Tongue and-Buccal Mucosa Cancer

 

Oral cancer accounts for most head and neck cancers. About 90% of oral cancers are squamous cell carcinomas, where cancer occurs in the thin, flat cells lining the oral cavity.

Tongue and buccal mucosa are parts of the oral cavity. The buccal mucosa is the lining of the back of the lips, cheeks and the part where they touch the teeth. The buccal area plays an important role in bolus formation and preventing food from spilling. Cancer can occur when the cells form lesions in the buccal cavity or tongue.

About tongue and buccal mucosa cancer

Tongue and buccal mucosa cancer occur when the cells that make up these parts grow out of control and form tumors or lesions. The cancer usually occurs in the squamous cells lining the buccal mucosa and tongue.

Tongue cancer can originate in the forward portion of the tongue (squamous cell cancer of the oral tongue) or at the rear part of the tongue (squamous cell cancer at the base of the tongue or oro-pharyngeal cancer). The characteristics of these two types of cancers are distinct.

In comparison to other types of cancers, oral cancers occur rarely; they contribute to only three percent of all cancers.

Causes/ Risk factors

The exact cause of tongue and buccal mucosa cancer is not known. However, there are several factors that can increase the risk of this cancer. Some of these factors include:

  • Inadequate oral hygiene
  • Thickened white patches on the mucous membrane
  • Common among men
  • More likely to occur at 50 - 80 years of age
  • Alcoholism
  • Tobacco smoking
  • Cirrhosis of the liver
  • Syphilis

Signs and symptoms

Usually, a pinkish-red sore at the side of the tongue that does not heal overtime is the first sign of squamous cell cancer of the oral tongue. In most cases, this sore may bleed if touched or bitten.

Other symptoms of tongue cancer include:

  • White, red or dark patches on the tongue
  • A sore throat that persists for a prolonged period
  • A lump or an ulcer on the tongue that does not go away
  • Pain when swallowing
  • Numbness in the mouth
  • Bleeding from the tongue

In case of buccal mucosal cancer, no symptoms appear in the early stages. The following are the symptoms that occur in later stages:

  • Red or white lump in the mouth that persists after two weeks
  • A raised red patch in the mouth that bleeds easily
  • Soreness in the throat or a feeling that something is caught
  • A lump in the mouth
  • Increased pain when eating or drinking
  • Numbness in tongue or other areas of the mouth
  • Difficulty chewing or swallowing
  • Hoarseness
  • Difficulty moving the jaw or tongue
  • Severe ear pain
  • Loose teeth or pain around teeth
  • Swelling in the jaw that causes poor fitting of the dentures

Diagnosis

The tests and procedures given below are used to detect and diagnose tongue and buccal mucosa cancer:

Physical exam: Inside the mouth and back of the throat is examined by the doctor to check the location and size of the tumor. The nose, ears and neck may also be examined to know if the tumor has spread to the nearby tissues and organs.

Fine needle aspiration biopsy: For this procedure, a thin needle is placed in the mouth and the cells are suctioned. These cells are examined under a microscope to check if the lump is cancerous.

Computerized tomography (CT) scan: An X-ray machine is connected to a computer which creates a series of images of areas inside the mouth and neck. Sometimes, a pill may be given, or a dye may be injected to highlight the tissue on the X-ray.

Magnetic resonance imaging (MRI): In this procedure, a large magnet, radio waves and a computer are used to produce detailed pictures of the inside of the mouth and neck.

Positron emission tomography (PET) scan: During the scan, a small amount of radioactive substance is injected into a vein, which is absorbed more by the cancer cells than the normal cells. The scanner generates images of the areas inside the mouth and neck.

Stages of tongue and buccal mucosa cancer:

The following are the basic stages of tongue and buccal mucosa cancer:

Stage 0: Anormal cells in the lining of buccal cavity and tongue.

Stage I: Tumor not > 2cm and has not spread to the lymph nodes.

Stage II: Tumor is >2 cm but <4 cm and has not spread to the lymph nodes.

Stage III: Cancer is >4 cm or has spread to the lymph node in the neck.

Stage IV: Tumour can be of any size and has spread to nearby tissues, such as the jaw and other parts, one or multiple lymph nodes, or distant organs of the body, such as the lungs.

Treatment

The aim of the treatment is to cure the cancer, retain the function and appearance of the mouth, and prevent the cancer from recurring.

Tongue and buccal mucosa cancer can be treated successfully if diagnosed early. The treatment involves either a surgery, radiation or chemotherapy. The treatment method depends on the stage of the cancer and the extent of spread of the cancer. A combination of treatments may be used for advanced cancers.

Surgery

The small tumors are removed from the buccal mucosa by using a scalpel. The incision size depends on the size of the tumor. If the tumor is small, incision through the cheek will not be needed.

To remove the tumors of the tongue, glossectomy is performed. This technique involves removing a part (partial glossectomy) or entire (complete glossectomy) tongue based on the size of the tumor.

In case the lymph nodes are also affects, they will also be removed during the surgery.

Reconstruction surgery may be performed to restore the part of the tongue or the cheek that is removed. A flap of skin and/or tissues underlying the skin may be taken for reconstruction.

Before and after the surgery, the patient may have to consult a speech and swallowing expert to design a customised rehabilitation program to maintain the functions as much as possible.

Chemotherapy

Chemotherapy involves administering certain drugs which circulate in the blood and interrupt the growth of cancer cells. These medicines are either given orally or intravenously over a period of time.

Chemotherapy can be recommended to reduce the growth of tumor. It can be combined with surgery to control growth and symptoms, and after surgery to decrease the chance of cancer recurrence.

Radiation Therapy

Radiation therapy involves delivering high-energy beams to the tumor, which damage the DNA and destroy the cancer cells. The dose, time and frequency of radiation therapy is customized according to each case. This method delivers radiation precisely to the tumor while protecting the healthy cells in the mouth.

Prognosis

Generally, the outlook for tongue and buccal mucosa cancer depends on the stage and location of the tumor. The survival rate is high when the tumor is diagnosed at an early stage. However, other factors also affect the survival rate, which include, age of the patient, tobacco usage, overall health, and the presence of human papillomavirus infection. The best prognostic factor for intraoral cancers and lip carcinomas is tumor staging.

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