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Mouth cancer

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VOL: 101, ISSUE: 42, PAGE NO: 25



Mouth cancer most commonly involves the tongue, lips, gums and floor of the mouth and can affect the inside of the cheeks or palate. It can begin in one of the salivary glands or spread into the mouth from surrounding areas such as the nose.



Mouth cancers are twice as common in men as women and are more likely to affect people over 40 but are becoming more prevalent in younger patients and women. Every year, over 4,400 new cases are diagnosed in the UK, and more than 1,600 people die from the condition (Cancer Research UK, 2005).



Mouth cancer is often related to tobacco use. Lower-tar cigarettes do not reduce risk. Chewing tobacco is a risk as holding tobacco in one part of the mouth for long periods often causes leukoplakia. Other factors include:



- Combining alcohol and smoking - this combination is a major cause as alcohol enhances absorption of carcinogens in cigarette smoke;



- Abusing alcohol;



- Rough or jagged teeth causing irritation to the tongue;



- Wearing ill-fitting dentures;



- Chewing the areca nut or betel leaf - common in certain ethnic groups such as Bangladeshis.



- Early diagnosis is crucial to maximise treatment benefits. It reduces the chance of metastasis and can help prevent speech problems and facial disfigurement.



- The first sign of mouth cancer will often be a lump or tissue change. This should always be reported to a doctor if it does not clear up within four weeks.



- The first stage is usually a visual examination, followed by feeling the area for lumps or other signs such as fissures or ulcers. An oral health history can be taken to see how long any irregularities have been present, whether there has been any pain, bleeding or problems with swallowing.



- A biopsy can be performed to confirm the diagnosis. X-rays and computerised tomography (CT) scans can establish the extent of the cancer and whether it has metastasised.



Early on, mouth cancer can be almost invisible, making it easy to miss. Signs and symptoms include:



- Oral ulcers or sores that do not heal within three weeks;



- Lumps or excess tissue growth anywhere in the mouth;



- White or red areas on the tongue, gums or mouth lining;



- Swallowing difficulties;



- Chewing difficulties;



- Numbness;



- A sensation of something being been stuck in the throat;



- Persistent chronic sore throat, particularly in smokers over 50 and heavy drinkers;



- Swelling in the jaw, resulting in poorly fitting dentures;



- Swelling in the neck;



- Persistent loose teeth;



- Nasal mass, ulcers in the nose or nasal obstruction - obstruction particularly if there is discharge.



- Treatment usually involves surgery to excise all cancerous tissue, chemotherapy, radiotherapy or a combination.



- Photodynamic therapy is being used on some types of mouth cancer. This new treatment uses lasers and a light-sensitive drug to destroy cancerous cells.



- When mouth cancer is diagnosed early, the prognosis is good. However, following surgery some reconstruction may be necessary, for example replacing bones with prosthetics.



- Dentistry, speech therapy and dietary counselling can be used for patients whose mouths have been altered by surgery.



- Counselling may be necessary for patients whose speech or appearance has been altered by surgery.

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