Oral cancers make up about 30% of ENT cancers. Mostly they are operated on, followed by radiation therapy. First Signs, Screening, Causes, Survival, and Treatments … Update on Oral Cancer.
Definition: what is oral cancer? At what age does this happen?
Cancer is a disease in which cells and tissues get out of hand and cause tumors. Oral cancer is a condition that affects the lining of the mouth. “These are all cancers of the oral cavity: tongue, gums, hard palate, the floor of the mouth, tonsils, inner surfaces of the days and lips,” reports Dr. Philippe Gorphe, ENT surgeon at the Gustave Roussy Institute. “90 to 95% of oral cancers are squamous cell carcinomas that develop in the epithelium or in the tissues of the mucous membranes. The tumor grows in its place and in-depth,” he explains. The first distant invasion of this type of cancer is the lymph node involvement of the neck. The average age for cancers of the oral cavity is 62 years.
What is the leading cause of this type of cancer? Tobacco and alcohol.
The leading cause of oral cavity factors is exposure to tobacco and alcohol. “One-third of the cases are related to smoking, one third to alcohol consumption and the last third of the cases not to risk factors,” the ENT surgeon developed.
People in danger
People at risk for oral cancer are people who smoke and have excessive alcohol consumption. The combination of tobacco and alcohol increases the risk of oral cancer. Men are most affected by these cancers, but the incidence is rising in women due to the consumption of tobacco and alcohol by women.
“Symptoms of oral cancer can include persistent pain and pain when swallowing, eating disorders, bleeding, ear pain, and tooth mobility, depending on the location,” reports Dr. Philippe Gorphe. Weight loss is widespread in cancers of the oral cavity and lymph nodes in the neck “.
Four stages are defined for cancers of the oral cavity:
- Stage 1. refers to a tumor with a large diameter less than or equal to 2 cm.
- Stage 2. tumor larger than 2 cm and smaller or equal to 4 cm,
- Stage 3. a tumor larger than 4 cm,
- Stage 4. (T4) a tumor that invades neighboring structures.
Cancer of the oral cavity (mouth) can develop on the lips, tongue, inner lips and cheeks, the hard roof of the mouth (top of the mouth), the floor of the mouth (under the tongue), and gums. The most common are cancers of the tonsils of the base of the mouth and tongue.
Gum Cancer: Causes, Symptoms, Treatments
Gum cancer is usually caused by excessive consumption of tobacco and alcohol. What are the symptoms? When should you consider gum surgery?
Definition: what is gum cancer?
Gum cancer is one type of cancer associated with the oral cavity, including cancers of the lips, cheeks, tongue, and palate. explains Dr. Philippe Gorphe, ENT specialist in the surgical department. Head and Neck Oncology at the Gustave Roussy Institute. Like other cancers of the oral cavity, gum cancer is more likely to affect men (75% of gum cancer cases). However, the incidence of gum cancer is increasing in women, as is the case with all cancers of the oral cavity. The average age of this cancer is 62 years, like other cancers of the oral cavity. Up to 30% of patients are over 70 years old and women over 70 make up 40%. Patients.”
The leading cause of gum cancer is smoking.
“The first cause of gum cancer is smoking, the second is the potentiation of the combined consumption of tobacco and alcohol,” explains Dr. Philippe Gorphe. These risk factors are common in the large “family” of upper aerodigestive cancers. “The ultimate cause of gum cancer is a combination of factors such as aging of the mucous membranes and various genetic predispositions,” reports the ENT surgeon.
Symptoms: pain, bleeding, loosening of the teeth.
“The first symptom of gum cancer is persistent gum pain, pain when chewing and swallowing,” explains Dr. Philippe Gorphe. “The gums can bleed spontaneously. The presence of blood on the pillow when you wake up is a case in point,” he says. Sagging teeth are the third symptom. The patients then discover their tumors. look at yourself in the mirror.
“The first step is a clinical examination carried out by the treating doctor and a specialist in head and neck cancer. Examining the oral cavity makes it possible to see the tumor,” reports Dr. Philippe Gorphe. Confirmation of the diagnosis requires a sample, called a biopsy, of the lesion with an analysis of its nature. The background of alcohol and tobacco poisoning heavily emphasizes its cancerous nature. In this regard, a more comprehensive examination called an upper aerodigestive tract panendoscopy is often done to determine the presence of other possible lesions that may suggest cancer and are also biopsied. “If the cancerous nature is confirmed, an imaging test (computed tomography and magnetic resonance imaging) is carried out to assess the extent of the disease,” describes the specialist.
Treatment: surgery, radiation therapy …
“If the disease is eligible for curative treatment, which is 90 to 95% of the time, the classic therapeutic sequence is surgery on the primary tumor and lymph node areas, followed by post-operative radiation therapy.” To explain. The surgeon. ENT. The operation depends on the local extension. Most often, the gums should be removed from a safe distance. The most common method is to rebuild the gum tissue. If the jaw is affected, the mandibulectomy is stopped (the jaw is cut), and then the jaw is reconstructed. “”
“If the analysis of the tumor did not reveal a serious factor, then surgical treatment cannot be followed by radiation therapy. On the contrary, if there are serious factors, chemotherapy can be added to radiation therapy,” says the ENT surgeon.
The first prevention of gum cancer is to control addiction:
- No Smoking,
- Reduce your alcohol consumption
- Visit your dentist and doctor regularly.
“Do not hesitate to talk about symptoms immediately, as this disease is still too often detected at an advanced stage. However, if it is diagnosed early, we can get rid of it superficially without breaking contact.”. Bones “. Reports Dr. Philippe Gorphe.
Jaw cancer: cause, symptom, the chance of survival
Jaw cancer is the most common cancer of the oral cavity with the invasion of the jaw. How do you recognize it? What are the chances of survival? Lighting by Dr Nadia Benmoussa-Rebibo, ENT at the Gustave Roussy Institute.
Definition: what is jaw cancer?
Jaw cancer belongs to the group of cancers of the upper aerodigestive tract (ADC) and in particular to the group of cancers of the oral cavity. “Jaw cancer is actually jaw cancer. It can be cancer of the oral cavity with the invasion of the jaw or cancer of the jawbone, ”reports Dr Nadia Benmoussa-Rebibo, ENT specialist at the Gustave Institute Roussy. “Bone cancers are less common. Mostly it concerns cancers of the oral cavity with the expansion of the jaw or even skin cancer of the lip with the expansion of the jaw, ”he explains. . Cancers of the upper jawbone are called the jawbone, or the lower jawbone is called the lower jaw. There are different types of jaw cancer, all kinds of bone cancer that can develop in the jaw (osteosarcoma, ameloblastoma, etc.).
Among the signs, bad taste or bad smell in the mouth.
Symptoms: difficulty speaking, pain, tooth loss …
Jaw tumours “manifest themselves as difficulty swallowing, speaking, restricted mobility of the tongue, pain in the oral cavity, lymphadenopathy (cervical ganglia), restriction of the tongue. The” opening of the tongue. Mouth “is described by the ENT doctor:” There is very often tooth mobility with spontaneously falling teeth and a bad taste or smell in the mouth, as is the case with other ENT cancers, “adds Dr Benmoussa-Rebibo.
Causes: tobacco, alcohol, dentures, irritation …
The causes of jaw cancer are identical to those of other VADS cancers. The risk factors are:
- Alcohol consumption,
- Tobacco and cannabis use
- As with cancers of the oral cavity, chronic irritation associated with dentures can also lead to the development of cancer, reports the ENT doctor.
There are 4 degrees of local invasion of cancers of the oral cavity (T classification of the eighth edition):
- Stage 1 denotes a tumour with a large diameter less than or equal to 2 cm and a deep infiltration less than or equal to 5 mm.
- Stage 2 a tumour between 2 cm and 4 cm and a deep infiltration between 5 and 10 mm
- Stage 3 a tumour larger than 4 cm and a deep infiltration larger than 10 mm
- Stage 4 T4 a tumour that invades neighbouring structures such as the jawbone.
- Oral cancers are often diagnosed at an advanced stage (stages 3 and 4). This explains why the 5-year survival rate for these cancers is 40% after five years.
If clinical signs suggest it, a clinical examination of the jaw, teeth, and inside the oral cavity may reveal an abnormal lesion. “An endoscopy under general anaesthesia makes it possible to see the tumour and look for synchronous cancer (2nd cancer) of the VADS because all the mucous membranes were exposed to the same toxin,” explains Dr Nadia Benmoussa-Rebibo.
If the lesion is suspicious, a sample called a biopsy is needed to analyze its nature. “The biopsy of the oral cavity can be performed under local anesthesia in consultation, but an endoscopy is always performed.” If cancer is confirmed, an extension assessment is required, that is, looking for other sites of cancer cells in the body.
If the diseased jaw is removed, a reconstruction technique is required.
Treatments and how it works
Different treatment alternatives for jaw cancer are possible depending on the type of cancer and its assessed progress in assessing its extent. “The treatment can be surgical or in the form of chemoradiotherapy,” explains Dr Benmoussa Rebibo. A combination of these techniques is also possible. “When possible, we usually offer first-time operations,” he explains. When removing the diseased jaw, a reconstruction technique with a bone flap (fibula, scapula) is necessary for aesthetic and functional reasons (speech, chewing, etc.).
What are the chances of survival?
“Depending on the stages of the tumour, the survival rate is higher or lower, but several factors play a role, so it is often difficult to give numbers to patients,” specifies Dr Nadia Benmoussa-Rebibo. For cancers of the oral cavity, the 5-year survival rate is approx. 60% to
Tonsil cancer: causes, symptoms, survival
15% of ENT cancers are almond cancer. This disease is mainly caused by papillomavirus (HPV) infection. What are the symptoms, the prognosis for survival, and how can they be treated to prevent recurrence?
Definition: What is Almond Cancer?
“Almond cancer is part of oropharyngeal cancer and is itself part of upper aerodigestive tract (VADS) cancer,” explains Dr Nadia Benmoussa-Rebibo, ENT specialist at the Gustave Institute Roussy. VADS cancer is the fourth most common cancer in France, with 14,000 new cases per year.
Cancer of the oropharynx, and particularly the amygdala, has increased in recent decades. This increase is caused by oncogenic papillomavirus (HPV). “There are two types of tonsil cancer: those related to HPV and those that are not. The latter is preferred due to the consumption of tobacco, cannabis and alcohol,” explains Dr Nadia Benmoussa-Rebibo. The management of these two cancers is different. “If cancer of the tonsils is associated with toxic uptake, a second cancer of the ENT sphere (synchronous cancer) may be associated.
Symptoms: pain, eating disorders, swallowing …
Several signs can indicate almond cancer (which usually only affects one almond):
- “Difficulty swallowing called odynophagia,
- Difficulty eating (dysphagia)
- Angina-like pain in the throat that lasts over time.
- More rarely, tonsil cancer can manifest as an earache (reflex earache) on the affected side.
- The appearance of cervical lymph nodes can also occur.”
Causes: tobacco, alcohol, or papillomavirus (HPV)
“The consumption of tobacco, alcohol or cannabis is a risk factor for non-oncogenic HPV-induced tonsil cancer. The consumption of alcohol and tobacco has a synergistic effect; H. Consuming together increases the risk of cancer, “reports Dr. Benmoussa-Rebibo. This type of tonsil cancer affects mostly men between the ages of 50 and 60. The second type of tonsil cancer is linked to HPV infection.” This can affect younger profiles “Says the specialist. In France, 34% of new cases of oropharyngeal cancer in 2015 were due to HPV (National Cancer Institute)
Almond cancer and papillomavirus
The infection occurs sexually during oral and genital sex. It’s a common infection. Studies have shown that around 10% of men and 4% of women have an oropharyngeal HPV infection at any point in time. Most of these oropharyngeal HPV infections are cleared by the immune system. Only a minority last for many years and can develop into cancer. As with any sexually transmitted disease, the risk of infection increases with the number of sexual partners and the first sex.
“If tonsil cancer is suspected, an endoscopy is performed under general anesthesia,” reports Dr Benmoussa Rebibo. It allows direct visualization of the lesion, which is sometimes uncomfortable in consultation. During this endoscopy, all mucous membranes of the upper aerodigestive tract are examined so as not to miss a second lesion. This examination is performed under general anaesthesia and is known as VADS panendoscopy. “Suspicious lesions are biopsied to confirm the diagnosis or not,” says the ENT doctor. If any of them are cancerous, an extension assessment is done, that is, tests are done to detect the existence of other locations of cancer cells that have migrated to them. Lymph nodes pass through the lymphatic system or metastasize to other organs.
Treatment: which surgery or surgery?
“Amygdala cancer is sometimes treated in combination with surgery or chemoradiotherapy,” explains Dr. Nadia Benmoussa-Rebibo. The types of cancer induced by HPV are most commonly treated with radiation therapy combined with chemotherapy. However, the treatment chosen will depend on several factors: the patient’s health, the location of the lesion and especially its extent, the lymph nodes, etc. “Oropharyngectomy is the technique used to surgically remove these cancers. This operation can be performed in a minimally invasive manner using a robot, which avoids cervical access and thus an obvious scar. Of course, this technique can only be proposed if the structure has this technology and a trained surgeon, specifies our interlocutor. This operation can be followed by chemoradiotherapy. The size of the lesion is important and a free flap reconstruction technique may be required. “
“The survival rates for ENT cancer after 5 years are 60%.”
Survival rate and prognosis
“As a rule, the survival rate for ear, nose and throat cancer after 5 years is 60%. This percentage differs depending on the stage of the tumour,” reports Dr. Benmoussa Rebibo. HPV-induced tumours have a better prognosis. The 5-year survival is 85% for cancer-associated only with papillomavirus (70% for associated smoking) versus 45% for cancer caused by tobacco, alcohol and in the absence of papillomavirus.
Prevention to avoid repetition
To prevent the development of almond cancer and by spreading all VADS cancers, it is advisable to avoid exposure to tobacco and cannabis smoke, as well as alcohol, as the combination of tobacco and alcohol is known to increase your risk. HPV infection cannot be prevented with a condom. The only way to reduce the risk of disease is not to multiply the partners. “We still don’t have enough retrospect to know whether vaccinating girls against papillomavirus to prevent cervical cancer will affect the development of oropharyngeal cancer,” said Dr. Nadia Benmoussa-Rebibo.