Pre Cancerous Tumor

The most common precancerous conditions of the oral cavity are:

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Oral submucous fibrosis

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Leukoplakia

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Erythroplakia

Oral Submucous Fibrosis (OSF)

What is OSF?

It is condition which affects people who chew tobacco like Gutka,Paan masala,Areca nut or Supari. It is characterised by inability to open the mouth completely. This happens due progressive fibrosis of submucosal tissues and juxta-epithelial inflammatory reactions. It means inner cheek lining which is usually red or pink and stretchable turns into thick white hard like a parchment and become un-stretchable. In advanced stages there are fibrotic bands are formed which does not allow the mouth to open.

In the initial phase of the disease, the mucosa feels leathery with palpable fibrotic bands. In the advanced stage the oral mucosa loses its resiliency and becomes blanched and stiff. The disease is believed to begin in the posterior part of the oral cavity and gradually spread outward.

Signs and Symptoms of OSF

The symptoms may include the following

  • Xerostomia(Dry Mouth)
  • Recurrent ulceration
  • Pain in the ear or deafness
  • Nasal intonation of voice
  • Restriction of the movement of the soft palate
  • A budlike shrunken uvula
  • Thinning and stiffening of the lips
  • Pigmentation of the oral mucosa
  • Burning sensation
  • Decreased mouth opening and tongue protrusion

Diagnosis of OSF

Physical exam of the lips and oral cavity: An exam to check the lips and oral cavity for abnormal areas. The medical doctor or dentist will feel the entire inside of the mouth with a gloved finger and examine the oral cavity with a small long-handled mirror and lights. This will include checking the insides of the cheeks and lips; the gums; the roof and floor of the mouth; and the top, bottom, and sides of the tongue. The neck will be felt for swollen lymph nodes. A history of the patient’s health habits and past illnesses and medical and dental treatments will also be taken.

Disadvantages

1) Inability to eat normally as mouth does not open; there may be burning sensation in the mouth also.
2) It is precancerous condition i.e. this lining has tendency to turn into cancer, symptoms one should be watchful of any ulcer which is to healing, pain during opening the mouth, pain in the ear or during eating. White or red patch can also develop.

Treatment

Treatment depends upon the size of the tumor and Overall health of the Patient. Counselling is done before going for further options.

1) Stop tobacco– most important in early stages as changes can halt and might revert back, in other stages a least it will not further progress.

2) Injection of local steroid with mouth opening exercise.

3) If these do not work then surgery has to be done,Co2 LASER incision which is gentler, more predictable, and often times will not require local anaesthetic. Co2 lasers cut with a very small zone of necrosis, allowing us to perform a wide array of soft-tissue procedures with little to no discomfort, no  fear  of  gingival recession,  and  rapid  healing followed by mouth opening exercise, or putting a flap or piece of skin taken after the excision.

Importance of Treatment

Our treatment is in accordance with the increased mouth opening. First and foremost thing is cessation of the habit and improve the lifestyle of the patient with a balanced and healthy diet.Physiotherapy for OSMF is a very important part of treatment as it helps in increasing mouth opening. Muscle stretching for the mouth may be helpful in preventing further limitation of mouth movement. If physiotherapy is used along with micronutrients, results are more favourable.

Leukoplakia

What is Leukoplakia?

Leukoplakia is an abnormal white area or spots on the mucous membrane lining the mouth with no clear cause. There are many conditions that present with white areas, such as thrush and lichen planus. White spots may also be caused by irritation, such as biting the cheek or lip.
The presence of leukoplakia does not necessarily mean cancer. About 3%–17.5% of people develop squamous cell carcinoma in an area of leukoplakia within 15 years of developing leukoplakia.The actual risk of developing oral cavity cancer depends on how abnormal the cells lining the mouth are in shape, size and appearance. This abnormality is called dysplasia. People who have leukoplakia are closely followed to look for signs of cancer.

Signs and Symptoms of Leukoplakia

The signs and symptoms of leukoplakia may include a whitish area or spots inside the mouth that cannot be easily scraped off.

Risks Factors

The following risk factors may increase a person’s chance of developing leukoplakia

  • Heavy smoking and excessive alcohol use
  • Chewing tobacco (snuff)

Diagnosis

If the signs and symptoms of leukoplakia are present, We do an oral examination and order tests to make a diagnosis and rule out other conditions that can cause similar lesions. Tests may include taking a sample of cells from the abnormal area and examining them under a microscope (biopsy).Biopsy may also be considered in case of any suspicious area, especially in people at high-risk of developing cancer, such as those who use tobacco products.

Treatment

There are no standard treatments for leukoplakia. We try to manage it by active surveillance, which involves closely monitoring a person’s condition. Tests and exams are done on a regular schedule to detect any cancerous change early. Pre-cancerous counselling is done for the patients because leukoplakia has the potential to develop into cancer. Also people with this condition are advised to avoid known risk factors, such as tobacco and alcohol.

Erythroplakia

What is Erythroplakia?

Erythroplakia is an abnormal red area or red spots that form on the mucous membrane lining the mouth with no clear cause. The presence of Erythroplakia does not necessarily mean cancer, but this precancerous condition has the highest risk of developing into cancer. About 51% of these lesions develop into squamous cell carcinoma and 40% develop into carcinoma in situ.

Risks Factors

The following risk factors may increase a person’s chance of developing Erythroplakia :

  • heavy smoking and excessive alcohol use
  • chewing tobacco

Sign and Symptoms of Erythoplakia

The signs and symptoms of Erythroplakia may include a raised, velvety, red area that often bleeds when scraped.

Diagnosis

If the signs and symptoms of Erythroplakia are present, the doctor will do an oral examination and run tests to make a diagnosis and rule out other conditions that can cause similar lesions. Tests may include taking a sample of cells from the abnormal area and examining them under a microscope (biopsy). Doctors may do a biopsy of any suspicious area, especially in people at high-risk of developing cancer, such as those who use tobacco products.

Treatment

Treatment options for Erythroplakia may include:

  • Careful watching (surveillance) and frequent follow-up
  • Surgical removal
  • Cryosurgery and laser surgery –( uncommon)

Because Erythroplakia has the potential to develop into cancer, people with this condition should avoid known risk factors, such as tobacco and alcohol.