Mouth cancer Symptoms and causes

Floor of the mouth cancer is a form of oral cancer that can grow in the tissues located beneath the tongue. This disease originates from the uncontrolled growth of abnormal cells in this specific area of the mouth. 

The majority of these cancers arise from the thin, flat cells called squamous, which line the interior of the mouth. When cancer develops in these cells, it is referred to as squamous cell carcinoma. 

The development of this cancer can lead to noticeable changes in the tissue under the tongue, such as the formation of a lump or a sore that fails to heal.

Recognizing the Symptoms

• A persistent sore, lump, or thickened area on the floor of your mouth
• White or red patches appearing on the tissue under the tongue
• Difficulty or pain when moving the tongue or swallowing
• Persistent mouth, jaw, or ear pain
• Numbness in the tongue or another area of the mouth
• Teeth are becoming loose for no specific reason.
• A noticeable lump in the neck
• Changes in your voice
• Unexplained weight loss

Understanding Cancer's Progression

Once the cancer in the floor of the mouth is diagnosed, doctors determine its stage to understand the extent of the disease and formulate the most effective treatment plan. The process generally uses the TNM system and is classified into four main stages:

• T (Tumor): This letter indicates the size of the primary tumor. A smaller number corresponds to a smaller tumor.
• N (Node): This refers to whether the cancer cells have spread to the regional or nearby lymph nodes in the neck.
• M (Metastasis): This tells us if the cancer has spread (metastasized) to other nearby organs, such as the lungs or bones.

Stages

• Stage 1: In this early stage, the tumor is considered localized. It measures 2 centimeters or smaller and has not yet spread to the lymph nodes or any other part of the body. The cancer is confined entirely to the floor of the mouth.
• Stage 2: At this stage, the tumor is bigger than 2 cm but not more than 4 cm. Similar to Stage 1, the cancer has not spread to the lymph nodes or any distant sites. It remains localized to its original area.
• Stage 3: This stage indicates a more advanced cancer. It can mean one of two things: either the tumor is larger than 4 centimeters but has not spread to lymph nodes in the neck, OR the cancer is of any size and has spread to a single lymph node on the same side of the neck as the tumor. The affected lymph node is no larger than 3 centimeters, and the cancer has not spread to distant parts of the body.
• Stage 4: This is the most advanced stage and signifies that the cancer is widespread. It is often divided into sub-stages, but generally, it means the tumor has grown into nearby tissues and structures, such as the jawbone, skin of the face, or deep muscles of the tongue. It may have spread to multiple lymph nodes, a large lymph node, or lymph nodes on both sides of the neck. In its most advanced state (metastatic cancer), it has spread to closer organs like the lungs or bones.

Factors Contributing to Cancer Development

• Tobacco Consumption: Using tobacco in any form—including cigarettes, cigars, pipes, and smokeless or chewing tobacco—is a primary risk factor.
• Heavy Alcohol Use: Frequent and heavy consumption of alcohol significantly elevates the risk. The risk is higher for individuals who both use tobacco and drink heavily.
• Human Papillomavirus (HPV): Infection with strains of this common virus is a known risk factor for developing oral cancers.
• Weakened Immune System: Individuals with a weak or compromised immune system, whether due to medical conditions or immunosuppressive drugs, are more susceptible.
• Age and Gender: The risk of oral cancers increases with age, with most cases being diagnosed in individuals over the age of 55. Statistically, men are more than twice as likely as women to develop these cancers.
• Nutritional Deficiencies: A diet that is low in fruits & vegetables has been linked to an elevated risk for developing oral cancers.
• Genetic Predisposition: Certain inherited genetic syndromes, though rare, can significantly increase the risk. These include conditions like Fanconi anemia and Dyskeratosis congenita, which can lead to a much higher-than-average risk of oral cancer at an early age.
• Precancerous Lesions: The presence of specific types of sores, known as lesions, in the mouth can be precursors to cancer. One such condition is leukoplakia, which appears as persistent white patches. While not always cancerous, these lesions can transform into cancer over time.

The Diagnostic Process

• Physical and Visual Examination: The process begins with a thorough examination of your mouth & neck. A doctor or dentist will look for any abnormal areas, such as sores or white patches (leukoplakia), and feel the floor of the mouth, tongue, and neck for any lumps or swollen lymph nodes, as this is often the first place the cancer spreads.
• Tissue Biopsy: This is the definitive way to diagnose cancer. A small sample of the abnormal or suspicious tissue is removed & sent to the lab for analysis. This procedure, known as a biopsy, can be done by cutting away a piece of the tissue or by using a thin needle to draw out cells (fine-needle aspiration), which is common for lumps in the neck. The lab tests will confirm if cancer cells are present.
• Using a Scope to See the Throat (Endoscopy): To check if the cancer has spread to deeper parts of the throat, a specialist may perform an endoscopy. This procedure involves inserting a flexible, thin tube with a camera on the end through the mouth to get a clear view of the throat and larynx (voice box).
• Imaging Tests: Once a cancer diagnosis is confirmed, various imaging tests are used to understand the tumor's size, location, & whether it has spread to the jawbone, lymph nodes, or distant organs. These tests are crucial for staging the cancer & may include:
• CT (Computed Tomography) Scan: Provides detailed cross-sectional images of the head and neck to assess the tumor and check for spread to bone and lymph nodes.
• MRI (Magnetic Resonance Imaging): MRI uses magnetic fields to create detailed images, offering a superior view of soft tissues like the tongue & muscles.
• PET (Positron Emission Tomography) Scan: Can detect cancer cells in all parts of the body by using a radioactive sugar that cancer cells absorb more actively than normal cells. It is often combined with a CT scan (PET-CT).
• X-rays: A panoramic X-ray of the jaw can help determine if the tumor has grown into the jawbone.

Treatment Approach

Surgery 

Surgery is often the first treatment, especially for early-stage cancers. The goal is to remove the tumor along with a lining of surrounding healthy tissue to ensure all cancerous cells are eliminated. 

Depending on the cancer's size and how far it has grown, the procedure may involve removing a portion of the tongue or the jawbone (mandibulectomy). If there is evidence or a high risk of the cancer spreading to the lymph nodes, a surgeon will remove them from the neck in a procedure called a neck dissection.

Reconstructive Surgery 

Following extensive surgery to remove the cancer, reconstructive surgery is often necessary. Surgeons can rebuild parts of the jaw, tongue, or other structures using bone, muscle, or skin taken from another part of the body.

This step is crucial for restoring the ability to speak and swallow, as well as for maintaining facial appearance.

Radiation Therapy 

Radiation therapy is a treatment that utilizes powerful, high-energy beams, such as X-rays or protons, for the purpose of destroying cancer cells. It can be used in several ways: as the sole treatment for tiny cancers, after surgery to remove any remaining cancer cells, or in combination with chemotherapy to enhance its effectiveness. For advanced cancers, radiation may also be used to relieve symptoms like pain.

Chemotherapy 

Chemotherapy involves the use of strong drugs to destroy cancer cells throughout the body. For floor of the mouth cancer, it is typically administered in combination with radiation therapy (a treatment known as chemoradiation) to make the cancer cells more vulnerable to radiation. It may also be used to treat cancer that has either returned or spread to other parts of the body.

Targeted Therapy 

This newer class of treatment uses drugs designed to attack specific vulnerabilities in cancer cells. For instance, some drugs block proteins like the epidermal growth factor receptor (EGFR), which many oral cancer cells need to grow. Targeted therapy can be given alone or combined with chemotherapy for advanced cancers, often with fewer side effects than traditional chemotherapy.

Immunotherapy 

Immunotherapy works by activating the body's own immune system to recognize and fight cancer cells. Cancer cells can often produce proteins that allow them to hide from the immune system. Immunotherapy drugs, known as checkpoint inhibitors, block these proteins, effectively "unmasking" the cancer cells so the immune system can attack and destroy them. This treatment is generally reserved for advanced cancers that have spread or have not responded to other therapies.

Management and Recovery

Rehabilitation and Functional Recovery 

Treatment for floor of the mouth cancer can significantly impact essential functions like speaking and swallowing. A dedicated rehabilitation team is vital to help manage these challenges.

• Speech and Swallowing Therapy: A speech-language pathologist is a key member of the recovery team. They design exercises to strengthen the muscles of the mouth and throat, helping to improve swallowing (dysphagia) and the clarity of speech. They can teach new techniques for eating safely and communicating effectively. For some, this therapy may begin even before treatment to prepare the muscles and may continue for a long time afterward.
• Nutritional Support: A dietitian helps manage eating difficulties and prevent weight loss. They can recommend soft foods, high-calorie supplements, or, if necessary, coordinate the use of a feeding tube to ensure proper nutrition while you heal. They also provide guidance for managing long-term side effects like dry mouth or changes in taste.
• Managing Jaw Stiffness (Trismus): Radiation or surgery can cause the jaw to become stiff, making it difficult to open your mouth. A physical therapist can recommend specific, gentle exercises to maintain and improve your jaw's range of motion.

Follow-up Care and Monitoring 

Long-term monitoring is essential to watch for any signs of cancer returning (recurrence).

• Regular Check-ups: Follow-up appointments are most frequent in the first two years after treatment—often every few months. The frequency will decrease over time, but you will likely have annual check-ups for many years.
• Examinations and Tests: During these visits, your doctor will perform a thorough physical exam of your mouth and neck. Depending on your situation, you may also undergo periodic imaging tests like CT or PET scans, blood tests to check thyroid function (if you had neck radiation), and endoscopic exams to look inside your throat.

Lifestyle and Emotional Well-being 

Adjusting to life after cancer involves both physical and emotional changes.

• Quitting Tobacco and Alcohol: If you use tobacco or drink alcohol, stopping is the most critical step you can take. Continuing to use these substances makes treatment less effective, slows healing, and dramatically increases the risk of the cancer coming back or a new cancer forming.
• Emotional Support: A cancer diagnosis can bring feelings of anxiety, depression, and stress. It is integral to address your mental health. Talking with family, friends, a counselor, or joining a support group for cancer survivors can provide an important outlet and help you cope with the emotional challenges of recovery. Don't hesitate to ask your medical team for a referral to a mental health professional.

Prognosis and Long-Term Outlook

The long-term outlook for an individual with floor of the mouth cancer is most significantly influenced by the stage of the cancer at the time of diagnosis. As with most cancers, early detection is the most critical factor for a favorable outcome. When the cancer is found and treated before it has had a chance to spread, the prognosis is considerably better.

The 5-year relative survival rate provides a statistical estimate of what percentage of people with the same type and stage of cancer are alive five years after their diagnosis. For localized floor of the mouth cancer (cancer that has not spread beyond its original site), the survival rate is approximately 75%. 

However, if the cancer has spread to nearby regional lymph nodes, that rate drops to about 39%. For distant cancer that has metastasized to other parts of the body, the 5-year survival rate is approximately 25%. It's also important to note that a patient's overall health and commitment to lifestyle changes, such as quitting tobacco and alcohol, play a crucial role in improving their long-term prognosis and reducing the risk of recurrence.

Sterling Hospital is Your Partner in Health Across Gujarat

At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to a healthier and brighter life. We've got you if you are looking for the best oncologist in ​​Ahmedabad-Gurukul, Ahmedabad-Sindhu Bhavan, Vadodara-Bhayli, Vadodara-Race Course Road, or Rajkot. 

With considerable years of experience, we have built a team of the best oncologists in these regions to provide you with premium treatment and the best results. Contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier future.