CLOSE

Oral Cavity Cancer

Oral cavity cancers include a set of malignancies, mainly carcinomas that originate from the mucous membranes (95%), but also tumours of salivary origin, connective tissue or melanomas (5%) that originate at the level of the lip, tongue, floor of the mouth, cheeks, gums, palate (hard and soft) and the anterior tonsil pillars (mouth opening).

Select your topic of interest

IN SHORT

Oral cavity cancer, or just oral cancer, is cancer that starts in the mouth (also called the oral cavity).

RISKS OF ORAL CAVITY CANCER

Oral cavity cancer risk factors are related to lifestyle habits, especially the abuse of tobacco and alcohol. Also a poor diet and poorly-conditioned teeth seem to act as co-factors. The role of viruses (HPV Papillomavirus) is currently under investigation. Cancers of the oral cavity are manifested primarily by a lesion of the mucous membrane. This initially superficial lesion appears like a milky white or red spot as well as a small ulceration that does not usually spontaneously heal, and sometimes bleeds on rubbing.  

The most important characteristic differentiating this lesion from other inflammatory and traumatic lesions (for example ulcer or biting injury) is that it is completely asymptomatic, at least initially. In more advanced stages it may appear as an ulceration, submucosal nodule, more or less hard, florid, cauliflower-like vegetating lesion. In some cases, a pain may occur that radiates to the ear, with difficulty swallowing, bad smell of the mouth, whereas in others, there may be a swelling of the neck.

 

PREVENTION AND DIAGNOSIS

Diagnosis of oral cavity cancer is easy, given the accessibility of the mouth. Histological diagnosis can be made by a simple biopsy under local anaesthesia, a procedure with minimal pain that can be performed in a few minutes. An early diagnosis of vocal cord cancers can be made using a fibro-laryngeal endoscopy with NBI and iSCAN. These very sophisticated instruments allow us to diagnose lesions at the onset stage or when they are very small and hardly recognisable with traditional standard methods. Ultrasound, magnetic resonance and PET (or even a total body CT) allow correct staging. There are no blood tests that can detect the presence of a cancer of the oral cavity.

Good standards for prevention

  • Adopting a healthy lifestyle, not smoking and limiting alcohol intake.
  • Adopting a few precautions in eating habits: eating fruit, vegetables, and foods rich in carotenoids, such as tomatoes, carrots, sweet and spicy peppers, pumpkin, apricots, herbs (probable evidence).
  • Keeping a careful eye on oral hygiene.
  • Not underestimating any injury of the mouth although small or painless (nodules, small ulcers, white or red patches, growths).
  • After the age of 60 in subjects with risk factors, examination of the oral cavity and pharyngeal-laryngeal district is recommended.
  • Undergoing regular visits, if already affected in the past by a carcinoma of the head and neck district.

The most common symptoms and signs are small ulcers of the lip or mouth, a white or red spot in the oral mucosa, frequent epistaxis (nosebleeds), nasal respiratory obstruction, hoarseness, persistent sore throat, feeling of closed ears, pain radiating to the ear, blood in sputum, difficulty chewing, swallowing or breathing, numbness of the tongue, painless and persistent swelling in the neck. The durability of these disorders should be considered as an alarm bell; if they have not resolved spontaneously or with treatment within 3 weeks, a specialist should be consulted.


TREATMENTS AND CLINICAL TRIALS

The first approach to treatment is essential. Cure is the main goal, and is considered as important as the quality of life and functionality of the treated organs, such as the voice, language, swallowing, taste and breathing. IEO provides patients with a multidisciplinary team dedicated to diagnosis, treatment and rehabilitation.

THE VALUE OF A MULTIDISCIPLINARY TEAM

Our multidisciplinary team is dedicated to the diagnosis, treatment and rehabilitation of patients with tumors of the head and neck, and to the study of these diseases. Our team includes over thirty oncology professionals with expertise in various specialties, such as ENT, maxillofacial surgery, emergency surgery, plastic-reconstructive surgery, radiotherapy, medical oncology, radiology, pathology, nuclear medicine, nutrition, physiotherapy, endocrinology, dentistry, voice therapy, speech therapy, psychology, and biology.

The integration of various skills can address complex clinical problems, from diagnosis and treatment planning, to the functional recovery (speech, breathing, swallowing) in order to achieve the best results with cancer and adequate quality of life. The team works in harmony and meets on a weekly basis to discuss cases of patients who trust in our structure. They develop comprehensive personalized care plans considering all aspects of treatment and rehabilitation, considering the different treatment options, taking into account the needs of individual patients in accordance with internal, national and international guidelines.

The team, in close collaboration with the Scientific and Health Management Board, monitors the results of treatment and the quality of the performances in real time in order to point out critical issues and identify areas for improvement and development. The multidisciplinary meetings are an opportunity for professional development based on the exchanges in the group, the evidence in the literature, and the critical review and update of guidelines as well as diagnostic and therapeutic approaches. The information obtained from the critical review of the clinical activities, from technological innovations, from the study of the evolution of the cancers treated, and from continuous updating are used to identify open issues and propose research activities. Thanks to this approach, clinical research activities and institutional research projects in collaboration with national and international institutions have been put in place.

Oral cavity cancers

 

Therapy is primarily surgery. The earlier the diagnosis, the lighter the surgery will be and the milder the consequences on functionality. In more advanced cases, larger removals are necessary, followed by sophisticated reconstructions through autografts, and rehabilitations of variable duration after surgery. Radiotherapy and chemotherapy are only used as complementary to surgery in selected cases, or as curative therapies in cases where surgery cannot be performed or when it is refused by the patient. 

At IEO, a new method has been developed for the surgical removal of the oral cavity and oropharynx tumours, called compartmental surgery, which allows an significant improvement in prognosis in over 400 cases of advanced tongue cancer treated.

Distant metastases of head and neck carcinoma

Distant metastases are defined as tumor spread to other organs. Lung, liver, and bone are the most common sites for hematogenous metastases of head and neck squamous cell carcinoma. The incidence of distant metastasis in head and neck squamous cell carcinoma is low for the general head and neck squamous cell carcinoma population: generally below 5% at presentation. Head and neck squamous cell carcinoma patients with distant metastases are generally candidates for palliative treatment scenarios only, because currently no systemic therapy has curative potential in head and neck squamous cell carcinoma patients with distant disease. Consequently, extensive locoregional treatment is usually considered futile in these patients. Particular attention is paid to our collaboration with CNAO, National Centre of Oncology Hadrontherapy) for Phase II, the clinical trial on radiotherapy boost, using protons (hadron therapy) for locally advanced tumours of the cervical-cephalic region.

 

USEFUL LINKS

  • International Office

    The IEO International Office is fully dedicated to providing a tailored welcome and a comfortable hospital stay, by meeting all individual needs.

  • Request the IEO Second Opinion

    IEO Second Opinion is a service for who would like to confirm the diagnosis and treatments recommended by other physicians.

  • Contact Us

    An assistant from the IEO International Office will be glad to give you all information needed and personally assist you.

PARTNERSHIP

Università degli Studi di Milano Ecancer Medical Science IFOM-IEO Campus

CREDITS

Ministero della Salute Joint Commission International Breastcertification bollinirosa

© 2013 Istituto Europeo di Oncologia - via Ripamonti 435 Milano - P.I. 08691440153

IRCCS - ISTITUTO DI RICOVERO E CURA A CARATTERE SCIENTIFICO

facebook IEO googleplus IEO twitter IEO pinterest IEO vimeo IEO