White or reddish spots, wounds that do not heal after 15 days, lumps on the neck. In more advanced cases, bleeding, difficulty swallowing and speaking. These are some of the symptoms of mouth cancer - also known as cancer of the oral or oral cavity. According to Inca (National Cancer Institute), it is more common in men over 40 years old, being the 4th most frequent tumor in males in the Southeast region. The challenge, as with other types of cancer, is a quick and accurate diagnosis.
"The sooner the diagnosis is made, the greater the patient's chance of cure", explains Letícia Lang, oncology dentist at Oncoclínicas Londrina and the Oncology and Radiotherapy Center of Londrina, Paraná. The tumor can affect any region that is inside the oral cavity, that is, in the mouth. It can also involve the oropharynx, which is the junction of the back of the tongue with the pharynx - in this case, there is a greater relationship with infection by HPV, the human papillomavirus. Even so, it is more common for lesions to appear in the following regions:
- Lateral edge of the tongue;
- Buccal floor (under the tongue);
- Lower lip (depending on the type of tumor, it may be considered skin cancer);
-Palate;
-Inner part of the cheek.
According to Luciana Ramalho, a dentist and stomatology consultant at Grupo Oncoclínicas in Bahia, cancer does not happen overnight, but it gives signs that may go unnoticed and that are confused with other wounds. The canker sore, for example, heals and heals. "Most of the time, it appears as a white or red spot or as a wound that doesn't heal and doesn't hurt either. If it doesn't heal in 15 days, it should trigger an alert", she says.
That's because the more time passes, the more the symptoms can get worse. "These spots or wounds are gradually transformed. In more advanced cases, bad breath appears, difficulty speaking and swallowing, in addition to lumps in the neck", he points out. See the symptoms:
-White or reddish spots;
- Wounds that do not heal after 15 days;
- Nodules or growth of the mucosa;
- Lumps in the neck (sometimes this is the only symptom present).
Signs in more severe cases:
- Difficulty chewing, swallowing and talking;
- Feeling that there is something stuck in the throat;
-Bad breath;
- Difficulty moving the tongue;
- Bleeding.
Don't forget your mouth, do a self-examination – The mouth has an "advantage" over other parts of the body: we can analyze it without much difficulty, every day, especially when we do hygiene. This is exactly why we should keep an eye out for possible changes, but how?
There is a self-examination that can be done quickly, according to experts. "Open your mouth wide in front of the mirror with your tongue out. Look to the right and left, see if there are any of the symptoms. Place two fingers on the inside of the cheek to assess the region. Also check the roof of the mouth and the bottom of the tongue.
If you have any injury, look for a specialist", explains Leonardo Arcoverde, oncological surgeon at SBCO (Brazilian Society of Oncological Surgery), head and neck coordinator at Hospital Esperança Recife and head of the Hospital do Câncer de Pernambuco. replaces the need for a consultation with a health professional. It is not the patient's obligation to make the diagnosis, but the doctor or dentist's. "The self-examination is an initial screening. If he identifies something different, he should, yes, look for a dentist", says surgeon-dentist from Londrina.
But if you are still in doubt, check out this image below, created by dentist Letícia Lang. It is these regions that you should look at most carefully.
Tobacco, alcohol and HPV: the risk group – Some people may be more at risk of developing oral cancer. Patients (more men) who smoke tobacco and/or are alcoholics, mainly, are more likely to have tumors in the oral cavity region. Considering the regions of the mouth, cancer of the lips is the third most frequent type, corresponding to 25% to 30% of all types of oral cancer. It occurs mainly in fair-skinned men over 50 years of age. Lip protection, in this case, is essential for anyone who spends the day exposed to the sun.
But that doesn't mean that individuals outside this group can't also develop cancer. Even younger people are often diagnosed with an association with HPV infection, as explained by Felipe D'Almeida Costa, pathologist, director of Education at the SBP (Brazilian Society of Pathology) and head of pathological anatomy at the ACCamargo Cancer Center (SP).
"They are younger patients with no history of smoking or alcoholism. Generally, the primary lesion in the tonsil is small and hidden. While the ganglion in the neck is already enlarged", says the medical coordinator of Pathology Education at Dasa. "With tumors not associated with HPV, they are alcohol and tobacco dependent patients. They are older and the primary lesions are larger than those in the neck", he concludes.
It is important to point out that, in addition to mandatory condoms in all sexual relations, there are still vaccines against HPV offered free of charge for boys aged between 11 and 14 years and for girls aged 9 to 14 years. For adults, it is also indicated, it is possible to find it in private clinics. Another important point raised by specialists is that oral cancer has a strong social component involved, affecting low-income people, without access to dentists and with little knowledge of the importance of oral hygiene.
"When we go to the poorest regions of the country, we notice that the risk of oral cancer grows a lot, if compared to regions where people with greater purchasing power live", says an oncological surgeon from SBCO.
There are ways to prevent mouth cancer, which involve the following precautions: No smoking; Limit alcohol consumption, drink socially; Maintain good oral hygiene; Have a healthy eating; Going to the dentist regularly; Use a condom during sexual intercourse; Get vaccinated against HPV; If you work in the sun, wear a wide-brimmed hat and lip balm; Seek medical attention quickly if any symptoms appear. Challenge: the diagnosis arrives in advanced stages It is a disease of important magnitude in Brazil, with significant regional variations, both in incidence and mortality. It is estimated 11,180 new cases of the disease in men and 4,010 in women for each year between 2020 and 2022. The Southeast and South regions have the highest incidence and mortality rates of the disease, according to Inca. Unfortunately, patients arrive with an advanced diagnosis, especially if they are from the public network, which greatly reduces the chances of cure. This is even one of the main challenges of oral cancer: early diagnosis.
"The treatment can be aggressive, so the sooner it is detected, the less problems the patient will have in relation to the treatment. They will be more conservative surgeries and the quality of life will be better", explains Lang.
It is the biopsy that will close (or not) the diagnosis. Among the most common types of cancer is squamous cell carcinoma, also called squamous cell carcinoma, with 95% of cases, and then tumors in the minor salivary glands, representing 5% of cases.
There are ways to treat and cure oral cancer – Treatment involves surgery, radiotherapy and chemotherapy – sometimes a combination of them. This depends on what stage the cancer is at and where it is located. Who takes care of this part is the surgeon, but dentists accompany the patient throughout the treatment.
According to Arcoverde, the "gold standard" of treatment is surgery to remove the tumor when there are safety margins. "Therefore, I recommend prevention and early diagnosis. Thus, we manage to treat the tumor even 'small', performing less radical and more conservative surgeries", he says. Rapid diagnosis not only helps in treatment, but also in survival. "Unfortunately, the majority arrive at professionals in more advanced stages, with a survival rate of less than 50% in 5 years. This is low in relation to other tumors", explains Ramalho.
Have a healthy mouth – This article is part of the VivaBem Have a Healthy Mouth campaign, which aims to explain how and why it is important to maintain good oral hygiene. We will also address common mistakes in brushing, oral cancer, how mental health affects teeth, the limits of aesthetic and corrective procedures, oral health of children and pregnant women, among other subjects.
