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Vincent’s S.C.A.N.S 
Ear, Nose and Throat (ENT), Head and Neck Surgery
Specialist Clinic
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Last update:  10/5/14 
EDUCATION Oral Cavity (mouth, lips, throat)    Cancer
This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
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An Aphthous Ulcer on the Lip (Mouse over to zoom in)
Flexible endoscopy of the upper airway. The black tube represent the scope (source of unlabelled diagram: Netter Atlas of Anatomy) NASAL CAVITY TONGUE POSTNASAL SPACE BRAIN SOFT  PALATE HARD  PALATE BASE OF TONGUE EPIGLOTTIS WINDPIPE/TRACHEA TONSIL CERVICAL SPINE VOCAL CORDS LOWER JAW/ MANDIBLE POSTERIOR PHARYNGEAL WALL © Vincent Tan ENT Flexible endoscopy of the upper airway in a real ENT clinic setting.
Right neck lymph node enlargement (red arrow) as a result of secondary spread of the oral cancer to the nearby draining lymph node.  © Vincent Tan ENT
‘When was the last time you had your mouth examined - I mean,  thoroughly checked ?’
Just   like   anywhere   else   in   the   rest   of   the   body,   cancer   can   also   form   in   any   part   of   the mouth   or   throat.   Oral   cancers   most   commonly   are   found   at   the   lip   especially   the   lower   lip, sides   of   the   tongue   and   in   the   floor   of   the   mouth.   The   commonest   histology   is   squamous cell carcinoma (SCC). It is also more commonly found among those with the following risk/predisposing factors: Cigarette smoking (risk = 6X) Pipe smoking betel nut (‘kapur sirih’), tobacco chewing alcohol (risk = 6X) dental infections, poor hygiene trauma (dental – dentures, sharp teeth) Human papilloma virus (HPV) the same group of virus that causes genital warts, here it is transmitted through oral-genital route UV/sunlight, radiation (lip) chronic erosive skin diseases, e.g. lichen planus Syphilis Immunosuppression. nutritional deficiencies (riboflavin, Plummer-Vinson, sideropenic dysphagia)
A Non-healing Ulcer on the Lip (Mouse over to zoom in)
What are the symptoms ? Common symptoms may include: A mouth ulcer/sore that won't heal with common over-the- counter medication especially if the ulcers are painless. Common mouth ulcers are called ‘aphthous ulcers’ –these are usually painful but heals within a week or two with or without medication. Most of us would have had it one time or another before. White or red patches in your mouth –leukoplakia (white patches) or red patches (erythroplakia) can means high probability of cells transforming into cancer later (considered a pre-cancerous lesion) Bleeding in your mouth, easy bleeding even with minor trauma, blood-stained sputum Loose teeth or denture not fitting well anymore Problems or pain with swallowing A lump in your neck, commonly due to an enlarged lymph node An earache, as a result of pain transmission through the common nerve root supply between the ear and oral cavity Foul smell in the mouth of recent onset Difficulty in mouth opening –‘my mouth feels tight’
Diagnosis of oral cancer A thorough check of the oral cavity is important - the doctor or dentist checks your mouth and throat for red or white patches, lumps, swelling, or other problems. This exam includes looking carefully at the roof of the mouth, back of the throat, and insides of the cheeks and lips. Nowadays with the advent of flexible endoscopes, the inner recesses of your throat and opening to the food passage can be closely examined in the clinic to exclude other contributing factors to the symptoms. The floor of your mouth and lymph nodes in your neck also are checked. At   any   region   that   shows   changes   suspicious   of   cancer,   a   small sample   of   tissue   may   be   removed   for   biopsy,   usually   done   with local     anaesthesia .     Sometimes,     general     anaesthesia     maybe required   for   harder-to-reach   areas   where   special   instruments   are used.    The    specimen    would    be    sent    to    the    laboratory    for    a pathologist   who   will   examine   the   tissue   under   a   microscope   to confirm   or   exclude   cancer   cells.   A   biopsy   is   the   only   definitive   way to know if the abnormal area is cancerous.
Treatment Once   the   cancer   is   confirmed   and   before   treatment   can   be   commenced,   it   is   important   to ‘stage’   the   cancer   i.e   to   delineate   the   local,   regional   and   distant   involvement   of   the   cancer. This may require other investigative modalities like CT scan, MRI, ultrasound etc. Oral   cancer   treatments   may   include   surgery,   radiation   therapy   or   chemotherapy.   Some   patients require a combination of treatments to achieve the best outcome. Surgical treatment can be as simple as excising the pre-cancerous lesion to major removal of the cancer and its draining lymph nodes (neck dissection surgery) with reconstructive surgery of the defect. Prognostic factors in oral carcinoma are very much dependant on: Tumour site Tumour depth (how much deeper it has invaded the surrounding tissue) Type of histology of the cancer Degree of differentiation of the cancer Presence of perineural spread (i.e spread along the adjacent nerves) Level and size of metastatic/secondary lymph nodes Mandibular invasion
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D R. V INCENT T AN Consultant Ear, Nose and Throat, Head and Neck Surgeon, MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore) Fellowship in Head and Neck Oncology & Surgery (Amsterdam)
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