Treatment of oral tumors. Benign tumors of the oral cavity

Malignant tumors of the oral cavity are cancerous pathologies that develop in epithelial or connective tissuescharacterized by infiltrative growth and early metastasis.

It manifests itself in the form of papillary or ulcerative formations. Is accompanied by soreness and fast transition from stage to stage.

Depending on the location of the tumor, cancer is divided into the following types:

• buccal - localized in the corners of the mouth and at first looks like an ulcer. Then - education grows and interferes with eating, and the mouth can only be opened to a certain part;
• bottom cancer oral cavity - affects the muscle tissue of the bottom and the lower lingual region;
• language education - the tumor develops on its lateral zones, less often at the root or at the end;
• alveolar cancer - located both on the top and on lower jaw;
• palatine - amazing soft tissue sky.

Causes

Based on the data of the studies carried out, we can confidently talk about the following reasons for the development of the pathology of this organ:

• abnormal tissue changes - appear due to inflammatory processes of any etiology, up to dyskeratosis;
• nicotine and alcohol addiction - their systematic use disrupts the structure of the soft tissues of the oral cavity, provokes cellular mutation and causes cancer;
• mechanical injuries of a chronic nature - regular rubbing with sharp chips of bison, improperly made implants or removable dentures;
• specificity of the products used - excessively spicy or too hot dishes injure the mucous membrane and change its quality content.

Clinical picture

Depending on the zone of localization of the malignant tumor, the clinical picture and symptoms of the course of the disease can be different and look as follows.

Tongue

With lesions of the lateral segments of the organ, a more intense pain syndromethan with the defeat of the base or tip. The most severe discomfort is during swallowing.

The tumor looks like a large ulcer, the edges of which are blurred, the structure is denser than in the middle. When pressed or rubbed, it bleeds. When probing the surface of the pathology, the doctor can palpate the infiltrate, and its consistency is quite dense. Often accompanied by itching.

Sky

The most painful type of oral oncology. It is characterized by the rapid growth of the tumor, its rapid manifestation, extensive metastasis in the early stages of the disease. It is extremely difficult to transfer, the pain is almost impossible to stop. Disgust for food and communication appears. Speech is difficult.

Bottom muscles

If the cancerous seal is concentrated in the area of \u200b\u200bthe floor of the mouth, then the patient there is always a feeling of being under the tongue of a foreign object.

The pain is present, but less intense than in the situation described above, and occurs mainly episodically, at the time of chewing food fragments. If acidic or salty components come into contact, long time the burning effect remains in the affected area by the anomaly. Hypersalvation is present.

Salivary glands

A characteristic feature of salivary gland tumors is their "ragged", irregular shape. Small in size, they characterized by a multiplicity of formations, over time developing into a single seal... It complicates the respiratory processes, prevents the full opening of the mouth, interferes with speaking.

Cheeks

This form of oral cavity cancer is accompanied by papillary lesions and ulcerative formations. Characterized by inflammation of the lymph nodes, concentrated in the submandibular area. Sometimes - a change in the timbre of the voice.

Gum

Gum cancer remains undetected longer than others. The main symptoms appear when the pathology is already actively progressing. The pain syndrome is extensive, at advanced stages it radiates to the temporal region and the ear zone.

Manifests itself as whitish formations, gradually developing into red-blue ulcers... It provokes diseases of the teeth and bone tissues.

Stages

Depending on the damaging effect on the organ of cancerous manifestations, as well as the size of the tumor, oncologists distinguish the following stages of the course of the disease:

• 1st stage - the anomaly is still concentrated in the mucous tissues of the cavity. Retains its size and does not leave the organ. Not more than a few millimeters in size. Symptoms are completely absent;
• Stage 2 - pathology is rapidly increasing, its size is of the order of several cm in diameter. Despite the pronounced progress of the anomaly, neighboring the lymph nodes still normal and have no cancerous lesions. Metastases were also not identified;
• Stage 3 - the tumor is more than 5 cm, lymphatic system amazed. Education is actively spreading to neighboring departments and systems. Metastasis processes have started. Irreversible processes began in the body. The symptoms are extremely painful;
• Stage 4 - the final stage of oral cavity cancer. Almost all vital organs are affected by metastases. The situation is completely out of control. None of the treatments work. The bones of the face, sinuses, brain regions are all at the stage of dysfunction.

Metastasis

Cancer pathology is characterized by a high rate of germination into the surrounding tissue layers. The degree of activity of the development of the seal is determined by its shape and location.

The development of pathology is carried out in the overflow of mutant cells into the lymphatic ducts and nodal junctions.

• For oncology of the cheeks and alveoli the disease spreads to the mandibular zone.
• Anomalies that developed in the distal zones, metastasize to the jugular vein.
• With the defeat of the departments of the language metastatic processes work in the area of \u200b\u200bthe submandibular lymph nodes and cervical joints.

Distant metastases destroy bone tissue skull, liver, pulmonary system, heart.

Diagnostics

In order to identify the disease, as well as to obtain a complete clinical picture development of the disease, use the following methods for its diagnosis:

• inspection - the first step towards the detection of oral cancer. By visual examination, a specialist can identify a seal or ulcerative formation, and by palpation, find out its structure. Based on the results of the manipulation, additional examinations are prescribed;
• liquid test - the contrast agent is applied to the affected area and makes it possible to accurately identify the focus of localization, the size, shape and condition of the tumor;
• laryngoscopy - with the help of special devices, the most difficult areas for visual inspection are viewed. The size and shape of the pathology is determined. During the laryngoscopy, a sample of the material is taken for research;
• biopsy - a fragment of abnormal tissues taken for microscopic analysis allows one to diagnose the nature of the origin of the tumor and the degree of its aggressiveness as accurately as possible.

Treatment

To eliminate the tumor, surgical removal and X-ray therapy are used. These methods are shown for both single and complex applications.

Deleting

Surgical intervention involves several methods of its implementation, depending on the location of the lesion. Almost always, such removals do without excision of hard tissue.

With the development of a tumor in the labial area, micrography is performed - the formation is amputated in several stages, layer by layer. At the same time, healthy tissues retain their integrity as much as possible.

Sometimes, if access to the seal is difficult, it is necessary to amputate healthy parts of the organ in order to get to the neoplasm. In such situations, the removed fragments are then prosthetic.

Often after a successful surgical operation the patient is prescribed plastic to eliminate cosmetic defects of the face.

Irradiation

The most commonly used method. It is prescribed after the operation to consolidate the positive dynamics. If the tumor is small, it is used autonomously.

X-rays neutralize cancer cells, prevent the appearance of new ones. The method relieves pain syndrome, facilitates the process of chewing food, normalizes speech function.

As for chemotherapy, it is practically not used to treat mouth tumors. due to low efficiency. In addition, these drugs are characterized by a pronounced side effect in the form of bleeding and the appearance of new ulcerative manifestations in the oral cavity, which further exacerbates the situation.

A lot of useful information in a video from a medical conference dedicated to the treatment of malignant tumors of the oral mucosa:

Forecast

The prognosis for a complete cure of the disease will be favorable only in the initial stages of the development of the disease. In other cases, the statistics are pretty sad.

So, with a successful treatment, depending on the stage, they have a chance to overcome the 5th milestone:

• 1st stage - 86% of patients;
• 2 – 51%;
• 3 – 32%;
• Stage 4 - only 6% of patients live this period of time.

The postoperative consequences include not only the complexity of the rehabilitation period, but also visible facial defects. Some of them cannot be eliminated for a number of reasons, but most of the anomalies are corrected with the help of plastics.

Today, in the arsenal of plastic surgeons, there is a huge number of techniques that can return a patient to a normal appearance. At the same time, prosthetics are successfully used for amputation of fragments of the oral cavity.

Photo of the patient after surgery

With the use of microsurgical technologies and the use of high-quality plastic materials, external defects after such manipulations become almost invisible, and artificial tissues quickly and successfully take root in the cavity.

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Malignant tumors of the oral cavity develop in men 5-7 times more often than in women. Most often people are sick at the age of 60-70 years.

Among neoplasms of the oral cavity, 65% are malignant tumors of the tongue, 12.9% are in the mucous membranes of the cheeks, 10.9% are at the bottom of the oral cavity, 8.9 are at the mucous membrane of the alveolar processes of the upper jaw and hard palate, 6.2% - on the soft palate, 5.9% - on the mucous membrane of the alveolar process of the lower jaw, 1.5% - on the uvula of the soft palate, 1.3% - on the anterior palatine arches.

Precancerous conditions:

Obligate precancer: Bowen's disease and Keir's erythroplasia.

Optional precancer: verrucous and erosive forms of leukoplakia, papilloma and papillomatosis of the gums.

Background diseases: smokers' leukoplakia, flat leukoplakia, chronic oral ulcers.

Factors contributing to malignancy:

bad household habits (smoking, alcohol abuse, nasa consumption, betel nut chewing);

harmful production factors (chemical production, hot shops, work in dusty rooms, constant exposure to the open air, in a humid environment at low temperatures, excessive insolation);

the nature of the diet (insufficient content of vitamin A in food or a violation of its digestibility, the systematic use of too hot food, spicy foods);

chronic mechanical injury a crown of a decayed tooth, a sharp edge of a filling or a poorly manufactured prosthesis;

a single mechanical injury (biting the tongue or cheek while eating or talking, damage to the mucous membrane with an instrument during treatment or tooth extraction.

International histological classification of oral malignant tumors:

Intraepithelial carcinoma (carcinoma in citu).

Squamous cell carcinoma - the underlying connective tissue grows.

Varieties of squamous cell carcinoma:

keratinizing squamous cell carcinoma (verrucous carcinoma);

non-keratinizing squamous cell carcinoma;

low-grade cancer consists of spindle-shaped cells that resemble sarcoma. This type of cancer is significantly more malignant than the previous ones.

Sarcomasarising in the oral cavity, are quite diverse, but they are more rare than malignant tumors of epithelial origin.

There are fibrosarcoma, liposarcoma, leiomyosarcoma, rhabdomyosarcoma, chondrosarcoma, hemangioendothelioma (angiosarcoma), hemangioperacytoma.

There are four stages of cancer of the oral mucosa.

I stage - a tumor (papillary growth), an infiltrate or ulcer up to 2 cm in diameter, which does not go beyond any part of the oral cavity (cheek, gum, palate, floor of the mouth), limited by the mucous membrane. In regional lymph nodes, metastases are not detected.

II stage - a lesion of the same or larger diameter, which does not go beyond any one part of the oral cavity, although it spreads into the submucosal layer. In regional lymph nodes - single mobile metastases.

III stage - the tumor has invaded the underlying soft tissues (but not deeper than the periosteum of the jaw), has spread to adjacent parts of the oral cavity (for example, from the cheek to the gum). In regional lymph nodes - multiple mobile or limited mobile metastases up to 2 cm in diameter. A tumor of a smaller size can be determined, but limitedly mobile or bilateral metastases are determined in the regional lymph nodes.

IV stage - the lesion spreads to several parts of the oral cavity and deeply infiltrates the underlying tissues, bones of the face, ulcers its skin. In regional lymph nodes - motionless or decaying metastases. A tumor of smaller size can be determined, but with the presence of distant metastases.

Cancer of the tonguemore common in the middle third of the lateral surface of the organ (62-70%) and at the root. The lower surface, the back (7%) and the tip of the tongue (3%) are much less frequently affected. Cancer of the tongue root occurs in 20-40% of patients. Squamous cell carcinoma of the anterior parts of the tongue is more often of 1-2 degrees of malignancy and comes from the small salivary glands.

Classification. According to the degree of spread, four stages of tongue cancer are distinguished:

I stage - a limited tumor or ulcer measuring from 0.5 to 1 cm in diameter, located in the thickness of the mucous membrane and submucosa. At the same time, there are no metastases in regional nodes.

II stage - a tumor or ulcer of large sizes - up to 2 cm in diameter, growing into the thickness of the underlying muscle tissuebut not beyond half of the tongue. In the submandibular and chin areas, there are single mobile metastases.

III stage - a tumor or ulcer occupies half of the tongue and extends beyond its midline or to the bottom of the mouth. Language mobility is limited. Determined by mobile multiple regional metastases or single, but limited mobile.

IV stage - a large tumor or ulcer that affects most of the tongue extends not only to adjacent soft tissues, but also to the bones of the facial skeleton. There are multiple regional, limited mobility, or solitary, but immobile, metastases.

Patients often find malignant tumors of the tongue on their own and quite early (with the exception of hard-to-reach distal parts). This occurs as a result of the appearance of painful sensations, early-onset functional disorders (chewing, swallowing, speech). With the help of a mirror, patients often examine the diseased part of the tongue themselves, while identifying pathological formations. On palpation, the presence of a dense tumor infiltrate at the base of the ulcer is determined. Sometimes the discrepancy between the size of a small ulcer and a large, deep infiltration around it is striking. The size of the tumor of the tongue increases in the direction from the tip to the root. It is necessary to take into account the possibility of tumor spread beyond the midline of the tongue. Pain in cancer of the tongue is initially localized, of low intensity. As the tumor grows, they become permanent, become more and more intense, and radiate along the branches of the trigeminal nerve. In the terminal stages, patients have difficulty speaking, often cannot eat or even drink. Respiratory failure in distal localizations is possible due to obturation by a tumor of the oropharynx.

A characteristic feature of malignant tumors of the tongue is frequent and early metastasis to regional lymph nodes. The presence of a dense lymphatic network, a large number of lymphovenous anastomoses between the vessels of both halves of the tongue explains the frequency of contralateral and bilateral metastases. The direct confluence of the lymphatic vessels of the distal parts of the tongue into the deep lymph nodes of the upper third of the neck leads to early detection of metastases in this group of lymph nodes. Often, patients find a lump in the neck, and not in the area of \u200b\u200bthe tongue, and turn to a general surgeon or therapist. If the doctor assesses these manifestations as lymphadenitis, then incorrect therapeutic tactics leads to neglect of the tumor process.

Oral floor cancer.Mostly men aged 50-70 are ill. Topographic and anatomical features are associated with proximity and, therefore, the possibility of spreading to the lower surface of the tongue, the alveolar process of the lower jaw, the opposite side of the floor of the mouth, which is a poor prognostic sign. In the terminal stage, the tumor invades the muscles of the floor of the oral cavity, the submandibular salivary glands, making it difficult to determine the starting point of growth. Often, the spread of the tumor occurs paravasally along the lingual artery system. Initially, patients notice a swelling felt by the tongue. With ulceration, pain appears, hypersalivation; when talking and eating, the pain increases. Repeated bleeding is possible. Sometimes, as with tongue cancer, the first sign is a metastatic lump in the neck. With localizations in the posterior parts of the floor of the oral cavity, the ulcer often looks like a gap. According to the histological type of tumor of this localization, most often squamous cell carcinomas.

Cancer of the mucous membrane of the cheeks... IN initial stage a malignant tumor can be difficult to distinguish from a banal ulcer. The localization of cancerous lesions of the cheeks is typical: the corners of the mouth, the line of closing of the teeth, the retromolar region.

Symptoms: pain when talking, eating, swallowing. Damage to the distal regions of the region leads to restriction of opening of the mouth due to the invasion of the chewing or internal pterygoid muscles. Cancer of the mucous membrane of the cheeks is more common in older men than malignant tumors of other localizations of the oral cavity.

Cancer of the mucous membrane of the palate... Malignant tumors from small salivary glands (cylindromas, adenocystic carcinomas) often appear on the hard palate. Squamous cell carcinoma of this localization is rare. Often there are secondary tumors as a result of the spread of cancer of the upper jaw, nasal cavity.

On the other hand, squamous cell carcinomas are more common in the soft palate. The morphological features of tumors of this localization are reflected in their clinical course. Cancer of the hard palate quickly ulcerates, causing discomfort at first, and later pain, which intensifies with eating and talking. Neoplasms from small salivary glands can be small for a long time, growing slowly, painlessly. In such patients, the first and main complaint is the presence of a tumor on the hard palate. As the tumor grows and the pressure on the mucous membrane increases, it ulcerates, a secondary infection joins. Pains appear. The underlying palatine process is early involved in the tumor process.

Cancer of the anterior palatine arches- more differentiated and less prone to metastasis. It usually occurs in men aged 60-70 years. Complaints of discomfort in the throat, later - pains that worsen when swallowing. Restricted mouth opening and recurrent bleeding are late and prognostically poor symptoms.

Mucosal cancer alveolar processes of the upper and lower jaws. Almost always has the structure of squamous cell carcinoma. It manifests itself quite early, because teeth are involved in the process and toothache occurs. This can lead the doctor down the wrong path. In the initial period, the tumor is local and bleeds with light touch. Infiltration of the underlying bone tissue occurs after several months and is considered a late manifestation of the disease. The extent of spread to bone is determined radiographically. Regional metastasis is observed in one third of patients.

Features of regional metastasis of malignant tumors of the oral cavity. Oral cancer usually spreads to the superficial and deep lymph nodes of the neck. The frequency of metastasis is high and, according to various sources, is 40-70%.

With damage to the mucous membrane of the cheeks, the floor of the mouth and the alveolar processes of the lower jaw, metastases are found in the submandibular lymph nodes. Chin lymph nodes are rarely affected by metastases when tumors are localized in the anterior parts of these organs.

Cancer tumors of the distal oral cavity often metastasize to the middle and upper jugular lymph nodes. With damage to the mucous membrane of the oral surface of the alveolar processes of the upper jaw, metastasis occurs in the retropharyngeal lymph nodes, which are inaccessible for palpation and surgical removal.

Distant metastases in oral cancer are rare. According to US oncologists, they are diagnosed in 1-5% of patients. Distant metastases can affect the lungs, heart, liver, brain, bones of the skeleton. Their diagnosis is very difficult and in some patients they are detected only at autopsy.

Treatment malignant neoplasms of the oral cavity is a very complex problem.

Conditionally, treatment can be divided into two stages:

1. Treatment of the primary focus;

2. Treatment of regional metastases.

Radiation, surgical and combined methods are used to treat the primary focus. One of the most common methods of treating tumors of this localization is radiation. It is used in 89% of patients with malignant tumors of the oral cavity.

Many authors point to the advantages of combined radiation therapy, when, at the first stage of the course, external external irradiation is used in the SOD of about 50 Gy, and then they switch to the method of interstitial irradiation, giving an additional dose of about 30-35 Gy.

The use of chemotherapy, especially a complex of chemotherapy drugs, made it possible to ensure tumor regression in some cases by more than 50% of the initial value. At the same time, it turned out that squamous cell carcinoma of the oral cavity is sensitive, mainly, to two drugs: methotrexate and bleomycin.

The surgical method of treating malignant tumors of the oral cavity is performed according to all the rules adopted in oncology: i.e. resection of the affected organ should be carried out within healthy tissues, departing from the visible and palpable borders of the tumor by 2.5-3.0 cm. The isolated surgical method for this localization of neoplasms is practically not used due to their special malignancy.

The most common type to date surgical interventions for tongue cancer, hemiglossectomy (half resection) is performed. This operation was first performed by a Dane Pimperhell in 1916.

The oral cavity is prone to a wide variety of diseases. Some of them negatively affect only the mucous membrane and teeth, others lead to more serious consequences, affecting all body systems.

These diseases include oral cancer.

Types and forms

Cancer that occurs in the oral cavity divided into several types, differing in the place of localization:

• bottom of mouth... Differs in active tumor growth, rapidly growing into the salivary glands, lower part tongue and jaw muscles. Further spread occurs through the artery system of the language department;
• language... It is mainly localized on the lateral surfaces of the tongue and its root. Root cancer occurs in 40% of cases. Occasionally found on the tip, dorsum and bottom;
• cheeks... Oncology most often develops at the level of the corners of the mouth in the area of \u200b\u200bthe molars. Often, the disease at first looks like an ordinary ulcer;
• palate... This cancer is characterized by rapid spread to the alveolar ridge.

The listed types of cancer can manifest themselves in various forms:

• Papillary... It is characterized by the appearance of small, elongated seals hanging into the oral cavity.
  This form is considered the easiest and rarely spreads beyond the site of localization.
• Knotty... It is manifested by the formation of rounded seals that have the correct shape. The structure and color of the mucous membrane does not change.
  In some cases, the seals may be covered with a whitish coating.
• Ulcerative... The most common form of pathology.
  It is characterized by the appearance of long-term non-healing manifestations of the mucous membrane of the lips or cheeks, which are constantly increasing in size.

Causes

Numerous studies and observations have revealed the main causes that act as factors provoking the disease. Smoking is the main reason. Because of it, a tumor occurs in 95% of cases.

Rest 5% of pathology is caused by the following reasons:

• alcohol abuse;
• papilloma virus (type 16);
• lichen planus;
• dental diseases in chronic formwhich lead to pathological changes structures of the tissues of the mouth;
• leukoplakia;
• erythroplasia;
• mechanical injuries of a permanent nature that remain without treatment;
• lack of vitamin A.

Symptoms and Signs

It is impossible to detect cancer on your own at home, but there are a number of certain symptoms, the manifestation of which should alert a person.

With the following symptoms, which may be the first signs of the disease, the patient must visit a doctor:

• long-term non-healing ulcers;
• pronounced swelling or induration, which can be detected by palpation or visually;
• decrease or complete loss of sensitivity;
• discoloration of the mucous membrane. Manifestations on it of spots of white or red color;
• difficulty swallowing and chewing;
• causeless pain radiating to the temporal lobe, or sensation of a foreign body in the larynx;
• swelling of tissues;
• disruption of work vocal cords;
• increased salivation;
• bleeding.

Data symptoms are not always precursors of malignant tumors.

By their appearance, more than one dental disease can be diagnosed, therefore, for an accurate diagnosis, it is imperative to visit a specialist.

Phases and stages

The development of a malignant tumor is a complex process that consists of several phases and stages.

Depending on the nature of the general clinical picture distinguish between the following degrees:

• Initial... This phase is characterized by the appearance of painful sensations in the oral cavity and shallow ulcers and seals.
• Active... Seals grow, taking the form of a pronounced tumor. Ulcers degenerate into deep wounds. The pain intensifies, accompanied by general weakness and sudden weight loss.
• Launched... The tumor grows, penetrating the surrounding tissues and nearby organs, gradually destroying them.

Based on the size of the lesions and the depth of penetration of the tumor into the tissue, distinguish certain stages:

• Initial (zero)... The development of education cannot be detected visually. Often, cancer at this stage is discovered by chance, during third-party examinations.
• The first... Unlike zero, it is characterized by the appearance of neoplasms up to 2 cm in diameter, which are located on the surface.
• The second... At this stage, the tumor grows up to 4 cm, affecting the deep layers of tissues.
• The third... Differs in an increase in the diameter of cancerous areas from 4 cm or more. As a rule, at this stage, the tumor affects the lymph nodes located nearby, the temperature may rise.
• Fourth... It is characterized by intense tumor growth and the onset of metastasis.

Diagnostics

All types of cancer can be in the body without showing any signs for a long time. In this case, only a thorough diagnosis will help to identify the disease.

Analyzes

To determine if cancer is in the body, the doctor must order a blood test.

Typically assigned several types of this analysis:

• General... He is not able to show the presence of cancer cells, but the development of inflammation can indicate an increased ESR and a decreased hemoglobin.
• For tumor markers... This assay aims to identify proteins and antigens produced by cancer cells. Tumor markers are also found in the blood of healthy people, but with serious pathologies, this indicator increases several times.

In both cases, blood is donated in the morning and only on an empty stomach.

Normally, a fence should be taken for analysis several times, this will allow, without additional examinations, to trace the dynamics of the development of pathology.

Surveys

For the need for regular examinations for early diagnosis of oral cancer, see the video:

For detailed information, use additional methods survey:

• visual method. It consists in a routine examination of the inflamed area, assessing the quality of the tissue structure, size and shape of the tumor;
• radiological... Used to identify pathologies from a secondary lesion that has spread to the jaw bone;
• morphological... For research using this method, a biopsy material is taken. He is sent for histology to determine the structure, volume and spread of the tumor into the surrounding tissue. Most often, it is on the basis of this method that treatment is prescribed;
• MRI... Use to determine the volume of cancerous lesions and the presence of metastases.

Therapy

Oral cancer responds well to treatment traditional methods, even if found in the later stages. The therapy process is developed individually, based on data obtained only after a comprehensive examination.

One of the methods is used to treat cancer or their complex:

• Radiation therapy... Appointed only with constant monitoring thyroid gland... During the procedure, the patient is inside the chamber, where he receives a dose of radiation.
• Operative intervention... It is carried out with a clear localization of the tumor, without spreading to surrounding healthy tissues.
• Chemotherapy method... As a rule, it is performed after surgical removal of the formation in order to suppress the active growth of pathological tissue.

How effective is it?

The prognosis of the effectiveness of the treatment will depend not only on the method used, but also on the stage of the disease.

The radiation technique is especially effective in the initial and first stages of cancer. To obtain the effect, remote gamma therapy or its combination with the intracavitary one is most often used.

Even as an independent method, it has positive result: in the first stage of cancer of the tongue and cheek in almost 90% of cases, and in the second - about 70%.

When treating cancer of the floor of the mouth, this figure is slightly lower, and for stage 1 it is 60%, and for stage 2 - 43%.

Radiation therapy does not cope well with stage 3 of the disease... The percentage of people cured does not exceed 25.

Combined techniquewhich includes surgery and chemotherapy, on the contrary, it shows high efficiency in later stages:

• The results in the treatment of stage 3 cancer of the mucous membrane or tongue are 95%.
• When treating cancer of the cheek and floor of the mouth, the rate drops to 37%.

Side effects

Methods for eliminating cancers are aggressive, and therefore have many side effectsharmful to the whole body.

After chemotherapyand the following side effectsi:

• stool disturbance;
• nausea and vomiting;
• baldness;
• decline immune defense organism.

Radiation therapy also causes side effects:

• disruption of the thyroid gland;
• skin burn;
• deterioration of the elasticity of the vocal cords, which leads to a change in the timbre of the voice;
• the appearance of pain in the nasopharynx.

Photo: squamous cell keratinizing cancer of the oral cavity

Are relapses possible?

Unfortunately, even after effective treatment, in 20% of patients, relapses occur.

As a rule, they develop within 3 years after the therapy. The cause of relapses can be both treatment carried out in the later stages, and disturbances in the functioning of the body's systems.

Due to the possibility of relapses, doctors recommend visiting specialists for a preventive examination at least once a quarter in the first 3 years after therapy.

Are there ways to prevent it?

To prevent cancer or reduce the risk of cancer recurrence, certain rules must be followed:

• Quit smoking and drinking alcohol completely.
• Balance your diet with a variety of vegetables and fruits.
• Do not avoid preventive examinations.
• In the presence of dental pathologies, timely qualified treatment should be carried out.
• Eliminate the possibility of injury to the mucous membrane.

Oral cancer is a serious disease that cannot be treated with home remedies and requires comprehensive diagnosis and treatment.

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Section 22Tumors and tumor-like formations of the face and neck

In the structure of tumors and tumor-like formations of the face and neck, the proportion of malignant tumors is relatively small. However, an increase in morbidity, high mortality, severe facial deformities, severe functional disorders after treatment for common tumors require an increase in the effectiveness of dentists in the prevention, early and timely diagnosis of the tumors in question. The approach to the choice of ways to solve these problems should be differentiated, taking into account the localization, tissue belonging, biological characteristics of the tumor process.

In children, tumors have characteristic features of origin, pathomorphological structure and clinical manifestations. In childhood, benign tumors and tumor-like processes predominate. Children are characterized by their very rapid growth, therefore, all diagnostic measures should be performed as soon as possible, and therapeutic measures should begin immediately after the diagnosis is established.

By localization, tumors and tumor-like formations are distinguished:

Oral cavity and oropharynx;

Lips (mainly the lower lip);

Jaws and other bones of the facial skeleton;

Salivary glands (large);

Facial skin and its appendages;

Lymphatic apparatus;

Ears and outer nose.

In some types of tumors and dysplastic processes, there is a pronounced relationship with the sex of the child. In boys, giant cell tumors, lymphangiomas, angiofibromas, malignant tumors of the lymphatic system are more common, in girls - hemangiomas, teratomas, papillomas of the oral mucosa, Albright's syndrome.

One of the most important features of childhood tumors is a family predisposition to certain neoplasms: gingival fibromatosis, neurofibromatosis, cherubism, osteomatosis of the jaw bones, hemangioma. Careful questioning of parents in order to identify the burdened heredity facilitates the timely recognition of these tumors and helps to outline ways of their prevention.

Tumors and tumor-like formations of the organs of the oral cavity, lips and oropharynx

According to the international classification (1974), tumors and tumor-like neoplasms of this localization are systematized as follows.

I. Tumors originating from stratified squamous epithelium:

Benign (squamous cell papilloma);

Malignant (intraepithelial carcinoma / carcinoma in situ /; squamous cell carcinoma; varieties of squamous cell carcinoma / verrucous carcinoma, spindle cell carcinoma, lymphoepithelioma /);

II. Tumors originating from the glandular epithelium(see Tumors of the salivary glands);

III. Tumors originating from soft tissues:

Benign (fibroma; lipoma; leiomyoma; rhabdomyoma; chondroma; osteochondroma; hemangioma / capillary, cavernous /; benign hemangioendothelioma; benign hemangiopericytoma; lymphangioma / capillary; cavernous; cystic / neurofibromoma /; neurofibromoma

Malignant (fibrosarcoma; liposarcoma; leiomyosarcoma; rhabdomyosarcoma; chondrosarcoma; malignant hemangioendothelioma / angiosarcoma /; malignant hemangiopericytoma; malignant lymphangioendothelioma / lymphangiosarcoma /; malignant schwannoma)

IV... Tumors originating from the melanogenic system(pigmented nevus; non-pigmented nevus; malignant melanoma);

V... Tumors of controversial and unclear histogenesis:

Benign (myxoma; granular cell tumor / granular cell "myoblastoma" /; congenital "myoblastoma");

Malignant (malignant granular cell tumor; alveolar soft tissue sarcoma; Kaposi's sarcoma);

VI... Unclassified tumors;

Vii... Tumor-like conditions(common wart; papillary hyperplasia; benign lymphoepithelial lesion; mucous cyst; fibrous growth; congenital fibromatosis; xanthogranuloma; pyogenic granuloma; peripheral giant cell granuloma / giant cell epulide /; traumatic neuroma; neurofibromatosis).

Among patients with malignant tumors of the oral cavity, lips and pharynx, the main group consists of patients with cancer of the oral mucosa, tongue, red border of the lower lip, oropharynx. This is followed by a group of patients with adenocarcinoma of the oral mucosa and tongue arising from the glandular epithelium of the small salivary glands. Less common are malignant tumors of connective tissue genesis - sarcoma, tumors from the myelogenous system - melanomas and malignant tumors of unknown origin.

In half of patients with cancer of the mucous membrane of the oral cavity, tongue, lower lip, its appearance is preceded by a pathological process (precancer), and in 70-80% patients are recorded long-term exposure to the mucous membrane of chemical, mechanical, thermal factors related to the group of carcinogens or co-carcinogens. This serves as the basis for raising the question of the possibility and necessity of cancer prevention of this localization.

The highest prevalence of tumors and tumor-like formations of the oral cavity in children occurs in the first year of life, and then in children aged 12-16 years. In early childhood, neoplasms of a dysontogenetic nature predominate. They arise as a result of a violation of the genetic programs of intracellular division or the process of development and differentiation of the embryo and are clinically manifested in children under the age of 5 years. An increase in the incidence of neoplasms in children aged 7-11 years is associated with the period of the most active growth of facial bones, and in children aged 12-16 years - with increased endocrine activity.

In children, neoplasms of epithelial origin predominate in the oral cavity and oropharynx, originating from the integumentary, tooth-forming and glandular epithelium, less often from connective tissue, blood and lymphatic vessels, and, extremely rarely, neurogenic tumors.

The first report on precancerous changes in the skin and mucous membranes was made in 1896 by Dubright, who called them keratosis precarcenoses. From a pathomorphological point of view, precancer is characterized by the phenomena of hyperplasia, hypertrophy, metaplasia of the epithelium into cells of lower differentiation.

There are four stages in the development of a malignant tumor (Shabad L.M., 1967):

Uneven diffuse hyperplasia;

The appearance of focal proliferates. This stage, bypassing the third stage, can pass into the fourth;

Benign tumor;

Malignant tumor.

From a clinical point of view, it is important that the described changes in tissues do not always lead to cancer. With the elimination of the carcinogenic effect, the further development of the process along the path of transformation into a malignant tumor may stop or its reverse development occurs.

In terms of the likelihood of cancer, pre-tumor changes are usually divided into obligateand optional:

The former include such pathological processes that are almost inevitably transformed into a malignant tumor;

With facultative precancerous changes, the likelihood of malignant transformation is not inevitable (fatal). Moreover, in the case of elimination of the carcinogenic effect, the reverse development of the pathological process can be observed.

The entire process from the onset of exposure to carcinogens that ultimately caused the appearance of cancer to the death of a patient as a result of progressive tumor growth can be represented graphically (Fig. 22.1).

Figure 22.1. Periods of carcinogenesis: I - the period of action of carcinogenic factors until the appearance of clinically detectable changes in tissues (can be calculated in tens of years); II - the period of clinically detectable precancerous changes in tissues (can last up to 10 years or more); III - preclinical period of the development of a malignant tumor (may last 1-2 years); IV- the clinical period of the development of a malignant tumor (without treatment, the average duration of this period in patients with cancer of the oral mucosa, tongue is 1-1.5 years: A- stage of locally limited tumor growth (3-4 months), B - stage of advanced tumor growth and generalization (8-9 months)

Carcinogenesis(Latin Cancer - cancer / malignant tumor/ + gr. Genos - origin) - the process of the emergence and development of a cancerous tumor. Carcinogens are substances of various chemical structures capable of causing cancer and other malignant and benign tumors when exposed to ultraviolet or ionizing radiation.

The period of action of carcinogenic factors.These factors cause reactive, initially imperceptible changes in tissues. The duration of this period can be calculated in decades. It depends on the aggressiveness of the carcinogen, the intensity, duration and regularity of the carcinogenic effect, the individual sensitivity of the organism to this effect.

The period of clinically detectable changes.The changes occurring in the tissues are interpreted as precancerous. This period can last up to 10 years or longer. Its duration also depends on the properties of the carcinogen, the intensity of its effect, the individual sensitivity of the organism and the effectiveness of the therapeutic and prophylactic measures taken. This period ends with the appearance of the first cells of a malignant tumor.

Preclinical period of tumor development.This period corresponds to the time elapsed from the appearance of the first cells of a malignant tumor until the moment when the tumor reaches such a size that it becomes noticeable, causes certain sensations in the patient, can be detected during examination, palpation. The preclinical period of the existence of a tumor can last up to 1-2 years or more (A.I. Gnaty-shak, 1975). This position is important for clinical oncology, as it opens up the possibility of detecting a tumor at the earliest stage using special diagnostic methods.

The clinical period of the development of a malignant tumor.It is divided into two phases: locally limited tumor growth and widespread tumor growth with generalization of the process.

Oral cavity and oropharyngeal cancer.For a detailed assessment of the prevalence of cancer of the oral mucosa, tongue, red border of lips, the international TNM classification is used:

T - primary tumor:

Tx - insufficient data to assess the primary tumor;

That - the primary tumor is not determined;

Tis - non-invasive carcinoma (carcinoma in situ);

Tl - tumor up to 2 cm in the largest dimension;

T2 - tumor up to 4 cm in greatest dimension;

T3 - tumor more than 4 cm in the largest dimension;

T4 - lip:the tumor spreads to neighboring structures - bone, tongue, neck skin;

- oral cavity:the tumor spreads to neighboring structures - bone, deep muscles of the tongue, maxillary sinus, skin;

N - the state of the regional lymphatic apparatus:

Nx - insufficient data to assess regional lymph nodes;

N0 - no signs of metastatic lesions of regional lymph nodes;

N1 - metastases in one lymph node on the affected side up to 3 cm in the largest dimension;

N2 - metastases in one lymph node on the affected side up to 6 cm in the largest dimension or metastases in several lymph nodes on the affected side up to 6 cm in the greatest dimension, or metastases in the lymph nodes of the neck on both sides or on the opposite side up to 6 cm in the largest measurement;

N2a - metastases in one lymph node on the affected side up to 6 cm in the largest dimension;

N2b - metastases in several lymph nodes on the affected side up to 6 cm in greatest dimension;

N2c - metastases in several lymph nodes on both sides or on the opposite side up to 6 cm in the greatest dimension;

N3 - metastases in lymph nodes over 6 cm in greatest dimension;

M- absence or presence of distant metastases:

Mx - not enough data to determine distant metastases;

M0 - no signs of distant metastases;

Ml - there are distant metastases.

Histopathological differentiation of cancer (G):

Gx - the degree of differentiation cannot be established;

G1 - high degree of differentiation;

G2 - medium degree differentiation;

G3 - low degree of differentiation;

G4 - undifferentiated tumors.

The stage of locally limited tumor (cancer) growth corresponds to the I-II stage of the disease according to the classification adopted in our country or the prevalence of the tumor process according to the value of T1N0M0, T2N0M0 according to the international TNM classification.

According to the Cancer Registry of St. Petersburg, there is an increase in the incidence of cancer of the oral mucosa and oropharynx. If in 1980 the standardized incidence rate of the city's population with cancer of this localization was 5.4; then in 1993-1994 it reached 8.7; that is, it increased 1.6 times (Merabishvili V.M., 1996). The same picture is observed in the whole Russian Federation. In these conditions, the problem of preventing cancer of the oral cavity and oropharynx acquires special relevance.

It should be noted that the gap between morbidity and mortality in cancer of the localization in question is small. This is primarily due to late diagnosis, since the result of treatment depends primarily on the prevalence of the tumor process. Thus, the five-year survival rate of patients with stage I tongue cancer reaches 90%, while 70% of patients with stage IV of the disease die within the first year after the tumor is detected (Holmand et al., 1979). At the same time, according to V.A. Korobkin (1995), in 61% of patients, cancer of the oral cavity and oropharynx is detected at stage III-IV of the disease, when the antitumor treatment is ineffective or the removal of the tumor is achieved through extended operations, leading to severe disability of the patient.

Considering the fact that from 70 to 80% of patients with oral cavity and oropharyngeal cancer seek medical help for the first time in dental institutions, every dentist, regardless of his profile, should show oncological alertness, know the clinical manifestations of cancer of this localization in the early stages of tumor growth, own methods of examining the oral cavity, oropharynx (direct examination, examination with a mirror, palpation); be able to take biological material for cytological, pathohistological research; to be guided in the organization of medical and diagnostic care for cancer patients in the region where he works.

The clinical manifestations of cancer of the oral cavity and oropharynx depend on the location, shape and stage of tumor growth. The frequency of damage to various parts of the oral cavity and oropharynx varies significantly depending on the socio-economic, ethnic characteristics of the population of certain regions. For example, where the bad habit of eating nasa, betel nut is widespread among the population (laying them under the tongue), cancer of the floor of the mouth is more common, where they are laid behind the cheek - cancer of the cheek, lateral part of the oropharynx.

In residents of the middle zone and north-west of Russia, the primary localization of cancer is most often observed in the area of \u200b\u200bthe tongue (40-45%), then the floor of the oral cavity (20-30%), the alveolar part of the lower and upper jaw (10-15%), cheeks (5-10%), lateral part of the oropharynx (10-20%). It should be noted that the primary tumor often occurs in the area of \u200b\u200bsuch border zones as the pterygo-maxillary fold, the zone of transition of the mucous membrane from the bottom of the oral cavity to the tongue, to the alveolar part of the jaw. In case of untimely treatment of the patient to the doctor, when the tumor already affects two or even three adjacent anatomical zones, it can be difficult to clarify the initial localization of the process.

Cancer of the tonguemost often occurs in its inferolateral regions on the border of the middle and posterior third. In every sixth patient with tongue cancer, the tumor affects the posterior third of the tongue, which is difficult to access for examination, requiring the use of special techniques during palpation. This circumstance should be taken into account when conducting preventive examinations and examining patients complaining of a sore throat when swallowing on one side. Cancer of the tongue, which is a mobile organ, is characterized by early onset of pain. It arises and intensifies when the tongue moves during a conversation, eating, swallowing saliva.

In childhood, dysembryonic tumors are more common in the tongue, therefore the nature and localization of tongue tumors are closely related to the embryogenesis of the tongue. In this regard, tumors of the tongue in children were allocated to an independent group. Children with new formations of such localization need a special examination. Tumors located in the posterior third of the tongue require special attention.

In the front two-thirds of the tongue, there are papilloma, neurinoma, myoblastomyoma, rhabdomyoma, which, as a rule, are combined with a congenital pathology of the development of the tongue and the anterior part of the alveolar part of the lower jaw.

The development of tumors and tumor-like formations in the posterior third of the tongue is usually associated with impaired embryogenesis of the lingual-thyroid duct (congenital median cysts and fistulas of the neck) or the thyroid gland. In some children, only individual embryonic areas of the thyroid gland can be localized at the root of the tongue in the presence of a normally developed and normally functioning thyroid gland. In other children, the bulk of the thyroid gland is retained at the root of the tongue, and in this case, the removal of the "tumor" will lead to the development of myxedema. Therefore, in the presence of any neoplasm in the root of the tongue, the child should be examined by an endocrinologist, and to clarify the diagnosis, a scan of the thyroid gland and the root of the tongue is performed.

Cancer of the mucous membrane of the floor of the mouthmore often occurs in the posterolateral regions, in the zone of transition of the mucous membrane from the alveolar part to the base of the tongue. Pain during spicy food intake is characteristic of this localization of cancer. When the tumor is located near the midline, in the area of \u200b\u200bthe mouth of the excretory ducts of the submandibular salivary glands, in the early stages of the disease, there may be difficulty in the outflow of saliva, accompanied by a temporary (after eating) or permanent increase in the submandibular salivary gland. Often a diagnostic error is allowed. The tumor is taken for a manifestation of sialodochitis and an unjustified surgical intervention is performed - dissection of the excretory duct of the salivary gland.

For cancer of the posterior part of the cheek, the area of \u200b\u200bthe pterygomandibular foldthe appearance of pain when opening the mouth is characteristic, and at a later stage (with the spread of the tumor to the external pterygoid muscle) - the development of contracture of the lower jaw.

For cancer of the mucous membrane of the alveolar edge of the jaws(gums) is characterized by pain and bleeding when brushing teeth. Usually, another symptom characteristic of cancer of this localization soon appears - the pathological mobility of one or more teeth caused by the destruction of the marginal periodontium.

The form of tumor growth. The most common forms of tumor growth are: ulcerative infiltrative, papillary (exophytic), infiltrative. It should be noted that over time, as the tumor grows into the underlying tissues, necrosis of a part of the tumor due to trauma, inadequate blood supply, one form of tumor growth can pass into another. For example, exophytic - into infiltrative, infiltrative - into infiltrative-ulcerative.

I
link-infiltrative formcancer occurs more often than other forms (more than 65% of patients). The shape and depth of a cancerous ulcer varies widely depending on the localization of the process and the stage of the disease. At the early stage of tumor growth, ulcers located in the area of \u200b\u200bthe hard palate, tongue of the cheek, usually have a round shape. The edges of the ulcer are raised in the form of a roller (Fig. 22.2).

Figure: 22.2.Ulcerative infiltrative cancer of the tongue

D
but covered with a fibrinous bloom, after removal of which a crater-like depression is visible, as if lined with fine-grained tissue, bleeding at light touch. In the area of \u200b\u200bthe floor of the mouth and palatine arches, the ulcer has an oval or irregular shape (Fig. 22.3). When the ulcer is localized in the posterior parts of the floor of the oral cavity, it has a slit shape and resembles in appearance a shell of a mollusc with ajar valves.

Figure: 22.3.Ulcerative-infiltrative cancer of the oral mucosa

As the tumor grows further, along with an increase in ulcer size, the geometric correctness of its contours is lost. This happens due to ulceration of the adjacent mucous membrane in the form of protrusions in one direction or another. This can expose the underlying bone tissue. If the tumor is p it is located in the area of \u200b\u200bthe alveolar edge of the jaw, destruction of the gums, periodontal tissues occurs, teeth mobility appears (Fig. 22.4).

Figure: 22.4.Cancer of the alveolar part of the lower jaw

Papillary (exophytic) formcancer occurs in approximately 25% of patients. In this form, the tumor looks like a patch of thickened tissue that rises above the surrounding mucous membrane. The surface of the tumor can be bumpy covered with scales of keratinizing epithelium or it is represented by pink papillary growths, resembling small fish eggs.

P
apillary forms of cancer often occur against the background of papillomatosis, verrucous leukoplakia. Having reached a certain size, papillary (exophytic) tumors are traumatized during eating, brushing teeth. Ulceration of the tumor occurs, pain appears, bleeding of moderate intensity can be observed (Fig. 22.5).

Figure: 22.5.Papillary (exophytic) cancer of the tongue

AND nfiltrative formcancer is relatively rare and the most difficult to diagnose. Patients with a similar form of the disease seek help from a doctor rather late, when severe pain appears, limitation of the mobility of the tongue occurs (Fig. 22.6). This is explained by the fact that most people associate the concept of a tumor with the idea of \u200b\u200ba mushroom-like formation, less often an ulcer.

Figure: 22.6.Infiltrative cancer of the tongue in a 19-year-old patient

With an infiltrative form of growth, diagnostic errors are often made by the doctor. A dense, slightly painful infiltrate, hyperemia of the mucous membrane covering it, enlarged regional lymph nodes - all this is often regarded as a manifestation of a specific or non-specific inflammatory process. Diagnosed with "glossitis", "sialodochitis", "palatinitis", "salivary stone disease", "actinomycosis" and subject the patient to unreasonable surgery (sometimes repeated), long-term conservative treatment, physiotherapy.

The stage of the disease as a whole determines the clinical picture. So in the period of preclinical development, the tumor does not manifest itself in anything. Due to its small size, it is impossible to detect it either visually (without the use of special optical equipment) or palpation. The patient's complaints are determined by the pathological process against which the cancer arose. The same process determines the data that can be obtained during examination and palpation of the oral cavity and oropharynx.

IN period of locally restricted growthtumor, the specificity of complaints and data of objective research can be noted, which is mainly determined by the localization and form of tumor growth. The pain is usually localized, of moderate intensity, constant in nature, often bothering at night. The general condition of the patient remains satisfactory.

IN period of widespread growth and generalizationtumor specificity of complaints and data of objective examination of the patient is gradually lost. Patients complain of constant, intense pain with a wide area of \u200b\u200birradiation, making it difficult or completely disturbing chewing and swallowing; weakness, sleep disturbance (due to pain). Due to malnutrition, intoxication, patients quickly lose weight, exhaustion and dehydration increase, up to cachexia. A putrid odor from the mouth is characteristic as a result of poor hygienic care of the oral cavity, tumor necrosis and the development of putrefactive microflora. At this stage of the disease (III-IV stage), when examining the oral cavity, a disintegrating tumor is usually detected, which spreads to several anatomical zones. A detailed examination of the oral cavity is often difficult due to the pronounced contracture of the lower jaw. Enlarged regional lymph nodes are determined, which can be fused to the surrounding tissues or to each other, forming packets.

Diagnostics. Taking into account the staging of the tumor process, three types of cancer diagnostics can be distinguished: early, timely and late.

Early diagnosis -detection of a tumor in the preclinical period of its development, when its size is still so small that it can be detected only by using magnifying optics, cytological, histological, immunomorphological, immunological, biochemical studies.

Timely diagnostics -detection of a tumor during the period of its locally limited growth, the appearance of the first metastases in regional lymph nodes. The use of modern methods of anticancer treatment at this stage of the disease (I-II stage) is quite effective.

03.03.2017

Among cancer diseases, cancer of the oral mucosa was recorded infrequently (3% of cases), but the number of cases is growing.

Early diagnosis increases the success of treatment. At an early stage, the disease is curable, especially if the tumor has not had time to affect the neighboring organs.

Men are more susceptible to this disease than women. Previously, the disease was recorded in patients over 50 years old, now in young people, and in some cases even in children. The risk of problems with the oral mucosa is associated with bad habits and lifestyle, personal hygiene, food, harmful working conditions and an unfavorable external environment.

Often the signs of the disease are detected by the dentist when examining or treating teeth and gums. Deviations in the state of the oral mucosa can be noticed on their own. Having felt the first symptoms of the disease, you need to see a doctor for help.

Forms of cancer of the oral mucosa

Cancer of the oral mucosa has the following forms:

1. Nodular - the appearance of a seal on a healthy mucosa, which begins to grow rapidly. Whitish spots may appear near a lesion that has dense edges.
2. Ulcerative - an ulcer appears on the mucous membrane, which worries the patient, for a long time does not heal, but begins to progress. It occurs in 50% of cases.
3. Papillary - a seal hanging from the mucous membrane in the oral cavity, growths on the mucous membrane can grow rapidly. With this form of cancer, tumor growth into adjacent tissues is not observed, so the treatment is successful.

Depending on the location of the tumor, the following types are distinguished:

• Cheek cancer.

The mucous membrane of the cheeks is most often prone to injury for various reasons. Neoplasms (seals, sores) appear on the inner surface of the cheeks, on the line or in the corners of the mouth. With large ulcers. There are discomforts and pains when talking and chewing, opening the mouth. When diagnosed, histological cancer is most often found. It is observed in 7.2% of cases.

• Oral floor cancer.

This area of \u200b\u200bthe mouth is composed of many muscles, blood vessels and lymphatic vessels, salivary glands. The neoplasm captures these tissues and quickly metastasizes. The patient feels the induration like a foreign body. Salivation, pain, decreased tongue mobility, difficulty swallowing appear. (24.6%) cases.

• Swelling of the tongue.

The tumor often appears on the lateral surfaces of the tongue, this pathology is more common. Less commonly - on the upper or lower part of the tongue, its tip or root. The mobility of the tongue decreases, there is pain when swallowing, difficulty in speaking. (43.5% of cases).

• Tumor in the alveolar processes.

The alveolar processes are the part of the jaw on which the teeth are located. The tumor appears on the upper or lower jaw and affects the teeth. May cause bleeding and pain in the area. (16%).

• Cancer in the area of \u200b\u200bthe palate.

The hard palate contains many small salivary glands. It is they who are affected by adenocarcioma or cylindroma - a tumor of the glands.

With the growth of the tumor, an infection can join and inflammatory process... There is pain and discomfort when eating and swallowing. The tumor can grow into the tissues and bones of the palate.

In the tissues of the soft palate, squamous cell carcinoma often occurs, which affects the soft tissues. Usually diagnosed early, less aggressive, and easier to treat. (8.7%).

• Gum cancer.Found on the gums of the lower jaw, it is rare, associated with the neglected condition of the teeth. Squamous cell carcinoma is characteristic of the gums - its histological type.
• Metastases.

Malignant neoplasms grow into nearby areas, tissues and lymph nodes in the form of metastases.

Regardless of the location of the tumor, the first signs of its formation: the appearance of an ulcer, induration and swelling without pain. Then pain at the site of neoplasia, with nerve damage - decreased sensitivity, numbness. Then pains in the temples, ear, head.

Causes of mucosal cancer

Factors that increase the risk of oral diseases that provoke cancer:

• Smoking, drug and alcohol consumption.
• Consuming alcohol-based mouthwashes and mouth fresheners.
• Poor dental condition (sharp edges of the tooth or fillings, uncomfortable dentures).
• Prolonged sun exposure.
• Inadequate nutrition (lack of vegetables, fruits, vitamins A. C, E), the use of foods that irritate the mucous membrane (too hot, spicy food).
• Weakened immunity long-term intake medicines.
• Contact with harmful chemicals (especially asbestos), paints and varnishes, dust, prolonged exposure to high temperatures.
• The entry into the body of the papilloma virus (HPV).

Currently, 600 strains (types) of papillomaviruses have been systematized. Some of them are harmless, some cause changes in tissues, the growth of warts, benign tumors and provoke cancer. In the human body, a virus can mutate from one species to another.

Oral cancer: symptoms

At first, the disease is similar to other, not so dangerous diseases. On the mucous membrane, spots appear, red (erythroplakia) or white (leukoplakia), which soon turn into an ulcer, induration or growth. Nodules may form in the mouth. Cracks that do not heal for a long time, but at first do not really bother the patient. These are not signs of cancer yet. But, if untreated, they can degenerate into cancerous growths.

With the further uncontrolled course of the disease, the symptoms become obvious and tangible:

• Long-term non-healing sores on the soft and hard areas of the palate.
• Bleeding and soreness of the oral mucosa.
• The pain begins to radiate to the jaw, ear, temple.
• Enlargement and numbness of the tongue.
• Poor gum health.
• Mobility, tooth loss.
• Swollen lymph nodes.
• Pain and swelling of the jaw.
• Weight loss.

Distant metastasis in cancer of the oral mucosa is extremely rare, alone in some advanced cases, even the lungs, liver, and bones can be affected.

Stages of mucosal cancer

Pretumor conditions of the mucosa:

Leukoplakia is a precancerous condition that can appear due to constant irritation and inflammation of the mucous membrane. It is manifested by keratinization of the mucous membrane and a red border on the lips.

Doctors consider external irritants to be the causes of the occurrence: hot tobacco smoke, burning lips when smoking a cigarette to the end, gastrointestinal tract pathology, lack of vitamin A, heredity, constant trauma due to poor dental health, the presence of dentures made of dissimilar metals in the mouth.

First, keratinization of a previously inflamed small area of \u200b\u200bthe mucous membrane occurs. A sign of malignancy is a partial, irregularly shaped seal in the area of \u200b\u200bkeratinization, a rapid increase in the size of erosion, and bleeding. Papillary growths.

Symptoms are similar to lichen planus, lupus erythematosus, syphilis. A biopsy is required for diagnosis. Prevention: tidying up the oral cavity (dental and gum treatment), treating gastrointestinal diseases, quitting smoking.

Erythroplakia

Small red foci with a large number of vessels appear on the mucous membrane. Half of these may be cancerous. Without delay, it is necessary to carry out examinations and start treatment.

Dysplasia (violation) - the appearance of violations in the process of maturation of cells: their irregular shape, change in size. With further development, dysplasia develops into cancer.

On stratified epithelium squamous cell carcinoma occurs in the oral mucosa, adenocarcioma (cancer of the glands) occurs on the salivary glands.

Regardless of the location of the tumor and its shape, the development of cancer goes through three periods:

1. Elementary.
2. Developed.
3. Launched.

Initial period... The patient complains of discomfort, sensation foreign body in the mouth, burning, pain when eating. On examination, the doctor may find small sores, erosion, outgrowths or whitish spots on the mucous membrane, seals on the upper layer or in the submucosa.

Developed period.The reason for going to the doctor is pain of varying intensity, which can be given to the ear, temple. During this period, it is important to determine the form of cancer:

Papillary form. Seals towering over the epithelium in the form of a hemisphere or on a wide leg. In the thickness of the tissue, an infiltrate is felt, which does not have clear boundaries. The tumor can be lumpy, fine-grained, bleeding with injury, with keratinized areas of the epithelium. When the infiltration spreads (compaction, accumulation of unusual cells with blood and lymph), patients complain of increased pain, bleeding, difficulty speaking and chewing.

Ulcerative infiltrative. It occurs in 65% of cases. The tumor has the form of an ulcer with roller-like, raised above the mucous edges. The crater-like bottom of the ulcer is covered with fine-grained tissue, bleeds when injured. Under the ulcer, a seal is palpable, which is larger in size and tends to spread to adjacent tissues.

The period of neglect.Depending on the place of the initial focus, the tumor can spread to the cheeks, the floor of the mouth, the palate, the lateral parts of the pharynx, and bone tissue.

Diagnosis of mucosal cancer

If you suspect cancer of the oral mucosa, you should contact an otolaryngologist. A preliminary examination by a specialist can detect suspicious places in the oral cavity: spots, ulcers, seals; check for enlarged lymph nodes.

The doctor examines the area using a special mirror and lamp, and uses an endoscope to carefully examine the areas under the tongue, the floor of the mouth and the pharynx.

For a correct diagnosis, it is not enough just inspection and pilping. To check, the lymph nodes are enlarged, they are affected by a tumor - radiation diagnostics are performed: ultrasound examination, computed tomography. To detect the penetration of metastases into the lymph nodes and neighboring organs, a cytological examination is performed. Take a puncture, smear-imprint or scraping of the affected tissue. The type, shape and number of cells are examined under a microscope.

Malignant cells have a distorted size, shape, and an incorrect ratio between the nucleus and the cell. Scintigraphy makes it possible to assess the condition of the jaws. A contrast solution is administered intravenously, X-ray is taken.

The histological appearance of the tumor is determined by a biopsy. When diagnosed - cancer, do not take it as a sentence, do not panic. The mental attitude and desire to be cured increases the chances of a full recovery.

Mucosal Cancer Treatment

The main method of treatment today is surgical removal of the tumor. If the disease is not yet at the stage of neglect, resection of the tumor and healthy tissue surrounding it is performed. If lymph nodes are already involved in the process, then they are also removed.

Bone tissue also has to be excised if metastases have affected the jaw. After extensive operations, it becomes necessary to reconstruct remote areas. Plastic and maxillofacial surgeons will help to reconstruct the affected parts of the face; parts of the bone can be replaced with an implant.

Using computed tomography data, the focusing of radiation is selected for conducting radiation therapy sessions. Special fixation devices and masks are used so as not to damage healthy tissues when the tumor is irradiated. For several hours or even days, thin radioactive rods and needles are inserted into the tumor to perform brachytherapy. The procedure is performed under local anesthesia.

Radiation therapy may cause side effects: the skin in the places of irradiation may redden and even hurt, the voice wheezes, due to a lack of saliva, it is difficult to swallow, the sensation of taste decreases. The doctor will prescribe necessary drugsto get rid of it. And after the termination of therapy, these phenomena gradually disappear.

Use medications to make radiotherapy more effective (eg Arbitox). This drug selectively destroys cancer cells. To destroy foci with metastases and remnants of cancer cells, as well as in case of relapses of the disease, chemotherapy is used.

In the treatment of cancer, in addition to surgeons and oncologists, a variety of specialists are involved. Rehabilitation may require the help of psychologists, dentists, speech therapists, physiotherapists, nutritionists and other specialists.

In the medicine of our time, there are many means of treating cancer. For more effective treatment, traditional medicine can also help.

For the prevention of diseases of the oral mucosa, it is necessary:

• Monitor oral hygiene;
• Visit your dentist regularly to maintain healthy teeth and gums;
• Correctly, eat in a balanced way (do not eat too hot, spicy food);
• In the presence of chronic diseases, be seen by a doctor;

At the first alarming symptoms in the oral cavity, contact your doctor. If necessary, undergo examination.