Causes and risk factors
The tumor occurs where the mucous membrane has been exposed to carcinogens or constant irritation for years. Tobacco in any form - smoking, chewing, nasvay - remains the main factor, and combination with strong alcohol greatly increases the harm, since alcohol increases the permeability of the mucous membrane to harmful substances. A separate group are tumors associated with the human papillomavirus: they more often affect the root of the tongue and occur in younger patients. Permanent trauma from a sharp tooth or poorly fitting denture also plays a role.
- Smoking and other forms of tobacco
- Nasvay and chewing mixtures
- Strong alcohol
- Human papillomavirus
- Chronic injury from a sharp tooth edge or denture
- Poor oral hygiene
- Precancerous changes: leukoplakia, erythroplakia
First signs
Early changes hardly bother you, so they are often noticed by the dentist during a routine examination. A non-healing ulcer with a dense ridge along the edge, a persistent white or red spot, or a lump that can be felt with the tongue should be alert. Later, pain occurs when eating and talking, a characteristic return to the ear on the affected side, limited tongue mobility, changes in speech, and an enlarged lymph node in the neck. Pain appears late, and waiting for it means wasting time.
- Non-healing ulcer on the side of the tongue
- White or red spot that won't go away
- Lump or bump
- Pain when swallowing, radiating to the ear
- Restricted tongue movements, unclear speech
- Bleeding and bad breath
- Enlarged dense lymph node in the neck
What happens is similar
Most mouth ulcers are benign: aphthous stomatitis heals in 7–14 days, a traumatic ulcer goes away after removing the sharp edge of the tooth, herpetic rashes are painful and accompanied by blisters. Leukoplakia and erythroplakia are not cancer, but are considered precancerous and require monitoring and sometimes removal. The main difference criterion is time: benign changes heal within 2–3 weeks, but the tumor persists and grows slowly.
- Aphthous stomatitis is painful, heals in 1–2 weeks
- Traumatic ulcer - disappears after eliminating the cause
- Candidiasis - a white coating that can be removed
- Lichen planus - mesh pattern
- Leukoplakia and erythroplakia - precancerous changes
- Persistence longer than 3 weeks is a reason for a biopsy
Diagnostics
The examination begins with a thorough examination of the oral cavity and palpation of the tongue, floor of the mouth and neck. Only a biopsy confirms the diagnosis: a piece of tissue is taken and examined under a microscope, if necessary, determining the connection of the tumor with the human papillomavirus. To assess the prevalence, ultrasound of the lymph nodes of the neck, MRI or CT of the soft tissues of the neck with contrast, as well as CT of the chest are performed to exclude distant lesions. Before treatment, sanitation of the oral cavity by a dentist is required.
- Inspection and palpation of the tongue, floor of the mouth and neck
- Biopsy of the formation with histology
- Determination of HPV status in a tumor
- Ultrasound of the lymph nodes of the neck
- MRI or CT scan of the neck with contrast
- CT chest
- Sanitation of the oral cavity before treatment
Treatment and recovery
Tactics are determined by the council. In the early stages, surgery becomes the main method: the tumor is removed within healthy tissues, if necessary, performing intervention on the lymph nodes of the neck. In more common cases, surgery is supplemented with radiation therapy and drug treatment, and in some situations radiation therapy is used as the main method. Recovery is of great importance: speech therapy rehabilitation, swallowing training, prosthetics and nutrition with sufficient protein. Quitting tobacco and alcohol is a must.
- Surgical removal of the tumor
- Surgery on neck lymph nodes according to indications
- Radiation therapy
- Chemotherapy and targeted therapy
- Reconstructive surgeries
- Speech therapy and swallowing rehabilitation
- Complete cessation of tobacco and alcohol
- Regular monitoring after treatment
