, raise the vigilance of cancer tumor, and promptly diagnose and treat the early suspicious lesions.
2.Removing the cause of the disease is the best prevention method. Promptly deal with the residual roots, residual crowns and misaligned teeth, grind down sharp tooth tips, remove bad restorations and bad partial full dentures to avoid repeatedly damaging the mucosa and inducing cancerous tumors.
3.Pay attention to oral hygiene, do not eat excessively hot food and stimulating food, advocate quitting smoking and alcohol, and pay attention to protective measures for outdoor exposure to the sun; avoid mental tension.
4.For precancerous lesions occurring in the oral cavity, such as white spots and red spots should be promptly consulted and surgically removed if necessary, so as to contact cancerous damage at an early stage.