Oral Cancer

Introduction to oral cancer Oral cancer refers to malignant tumors that occur in the mouth, including lip cancer, gingival cancer, tongue cancer, soft and hard cancer, jaw cancer, oral cancer, oropharyngeal cancer, parotid and maxillary sinus cancer, and facial skin. Oral cancer is one of the more common malignant tumors of the head and neck. Oral cancer is more common in men. Among the cases of oral cancer, cancer of the tongue is the most common, followed by buccal mucosal cancer. Oral leukoplakia and proliferative erythema are often a precancerous lesion. Silveman et al reported 257 cases of oral leukoplakia with an average follow-up of 7.2 years, and 45 cases were confirmed by squamous cell carcinoma (17.5%) by biopsy. 6% high, so regardless of the length of the oral leukoplakia and its benign performance, long-term follow-up is needed for early detection of cancer. According to the 1980 National Census of the Oral Mucosal Prevention and Treatment Research Group, the prevalence of Chinese leukoplakia is 10.47%. Although leukoplakia is rarely less than 3% to 5%, the tongue is a good site for leukoplakia. The plaque cancerous tongue cancer can account for 1.6% to 23% in tongue cancer. Silverman et al also pointed out that precancerous mucosa In addition to leukoplakia, proliferative erythema is more dangerous, and its malignant transformation is four times that of patients with leukoplakia. Some authors believe that erythema is actually an early cancer, and its red color is the result of tumor angiogenesis and the body's immune response to tumors. Kramer et al reported The patients with leukoplakia at the tongue and mouth have an average of 1.5% with cancer, and the red-white plaque is 5 times higher than that of leukoplakia. The biopsy for red-white lesions should be taken from the erythema area as much as possible. The positive rate in this area is higher. basic knowledge The proportion of illness: 0.1% - 0.2% Susceptible people: more common in men Mode of infection: non-infectious Complications: cancer pain, malnutrition

Causes of oral cancer

Long-term hobby of tobacco and alcohol (25%):

Most patients with oral cancer have long-term smoking, drinking history, and non-smoking and non-drinking oral cancer is rare. India's Trivandrum Cancer Center treated 234 cases of buccal mucosa in 1982, 98% of which had chewing tobacco and tobacco history, some in the world. In some areas, such as Sri Lanka, India, Myanmar, Malaysia and other places, there are habits of chewing betel nuts or "nas".

Chewing betel nut and other mixture can cause the increase of oral basal cell division activity in oral mucosa, which increases the incidence of oral cancer. The US Keller data show that the incidence of oral cancer in non-drinking alcohol or non-smokers is 2.43 times that of neither smoking nor drinking. 2.33 times, and the incidence of smoke and alcohol addiction is 15.5 times that of non-smokers and non-drinkers. The wine itself has not proved to be carcinogenic, but it has a cancer-promoting effect. Alcohol may act as a solvent for carcinogens and promote carcinogens. Enter the oral mucosa.

Poor oral hygiene (30%):

Poor oral hygiene habits, creating conditions for bacteria or molds to grow in the mouth and breeding, which is conducive to the formation of nitrosamines and their precursors, combined with stomatitis, some cells are in a proliferative state, more sensitive to carcinogens, so various Causes may promote oral cancer.

Malnutrition (20%):

Some people think that it is related to the lack of vitamin A, because vitamin A has the function of maintaining normal structure and function of epithelium. Vitamin A deficiency can cause thickening of oral mucosa epithelium, which is related to the occurrence of oral cancer. Demographic studies show that intake The incidence of oral cancer is high in countries with low vitamin A. There is no evidence of vitamin C deficiency related to oral cancer. It is also thought to be related to insufficient intake of trace elements. For example, low iron content in food, insufficient intake of total protein and animal protein may be Related to oral cancer, zinc is an indispensable element in the growth of animal tissues. Zinc deficiency may cause mucosal epithelial damage and create favorable conditions for the development of oral cancer.

Oral cancer is a kind of chronic pathological process. Before it enters a typical or obvious cancer lesion, it needs to go through several years or even a decade of precancerous lesions of the oral mucosa. It is more common in the superficial part of the oral cavity. Doctors and patients have directly checked and found that it is convenient for early diagnosis and timely prevention. At present, the oral medical community believes that oral leukoplakia, oral mucosa erythema, lichen planus and submucosal fibrosis should be regarded as oral precancerous lesions, including oral leukoplakia. The prevalence of the disease is the highest and the possibility of cancer is also greater.

(1) Long-term stimulation of foreign bodies

Tooth roots or sharp cusps, inappropriate dentures stimulate the oral mucosa for a long time, causing chronic ulcers and even cancer.

(2) leukoplakia and erythema

Oral leukoplakia and proliferative erythema are often a precancerous lesion. Silveman et al reported 257 cases of oral leukoplakia with an average follow-up of 7.2 years, and 45 cases were confirmed by squamous cell carcinoma (17.5%) by biopsy. 6% high, so regardless of the length of the oral leukoplakia and its benign performance, long-term follow-up is needed for early detection of cancer. According to the 1980 National Census of the Oral Mucosal Prevention and Treatment Research Group, the prevalence of Chinese leukoplakia is 10.47%. Although leukoplakia is rarely less than 3% to 5%, the tongue is a good site for leukoplakia. The plaque cancerous tongue cancer can account for 1.6% to 23% in tongue cancer. Silverman et al also pointed out that precancerous mucosa In addition to leukoplakia, proliferative erythema is more dangerous, and its malignant transformation is four times that of patients with leukoplakia. Some authors believe that erythema is actually an early cancer, and its red color is the result of tumor angiogenesis and the body's immune response to tumors. Kramer et al reported The patients with leukoplakia at the tongue and mouth have an average of 1.5% with cancer, and the red-white plaque is 5 times higher than that of leukoplakia. The biopsy for red-white lesions should be taken from the erythema area as much as possible. The positive rate in this area is higher.

(3) Ultraviolet and ionizing radiation

Engaged in outdoor workers, long-term exposure to direct sunlight, the incidence of lip cancer and skin cancer are high, ionizing radiation can cause changes in genetic material DNA, activate tumor genes and cause cancer, whether it is r-line or X The line has carcinogenic effects. In Guangdong Province, due to the wide application of radiotherapy for nasopharyngeal carcinoma, the risk of second primary cancer in any part of the oral cavity in the radiation area has increased.

(4) Other

Such as vitamin A1 and B2 and trace element drinking, zinc and arsenic deficiency will increase the body's sensitivity to carcinogens. In addition, chronic hepatitis, cirrhosis and viral infections cause diseases with low immunity and oral cancer. There is a certain relationship between the occurrence.

Oral cancer prevention

Pay attention to diet, avoid spicy foods such as peppers, peppers, peppers, and ginger.

Oral cancer complications Complications, cancer pain, malnutrition

In oral cancer, tongue cancer and gingival cancer complained of more pain in the early stage. If the pain site does not match the site of the ulcer of the oral cavity, it is necessary to consider the possibility that the tumor will spread to other sites.

A small number of oral cancers can be invaded along the nerves, among which hard parotid cystic carcinoma is the most prominent. Although the hard mass is not large, but there are symptoms of maxillary nerve invasion such as upper lip numbness, if CT examination shows that the pterygopalatine enlarges, the fat disappears, and sometimes the round hole enlarges and the root of the wing is destroyed. If the cancer is antegrade along the branches of the trigeminal nerve, the infraorbital neural tube enlargement and the apical tumor can be seen.

Oral cancer symptoms Common symptoms Toothache, mouth, difficulty, tongue movement limitation, tongue pain, gums, sore throat, lymph nodes, nasal congestion, eating foods... Oral ulcers

(1) Pain: Early oral squamous cell carcinoma is generally painless or has only paresthesia or mild tenderness. It is associated with obvious pain when it is accompanied by a lump ulcer, but the pain is not as severe as inflammation, so when the patient complains of pain, especially gums When pain or tongue pain, you should carefully check whether there is induration, mass and ulcer in the pain. If pain or tongue pain, you should carefully check whether there is induration, mass and ulcer in the pain, and there are some signs of pain in the pain. It should be highly suspected that there is cancer.

In oral cancer, tongue cancer and gingival cancer complained of more pain in the early stage. If the pain site does not match the location of the oral mass ulcer, it is necessary to consider the possibility that the tumor may spread to other parts. The toothache may be caused by gum cancer or by the buccal mucosa. Cancer, hard sputum cancer, oral cancer or tongue cancer spread invaded by gums or tongue nerves, earache, sore throat can be a symptom of oropharyngeal cancer, or it can be tongue cancer invading the base of tongue or cheek, hard palate, gums, or side Bottom cancer is caused by posterior invasion of the pharyngeal wall.

(2) Plaque: Oral squamous cell carcinoma can be a superficially infiltrating plaque when it is superficial, and it is difficult to distinguish it from leukoplakia or proliferative erythema without biopsy.

(3) Ulcer: Oral squamous cell carcinoma often develops ulcers. The typical appearance is hard, the edge is irregular, the base is uneven and infiltrated, and the ulcer surface affects the entire tumor area.

(4) Lump: Oral squamous cell carcinoma originates from the oral mucosa epithelium, and its mass is proliferated by the squamous epithelium. Whether it forms an ulcer into the oral cavity or infiltrates into the deep, the mass formed is shallow, and its mucosa Cancer tissue lesions are always seen. In addition, oral cancer is often transferred to the nearby cervical lymph nodes. Sometimes the primary tumor is small, and the symptoms are still not obvious. The cervical lymph nodes have metastasized and become larger, so the neck suddenly appears. The lymph nodes are enlarged and the oral cavity should be carefully examined.

Oral cancer examination

1, image diagnosis

In addition to providing information on tongue thyroid and oral cancer bone metastasis, radionuclide examination is rarely used in the diagnosis of oral cancer itself. Ultrasonography is also rarely used in oral cancer. X-ray film and tomography are used in oral cancer invasion. The mandibular and nasal paranasal sinus can provide more valuable information, but the location information of oral cancer, the scope of tumor invasion, especially the soft tissue surrounding the primary tumor can not meet the needs of clinicians for diagnosis and treatment planning. CT has made up for the above requirements to a considerable extent, but CT should not be used as a routine inspection method, and should be selectively applied on the basis of detailed medical history, physical examination and other inspection materials.

The fiber septum of the tongue presents a low-density plane on the CT, dividing the tongue into two halves. Its displacement or disappearance may indicate that the tongue tumor is benign or malignant, and its disappearance is accompanied by deformation of the contralateral lingual muscle. If it disappears, it indicates that the tongue cancer has invaded the contralateral side, and the surgeon should consider a full tongue resection.

The intralingual muscle is located in the center, which is spherical, without fascia separation, and the muscle cord is in an irregular direction. Therefore, the density is uneven in CT. The extralingual muscle surrounds both sides and the bottom surface of the internal muscle of the tongue, and the muscle cord is in the same direction. Arrangement, on the CT axial position of the hyoid bone, the genioglossus muscle is close to the fat septum on both sides of the tongue septum, which is arranged in a strip from the mandibular condyle nodules, ending in the internal lingual muscle; Muscle and stem lingual muscles are arched around the posterior lingual muscles. Patients with tongue or mouth cancer can have axoscopic CT examination of the lingual body to the hard palate when the tongue movement is restricted. The clinical judgment of tongue cancer invading the extralingual muscle can be further confirmed by muscle deformation or disappearance.

Patients with oral cancer, especially those with lesions located in the back of the mouth, have a limited mouth opening, that is, the upper and lower incisors are less than 4 to 5 cm after the mouth opening. The tongue and lower lip numbness should be used for CT examination. CT can clearly show the mandible. , wing inner plate, wing outer plate, pterygoid muscle, pterygoid muscle, diaphragm muscle, chewing muscle and various fascial space formed by them, these structures, especially the deformation of the pterygoid muscle and the wing jaw gap disappear frequently It is the direct evidence that the oral cancer violates the chewing gap and causes difficulty in opening the mouth.

A small number of oral cancers can be invaded along the nerves. Among them, hard adenoid cystic carcinoma is the most prominent. Although the hard lumps are not large, but there are symptoms of maxillary nerve invasion such as upper lip numbness, CT findings can be seen in the pterygopalatine fossa. Enlargement, fat disappears, and sometimes the circular hole enlarges and the root of the wing is destroyed. If the cancer is antegrade along the branches of the trigeminal nerve, the underarm nerve canal can be seen and the tumor of the sacral tip is seen. Therefore, patients with oral cancer have trigeminal The nerves, especially the second maxillary nerve symptoms, should focus on the CT examination of the pterygopalatine and its surroundings. In some cases, the adenoid cystic carcinoma with more sieving structures can show a low sieve shape in CT. Density area.

2, cytology and biopsy

Exfoliative cytology is suitable for asymptomatic precancerous lesions with superficial lesions or early squamous cell carcinoma with unclear range of lesions. It is suitable for screening examination, and then further biopsy for positive and suspicious cases, and for some precancerous lesions. Exfoliative cytology follow-up is easy to accept, but 60% of oral squamous cell carcinoma cells directly break through the basement membrane and infiltrate the surface epithelium, and exfoliative cytology often results in negative results.

For the diagnosis of oral squamous cell carcinoma, the biopsy is usually performed by clamping or cutting. Because the surface mucosa has been ulcerated or abnormal, and the position is superficial, necrosis and keratinized tissue should be avoided, and the tissue should be taken at the junction of the tumor and surrounding normal tissue. The obtained material has both tumor tissue and normal tissue, and the clamping device should be sharp, so as to avoid the deformation of the tissue and affect the pathological diagnosis. If the tissue is deformed under pressure, it should be taken separately, and the submucosal mass of the mucosa can be used. Fine needle aspiration cytology.

Although the above biopsy rarely causes the spread and metastasis of tumor cells, local tumor growth acceleration can still be seen in cases with long-term treatment delay, so the shorter the interval between biopsy and clinical treatment time, the better, biopsy should be The condition is treated in a hospital.

Diagnosis and diagnosis of oral cancer

diagnosis

Once the clinically determined mass is derived from oral cancer, the scope and depth of the invasion should be further judged. Anyone with sore throat, ear pain, nasal congestion, nosebleed, difficulty in opening the mouth, limited movement of the tongue, pain in the trigeminal nerve, numbness, etc. It should be considered that the tumor may have invaded the oropharynx, maxillary sinus, nasal cavity, extralingual muscles, chewing space and mandible, so that the appropriate site of the oral cancer is selected to further infer.

Oral cancer and oral mucosal leukoplakia

Oral squamous cell carcinoma often develops ulcers, which are usually characterized by hard mass, irregular edge bulging, uneven infiltrative mass on the basement, ulcer surface and the entire tumor area, which needs to be differentiated from general oral ulcers:

1 Traumatic ulcer: This ulcer often occurs on the lateral edge of the tongue. There are always fangs, tooth roots or irregular dental restorations corresponding to the ulcer, indicating that the ulcer is caused by the above stimulant, the ulcer is soft and the base is soft. There is no induration, and the ulcer can be self-healed after removing the above irritant for 1 to 2 weeks.

2 tuberculous ulcers: almost all secondary, mostly the result of direct spread of open tuberculosis, often occurs in soft palate, buccal mucosa and tongue back, ulcers are shallower than cancerous ulcers, ulcer base soft and invasive induration, anti-tuberculosis The treatment is effective, and imaging examination and tissue biopsy can be accurately identified and diagnosed.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.