What are the symptoms of oral cancer?

Oral cancer mainly refers to epithelial cancer that occurs in the oral mucosa and is one of the more common malignant tumors of the head and neck. Because of their different locations, they are called tongue cancer, buccal mucosa cancer, gum cancer, floor of mouth cancer, and hard palate cancer. The causes of oral cancer are related to the following factors: (1) Long-term addiction to tobacco and alcohol; (2) Failure to pay attention to oral hygiene, which creates conditions for bacteria or mold to breed and multiply in the oral cavity, which can easily promote the formation and development of cancer; (3) ) Long-term foreign matter irritation to the oral mucosa, such as dentures, chewing irritating foods, etc.; (4) Malnutrition, long-term lack of protein, vitamins and certain trace elements, such as zinc, etc., which over time can lead to mucosal damage and cancer; (5) Leukoplakia and moles on the oral mucosa are precancerous lesions and should be treated promptly.

The symptoms of oral cancer in different parts are roughly similar, with the main manifestations being: (1) Pain. In the early stage, there is usually no pain or only local friction. If ulceration occurs, there will be obvious pain. When the tumor further invades nearby nerves, it can cause ear and throat pain. (2) Plaque. If the oral mucosa becomes rough, thickened or indurated, especially if it occurs on the basis of white spots, stains and moles, cancer should be considered. (3) Ulcer. The wax in the mouth becomes partially hardened, with raised edges, uneven center, and even erosion and bleeding. (4) Swelling of cervical lymph nodes. Oral cancer often metastasizes to nearby cervical lymph nodes first. Sometimes the primary tumor is very small and even the symptoms are not obvious, and the cervical lymph nodes have metastasized and become enlarged. Therefore, if cervical lymph node swelling occurs suddenly, the oral area should also be carefully examined.

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Diagnosis of symptoms and signs of oral cancer

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(1) Pain: Early oral squamous cell carcinoma is generally painless Or there may be only abnormal sensation or slight tenderness, and more obvious pain will occur when accompanied by mass ulcers, but the pain is not as severe as inflammation. Therefore, when a patient complains of pain, especially gum or tongue pain, he or she should carefully check the painful area for nodules, masses or ulcers. If you have pain or sore tongue, you should carefully check the painful area for nodules, masses and ulcers. If the above-mentioned signs are present in the painful area, cancer should be highly suspected there.

Among the oral cancers, tongue cancer and gum cancer are more common in the early stage and complain of pain. If the location of the pain does not match the location of the oral mass and ulcer, you need to consider the possibility of the tumor spreading to other locations. Toothache can be caused by gum cancer, or by cancer of the buccal mucosa, hard palate, floor of the mouth, or tongue cancer that spreads and invades the gums or lingual nerve. Earache and sore throat can be symptoms of oropharyngeal cancer, or they can be caused by cancer of the body of the tongue invading the base of the tongue or cheeks, hard palate, and gums, or cancer of the floor of the mouth posteriorly invading the lateral wall of the pharynx.

(2) Plaque: When oral squamous cell carcinoma is located superficially, it may appear as a superficial infiltrating plaque. At this time, it is difficult to distinguish it from white spots or proliferative erythema without biopsy.

(3) Ulcers: Oral squamous cell carcinoma often develops ulcers, which are typically hard, infiltrated masses with irregular raised edges and uneven bases, and the ulcer surface spreads to the entire tumor area. Sometimes it needs to be distinguished from general ulcers:

① Traumatic ulcers: This ulcer often occurs on the lateral edge of the tongue. There are always canines, tooth roots or irregular dental restorations corresponding to the ulcers. Explain that the ulcer is caused by the above irritants. The ulcer is soft in texture and has a soft base without induration. The ulcer will heal on its own after 1 to 2 weeks of eliminating the above irritants.

② Tuberculous ulcers: Almost all are secondary, mostly the result of the direct spread of open pulmonary tuberculosis. They often occur in the soft palate, buccal mucosa and back of the tongue. The ulcers are shallower than cancerous ulcers and have a soft base. There is no infiltration and induration, and anti-tuberculosis treatment is effective.

(4) Mass: Oral squamous cell carcinoma originates from the oral mucosal epithelium, and the mass is formed by the proliferation of squamous epithelium. Regardless of whether it ruptures into the oral cavity to form ulcers or infiltrates deep into the mouth, the masses formed are superficial, and cancer tissue lesions can always be seen on the mucosa.

Once it is clinically determined that the mass comes from oral cancer, the scope and depth of invasion should be further determined. When accompanied by sore throat, earache, nasal congestion, epistaxis, difficulty opening the mouth, limited tongue movement, and pain, numbness and other sensory abnormalities in the areas innervated by the trigeminal nerve, it should be considered that the tumor may have invaded the oropharynx, maxillary sinus, nasal cavity, The external tongue muscles, masticatory space and mandible can be combined with the location of oral cancer to use appropriate phenomenological examinations to further infer.

Clinical Symptoms, Prevention and Self-examination of Oral Cancer

Li Zheng? Adjunct Chief Physician, Department of Oral and Maxillofacial Surgery, Department of Dentistry, National Taiwan University Hospital

Han Liangjun Department of Dentistry, National Taiwan University Department Professor

Director, Department of Oral and Maxillofacial Surgery, National Taiwan University Hospital

This article was reprinted in the 18th issue of Cancer Prevention Magazine

(1) Introduction

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Oral cancer is a general term for malignant tumors that occur in the oral cavity. It can appear in any part of the oral cavity, including

lips, tongue, floor of mouth, buccal mucosa, alveolar mucosa, gingiva, ? (open mouth), maxillary sinus and jawbone. Histologically, they include squamous cell carcinoma, verrucous carcinoma, sarcoma, malignant melanoma, etc. Among them, squamous cell carcinoma accounts for the vast majority. In addition, some systemic cancers may also metastasize to the oral cavity, including digestive tract cancer, prostate cancer, breast cancer, liver cancer, lung cancer, thyroid cancer, etc.

Oral cancer is a common disease. If it cannot be detected and treated early, its morbidity and mortality rates will be very high

. Approximately 12,000 patients die from oral cancer every year in the United States, and 26,000 new cases occur

, accounting for approximately 5% of all malignant tumors in men and 2% of malignant tumors in women. Although domestic oral medicine and hygiene education has gradually entered the forest of developed countries, unfortunately, most of the new cases of oral cancer have symptoms in the middle or late stages. Seeking medical treatment only after it appears, often results in poor treatment results due to the spread of the cancer.

Early detection, early treatment, and prevention are actually the most important issues in the treatment of oral cancer.

This article will introduce to you the causes of oral cancer, prevention methods, clinical symptoms and self-examination methods.

(2) Causes of oral cancer

Although there is no definite evidence that a single factor causes oral cancer, many studies have shown that multiple factors

Will increase the incidence of oral cancer. Chronic irritation is one of the more important causes generally accepted,

including mechanical irritation and chemical irritation.

There are many forms of chronic irritation, among which the more attention-grabbing ones are betel nut chewing, smoking, drinking, syphilis,

sun exposure, nutritional deficiencies, radiation therapy, poor oral hygiene and Possible reasons include prostheses, occupation, etc.

In addition, age, gender, race and geographical area also affect the incidence of oral cancer. The key points are summarized as follows

:

(1) Betel nut

Guan Xuewan, a professor of oral pathology at the Department of Dentistry, National Taiwan University School of Medicine, once targeted 103 patients at National Taiwan University Hospital< /p>

Oral cancer patients analyze the relationship between oral cancer and habits. She found that 66% smoked, 39.8% drank alcohol and 53.4% ??were addicted to eating betel nuts. Only 14.6% did not have the above habits; if based on the other 213 non-oral cancer patients, A survey of the control group showed that 42.5%, 22.5% and 0% smoked, drank alcohol and chewed betel nuts respectively, while 51.2% had no such habits. From this study, it can be seen that there is a significant difference in the percentage of betel nut chewers between oral cancer patients and non-oral cancer patients. In terms of location, the largest number of patients with buccal mucosal cancer are betel nut addicts, accounting for 81.8%

, followed by alveolar mucosal cancer, with 71.4% being addicted to betel nut.

The relationship between betel nut and oral cancer has recently attracted the attention of many scholars. In addition to Taiwan,

India has the highest incidence and mortality rate of oral cancer. In other words, many people also have the habit of chewing betel nuts.

In addition to oral cancer, many betel nut eaters will also develop oral pre-cancerous lesions such as leukoplakia

, oral submucosal fibrosis, severe wear of the occlusal surface of teeth, periodontal disease, etc. Serious illness.

(2) Tobacco

Smoking is also an important factor in the occurrence of oral cancer, especially cigars and pipe smoking. In a study, people who smoked cigars or pipes were four times more likely to develop oral cancer than non-smokers. People who smoked more than 35 cigarettes a day were more likely to develop oral cancer. The chances are similar to those of smoking a cigar or smoking a pipe.

Some people think that tobacco is not the initiating factor of oral cancer, but it has a promoting effect on oral cancer

especially those who have both smoking and betel nut chewing. Oral cancer is the most likely to "create"; in another study, it was found that among 102 cured oral or pharyngeal cancer patients who smoked, they continued to smoke six years later

32% of those who stopped smoking developed a second "smoking area" cancer, while only 5% of those who stopped smoking developed a second oral cancer.

Cigar smokers, especially pipe smokers, are associated with leukoplakia and nicotine stomatitis.

People with this habit are also susceptible to oral cancer, especially Lip cancer. In some places in India, people

put the lit end of cigarettes or cigars in their mouths and smoke, thus increasing the incidence of breast cancer. This

includes the chemical effects of tobacco , plus thermal stimulation. In addition, those who have the habit of chewing tobacco

are accustomed to chewing tobacco in a certain place in the mouth, and this area will gradually develop leukoplakia. After

one or twenty years left and right to form cancer.

(3) Alcohol

In Europe and the United States, there is a close relationship between spirits and oral cancer. 50% of oral cancer patients have the habit of drinking alcohol

; alcoholism The chance of oral cancer among those who smoke and drink is 15 times that of those who drink occasionally, and the proportion of those who have both tobacco and alcohol habits is even higher.

Although alcohol may have some direct carcinogenic effects, it is more likely to be an indirect carcinogenic effect of alcohol

The mechanism of its action is unknown. However, it has been concluded that excessive alcohol causes liver cirrhosis.

(4) Syphilis

Syphilis is an important factor causing cancer in the lips and the front two-thirds of the tongue. Cancerous lesions are mainly due to

Syphilitic tongue It is caused by inflammation; some scholars have found that among syphilis patients, 3% have intraoral precancerous disease

Vitiligo, of which 10% eventually develop into oral cancer.

(5) Sunlight exposure

Sunlight exposure is an important factor in lip cancer, especially lower lip cancer. It is currently believed that sunlight will increase

the incidence of lower lip cancer, especially among farmers, sailors and outdoor workers; the incidence of lip cancer is also higher in southern countries than in northern countries. . On the other hand, the incidence of lip cancer and skin cancer in black people is also less than that in white people. This may be due to the protective effect of melanocytes.

(6) Nutritional deficiency

For women, severe iron deficiency anemia is associated with atrophy of the oropharyngeal mucosa and dysphagia

. Among them, patients with Peterson-Brown-Kelly syndrome may also increase the incidence of oral cancer.

In addition, whether those who are addicted to tobacco, alcohol and betel nuts will also reduce their normal food intake, leading to malnutrition or reduced immunity and the development of cancer. It remains to be further studied. Discuss.

(7) Radiotherapy

Some reports show that after long-term follow-up

of head and neck cancers, it is found that in a small number of The cases show the occurrence of secondary oral cancers, most of which are sarcomas; it may be caused by mutations in normal cells caused by radiation.

(8) Poor oral hygiene and prostheses

Many clinicians believe that oral cancer occurs more often in patients with poor oral hygiene, but in

It is statistically difficult to prove because most of the population has some degree of cavities, bad repairs, or sharp edges on broken teeth. Although there is no evidence that bad prostheses cause oral cancer

, it has been noticed in the dental clinic of National Taiwan University Hospital that many patients had tongue problems due to chronic mechanical

irritation due to bad prostheses. The long-term traumatic ulcer eventually developed into a case of oral cancer; the patient

had good oral hygiene and had no habit of eating betel nut, tobacco, or alcohol, and the ulcer site was in the correct position

In bad repairs.

The death rate from oral cancer has dropped significantly in the UK recently, and local scholars also believe that it is related to the improvement in oral hygiene

levels.

(9) Occupation

In addition to outdoor workers, metal workers also seem to have a higher rate of oral cancer.

In addition, when studying the etiology of oral cancer, it is also necessary to consider the possibility of multiple lesions of oral cancer

Because if there is a certain area in the oral cavity that is prone to cancerous lesions, it may At the same time, there are several

areas with the same sensitivity; their anatomical locations are separated, or occur at the same time, or occur after a period of

interval, and their incidence rate is approximately 6.39-11 %between. In addition to oral cancer, multiple cancers throughout the gastrointestinal tract also have the same tendency to increase.

(3) Incidence rate of oral cancer

The occurrence of oral squamous cell carcinoma is clearly related to gender, and it is mainly male; the incidence rate of male and female is different

The largest difference was 9 to 1 for lip cancer, and the lowest was 1.5 to 1 for tooth cancer. The best age of onset is between 50 and 70 years old, and less often among young people.

In terms of incidence, there are great differences between regions; in Western countries, oral cancer accounts for about 5% of all cancers

but in Eastern countries, especially In India, the rate is as high as 50%. This is related to its special oral habits.

Betel nut chewing is also popular in Taiwan, and the rate of oral cancer is not low, and is increasing year by year

< p>high trend.

The location of occurrence also varies from region to region. In areas where betel nut chewing is popular, the cheeks

are the cheeks, alveolars, mucous membranes, tongue, ?, and The floor of the mouth is more common; the area where tobacco is chewed is more common in the cheek or buccal vestibule area.

(4) Clinical symptoms and self-examination methods of oral cancer

If early detection and early treatment can be achieved, the cure rate of oral cancer will be greatly improved, so the general public needs to understand< /p>

Precancerous lesions and early symptoms of oral cancer.

Precancerous lesions of oral cancer include leukoplakia, erythema, submucosal fibrosis, and chronic ulcers. The so-called precancerous lesions themselves are not real. Oral cancer, but if it is ignored for a long time or the source of irritation still exists, there is a very high possibility of developing oral cancer later.

Some of the causes of oral cancer mentioned earlier often lead to oral leukoplakia first. If left untreated, it sometimes turns into oral cancer.

In addition, there are often some betel nut chewers who, due to long-term local mechanical stimulation or chemical stimulation,

irritate the oral mucosa over many years, and finally the mucosa turns white, and the mouth Loss of elasticity and inability to open due to fibrosis and hardening of the submucosal membrane is also an early sign of oral cancer.

Those with white changes in the mucosa in the oral cavity are called white lesions. There are more than ten clinical lesions that fall into this category. Therefore, if there are any white changes in any part of the oral cavity, you should be alert. You should seek out a specialist immediately for differential diagnosis to determine whether it is precancerous vitiligo or submucosal fibrosis for early treatment.

In addition, you should also pay attention to oral ulcers that do not heal for more than two weeks, because ulcer formation is one of the earliest signs of oral cancer

It is common on the lips, cheeks, tongue, etc. The oral mucosa has different depths, obvious or irregular edges

, a hard bottom, uneven surface, and necrosis toward the center, and the surface sometimes bleeds.

In addition, you should pay attention to common villi-like or cauliflower-like hard lumps on the oral mucosa. Even red lesions, black spots or moles on the oral mucosa may be danger signals. .

As oral cancer invades the jaw bone downward, symptoms such as loose teeth, numbness, bleeding, lumps in the lower lip, and even pathological fractures may occur. When lymphatic metastasis of oral cancer occurs, immobile and painless swollen lymph nodes are often palpated on the side of the neck. If treatment is delayed at this time, the cancer cells will eventually metastasize to the lungs and liver.

In all parts of the body, such as bone marrow and bone marrow, cancer has reached the final stage and medicine has no effect.

Self-examination is a good way to prevent cancer. The following is an introduction to the clinical symptoms of oral cancer in various parts of the body and the method of doing oral self-examination in the mirror

.

(1) Symmetry of the face

First check whether the left and right sides of the face are symmetrical, including the surface skin and upper and lower jaw bones.

In oral cancer, some bone and flesh tumors

will not cause ulcers on the surface oral mucosa in the early stage, but will cause local swelling of the jawbone, sometimes

combined with jawbone sensation. Symptoms such as abnormality or shaking of the upper teeth.

In the examination of the surface skin, first observe whether the color is the same, and pay attention to whether prominent places such as moles and lumps are larger than before, or whether the color changes.

(2) Lip

Squamous cell carcinoma of the lower lip is often painless, grows slowly, and rarely invades deep and spreads far away. During the examination, use your hands to open the upper and lower lips outwards one after another. Pay attention to the color of each part of this part or any abnormal tissue in certain parts of the area, such as ulcers, protrusions, and white spots. . For those who smoke cigars or pipes for a long time, the location of their placement is often associated with the location of the tumor.

(3) Gums

Since gingival cancer often causes the loss of gingival tissue and exposure of alveolar bone, or even causes the teeth to shake

, patients and doctors It is necessary to make a correct differential diagnosis with chronic periodontal disease to avoid accidentally extracting teeth

which may cause the spread of cancer cells or delay the treatment opportunity. Generally, periodontitis rarely causes ulcers and surface necrosis.

Gingival cancer often causes pain, and it is easy to cause bleeding when brushing teeth. It often exists in the form of ulcers on the attached gums, and

It is easy to invade the underlying alveolar bone, and the incidence rate of the mandible is higher than that of the maxilla.

During the examination, turn your lips outward to partially expose the gums. Also pay attention to the buccal and lingual sides to check whether the color is

different. Pay attention to whether there are any lumps, ulcers, or ulcers on the surface. Bleeding and abnormal tooth shaking; due to the production of lumps

, a small number of patients initially complain that it is easier to bite the gum when clenching their teeth, especially in edentulous areas;

In addition, gingival squamous cell carcinoma is more likely to invade the mandible, and when it reaches the alveolar nerve under the mandibular canal, the lower lip may feel numb.

(4) Buccal mucosa

The inner surface of the cheek is a common site for oral cancer. The surface is often papillary or ulcer-shaped, especially near the occlusal surface.

Easily bitten by teeth. It often starts as a white spot lesion. The cancerous lesion sometimes feels painful, but it is not significant

Sometimes there is a burning sensation.

During the examination, open the cheek with two fingers to expose the mucosa. This part is usually easier to cover, so

it is less likely to notice changes.

(5) Tongue and floor of mouth

The tongue is also where oral cancer often occurs, and the prognosis is very poor. Tongue cancer often manifests as small ulcers in the early stages, and gradually invades deep and distant areas, causing the tongue to lose its normal mobility, causing difficulty in swallowing and speaking.

Tongue cancer often presents with painful symptoms in the early stages. As the disease progresses, the pain worsens and may even spread to the neck and

ears.

Tongue cancer often occurs on the side of the tongue, and less often on the ventral surface of the tongue. Certain diseases can cause atrophy of the dorsal papillae of the tongue

and increase the chance of leukoplakia and oral cancer in this area, such as severe iron deficiency and vitamin B deficiency

Asthenia, Plummer-Vinson syndrome, tertiary syphilis and very few lichen planus, etc.

Because it is located under the tongue, oral cancer at the bottom of the mouth requires careful examination to detect. However, patients often feel

dryness or irritation.

During the examination, stick your tongue out of the mouth and swing it left and right to check the mobility of the tongue. Normally it should be very active. Otherwise, you should pay attention to whether there are lumps on the base or edge of the tongue. Then roll up the tongue and look at the ventral surface of the tongue, the left and right edges of the tongue, and the tissues at the bottom of the mouth. Use your fingers to feel whether there are any protrusions or hardening on the tongue and the bottom of the mouth.

(6)? (also known as the mouth cover, at the top of the mouth)

For smokers, this is a place where oral cancer is prone to occur. It usually appears as white spots at first. Subsequent cancer recurrence

The tumor itself is papillary or exophytic, and less likely to be flat or ulcerated.

During the examination, stand in front of the mirror, tilt your head back, and you can see it when you open your mouth, that is, the tongue is raised upwards

in the mouth, and the surface it touches is Yes, look for any rough surfaces or protrusions.

(7) Both sides of the neck

Since the head and neck have a rich lymphatic network, cancer cells can easily cause local neck metastasis along this route

< p>, causing the cervical lymph nodes to swell painlessly, become hard and attached to adjacent tissues and lack mobility.

In addition to oral cancer, nasopharyngeal cancer, which is most common among Chinese people, also often exhibits this symptom.

During the examination, touch both sides of the neck with your hands to see if there are any hard lumps, including the lymph node groups in each area of ??the neck.

However, attention should be paid to general upper respiratory tract infections, odontogenic infections, tuberculosis or children. Inflammation and swelling of cervical lymph nodes are often found, so differential diagnosis is required.

Follow the above instructions for sequential inspection of various parts. If any of the following conditions are found, you should be alert and go to the hospital immediately for further examination or biopsy and pathological examination.

1 The color of the oral mucosa changes, such as turning white, red, brown or black, and cannot be wiped off.

2 Oral mucosal ulcers that have not healed for more than two weeks should be considered for biopsy

Tissue biopsy.

3 Hard lumps

Unexplained lumps inside and outside the mouth or neck.

(5) Conclusion

Although self-examination and early detection are good strategies for treating cancer, prevention is truly the best strategy for treating cancer

. Stay away from various risk factors such as betel nut, tobacco, alcohol, too much sunlight, poor oral health care or defective dentures, strong irritating or hot foods, and have regular oral examinations , I believe it will help you stay away from oral cancer and maintain oral hygiene and health forever.