Oral Cancer In Seniors

Introduction

Oral cancer is a type of cancer that affects the mouth and the inside of the mouth. Oral cancer may look like white patches or sores that bleed easily on your lips, on the inside of your mouth and in areas of the tongue. In the case of oral cancer, these common lesions may not go away and get worse over time. If left untreated, oral cancer can spread to parts of the mouth, throat, head and neck.¹

Epidemiology and risk factors

In the UK, oral cancer is the ninth most common type of cancer with over 2% of the cancers diagnosed, affecting those from the age of 50-74 years old. Worldwide around 11 in 100,000 of the population can develop oral cancer.^1,2

Common risk factors^1,2

These include:

• Smocking
• Excessive alcohol drinking
• Having human papillomavirus (HPV)
• Exposure to sunlight (UV) without proper protection
• Family history of oral cancer

Pathophysiology

Cellular mechanisms of oral cancer development 

Oral cancer develops due to abnormal cell growth. Abnormal cell growth is the random growth and division of cancer cells caused by a complicated process called oral squamous carcinogenesis. This causes the growth of many receptors on the cell surface and the signals inside of the cells. Consequently,  this can cause the cells to stick together less, making it easier for the cancer cells to invade the nearby tissues, and travel to other body parts.³

Clinical presentation

Symptoms and signs of oral cancer in the elderly^3,4

Some common signs and symptoms of oral cancer, include:

• Unexplained bleeding in parts of the mouth
• Earache
• Chronic bad breath
• Crusty areas on lips, gums or inside of the mouth
• Sores on the lip or inside of your mouth which bleed easily and do not heal
• Numbness or pain in your face, neck or mouth
• Difficulty in chewing, speaking, moving your jaw or tongue
• Sudden weight loss
• Teeth becoming loose
• Severe pain
• Hardened area of tissue

Diagnosis

Diagnostic tools¹

A few tests can be done to diagnose oral cancer. These include:

• Physical examination - your doctor will look at the entire inside of the mouth and might also feel around the mouth 
• Brush biopsy (scrappy biopsy)- a small brush is taken to gently scrape the area to get some the cancer cells
• Direct flexible pharyngoscopy and laryngoscopy - your doctor will take an endoscope (camera) to look at parts of the mouth and throat that cannot be seen with a normal mirror
• Indirect pharyngoscopy and laryngoscopy - use of a small mirror to look at the throat, tongue and part of the voice box 
• Incisional biopsy - a small part of tissue is removed to get cancer cells for examination in a laboratory

Treatment modalities^1,5

There are several options for the treatment of oral cancer. Your doctor will discuss with you the different options, depending on the type and severity of your oral cancer, including: 

Surgery

Some of the more common types of surgery for oral cancer are:

• Glossectomy - partial or total removal of the tongue 
• Primary tumour surgery - your doctor removes tumours through the mouth or an incision in your neck
• Mandibulectomy - surgery to remove cancer in your jawline
• Maxillectomy - partial or total removal of the hard palate 
• Neck dissection- removal of lymph nodes from the neck
• Reconstructive surgery 

Radiation therapy

Your healthcare team will also use combination therapy, including:

• Chemotherapy - use of anti-cancer medication to kill cancer cells 
• Immunotherapy - allows your own immune system to fight the cancer
• Radiation therapy - uses strong radiation beams to kill the cancer cells 
• Targeted therapy - uses medication to precisely and only attack the cancer cells and not the normal healthy cells

Prognosis and survival

Oral cancer, like other forms of cancer, should be diagnosed early and treated early to prevent the oral cancer from spreading. Around 1 ⁄ 3 of people treated for oral cancer develop new cancer. Therefore,  it is always necessary to talk with your doctor about follow-up examinations.¹

Prevention and management strategies^1,3

Oral cancer can be prevented with a good lifestyle and a good diet:

• Quitting tobacco, hookah. Try to talk with your doctor about quitting smoking 
• Drinking alcohol in moderation
• Eating a well-balanced diet
• Getting vaccinated against HPV
• Regularly using sunscreen 
• Having regular dental check-ups with your dentist 

Future directions and research

Emerging therapies and advancements in oral cancer treatment

A recent new discovery in the treatment of oral cancer is the use of nanoplatforms. This is to overcome the challenges that are associated with conventional oral cancer treatments, like poor drug solubility, toxicity and non-specific targeting. The nanoplatforms are formed from liposomes, nanoparticles and hydrogels, which help to control the release and to target the therapeutic agents better. Nanoplatforms are also more target-specific, so there is less damage to the healthy cells.⁶ 

Conclusion

Oral cancer is a serious disease that can be treated when diagnosed earlier. This is why seeing your dentist at least twice a year is important. There are many ways to prevent oral cancer, like following a good diet and avoiding tobacco products. Cancer diagnosis is scary, but do know you do not have to go through it on your own. Your healthcare team and your doctor can help you with your journey.