Oral Cancer

Oral cavity cancer is the one that basically occurs in any part of the
mouth. Oral cancer can also be termed as one of the head and neck
cancers. In addition, oral cancer and other head and neck cancers are
also treated in a similar way. If oral cancer is diagnosed in the early
phase, it can be treated easily. But it could be life-threatening if
diagnosed in the later phases. According to a report generated, the
average oral cancer case was 4.9 new cases per 1,00,000 men in Nepal.

Parts of Oral Cavity

As we’ve discussed previously, oral cavity can occur in any of the parts
that accounts to the mouth. Majorly, it can occur in the following
different parts:

  • Lips
  • Gums
  • Tongue
  • Inner linings of the cheeks
  • Roof of the mouth
  • Floor of the mouth.
    On the other hand, oropharyngeal cancer starts in the middle part of the throat and mouth, which can be seen if you open your mouth wide. In the oropharynx, cancer cells are primarily responsible for causing oropharyngeal cancer.

Symptoms of Oral Cancer

There can be many symptoms that can be observed for oral cancer. The major signs and symptoms of oral cancer might include these:

  • A continuous lip or mouth sore which doesn’t heal easily
  • A white of reddish patch in the mouth
  • Teeth loosening
  • A lump inside the mouth
  • Continuous mouth pain
  • Ear pain
  • Difficulty in swallowing.

Causes of the Oral Cancer

Oral cancer forms when there is a change in the DNA in the cells in the lips or the mouth, normally known as mutations. That DNA consists of the information which then tells the cell what it should do. The changes in the mutations tells the cell to grow continuously and divide if any of the healthy cells dies. Additionally, any kind of abnormal growth of cells in the oral cavity can result in forming a tumor, which is commonly known as oral cancer. If it stays undetected for a longer period, there is a higher chance of cancer cells spreading to other parts of the mouth, or areas of head and neck as well.
In general, oral cancers begin in flat and thin cells, called squamous cells that line up the lips and inside of the mouth. It is estimated that squamous cell carcinomas make up the majority of all cancers. Well, it doesn’t have a clear justification on what causes squamous cells to
mutate and form a cancer at the end. But, doctors have found out certain risk factors that contribute to increasing the chances of oral cancer.

Risk Factors of Oral Cancer

Most of the time, oral and oropharyngeal cancer are linked with other head and neck cancers. Many of the risk factors are also similar to one another. Let’s have a look at the risk factors of oral cancer:

Tobacco and Alcohol use

Use of tobacco can be considered as one of the major factors for head and neck cancer, which includes oral cavity as well as oropharyngeal cancer. People who smoke are at higher risk than the people who don’t smoke. The more you smoke, the higher the risk of having oral cancer. It includes smoking from cigarettes, cigars or pipes. Pipes majorly touch the lips, causing cancer on the lips. On the other hand, heavy drinkers are at higher risk of having oral cancer than light drinkers. Also, the one who smokes as well as drinks at the same time are at even higher risk, ultimately 30 times higher.

Betel quid and Gutkha

Majorly in the Asian region (more specifically the South Asian region), people prefer to chew betel quid which consists of betel nut, spices, lime and few other ingredients. They also prefer to chew gutka, which is a tobacco product as well. After chewing these products, they are at higher risk of oral cancer.

Human papillomavirus (HPV)

HPV virus itself is a group of about 150 viruses. It can cause cancer in
many different areas like: cervix, vagina, mouth, throat, etc. It is more
common on the younger generations who hence have a history of
multiple sex partners (oral sex) and no use of any tobacco or alcohol


In comparison to women, men are much more likely to develop oral
cancer and oropharyngeal cancer. It is because since the past, men are much more into consuming tobacco and alcoholic products.

Excess body weight

If you’re overweight, you’re at higher risk of cancers of the oropharynx or larynx. To reduce the risk, you can consume a lot of vegetables and fruits which will hence help you in reducing weight as well as chance of getting cancer.


Rather than any other cancers, oral cancer takes many years to develop. In general, the patients who develop this cancer in the first phase are about 45-50 yrs.

Ultraviolet (UV) light

Direct exposure to the sunlight can cause cancer of the lips. It is majorly common for the people who work outdoors all the time.

Poor nutrition

As discussed earlier, people who do not consume enough green
vegetables or fruit are at higher risk of getting oropharynx or oral cancer.

Genetic syndromes

The inherited mutations can also cause cancer. In case of certain genes, people who get the inherited mutations are at the higher risk of mouth and throat cancer.

Preventive Measures for Oral Cancer

You cannot assure to prevent all cases of the oral cancer, but you can
surely adopt these steps and reduce the risk of developing the cancers:

Avoiding tobacco and alcohol

Tobacco and alcohol consumption are termed as the greatest risk factors for oral cancer. If you do not smoke, you are not at the higher risk of these cancers. Or if you quit tobacco, it can also lower the risk.

Avoiding HPV infection

The risk of HPV virus in the mouth or throat increases if you’re prone to oral sex or have multiple sex partners. It is advised not to have oral sex frequently to prevent from getting oral cancer.

Do not expose yourself to ultraviolet (UV) rays

UV rays can also be considered as one of the important risk factors for lip cancer. It is suggested not to go outdoors during the mid-day when the UV rays are strongest. If you’ve to go, you can use some sunscreen, hats, etc.

Eat healthy and maintain a good health

Poor nutrition and excess body weight can also result in oral cancer as well as oropharyngeal cancer. If you eat healthy food and follow a strict routine, you can have a healthy body as well as a healthy mind all the time. As a result, there is a reduction in the risk of oral cancer as well.

Frequent dental checkups

In some cases, the leukoplakia and erythroplakia in the mouth can
sometimes turn into cancer. Doctors remove these areas, but removing them might not keep you away from getting oral cancer. Even if these areas are removed completely, you are still at the higher risk of getting oral cancer. So, it is a must to have frequent dental checkups.

Diagnosis of Oral Cancer

The patient himself/herself might notice the signs and symptoms for
oral cancer, which will then lead them towards diagnosing it. Here’s how you can properly diagnose oral cancer:


The majority of cancers are caused by tobacco and alcohol use, so it is more likely that more than one cancer will be discovered at a time. To assure that there’s no cancer in the esophagus or lung, panendoscopy is done. It also helps in the situation if it is unclear and the cells seem to be abnormal.

Thorough head and neck exam

If your doctor thinks you might have cancer, s/he will refer to a specialist, known as ENT doctors or otolaryngologists. The specialist will then go for a complete head and neck exam to know more about it.


In this method, the doctor takes out a small piece of tissue, so that it can be used in the lab to gather further more information. Biopsy is the only way to know whether cancer is present or not. That’s why a sample is taken to confirm right before the treatment procedure begins.

Exfoliative cytology

In this technique, the doctor scrapes the changed area and collects the tissue in a glass slide. It is then stained with a dye to exactly see the cells. If any of the cells look unfamiliar or abnormal, it can then be biopsied further.

Incisional biopsy

Here, a small portion of the tissue is taken out from the abnormal area, which is further used for biopsy. This method is commonly used to examine the changes in mouth or throat.

Fine needle aspiration (FNA) biopsy

In FNA biopsy, a very thin, hollow needle which is attached to the syringe pulls out a certain portion of cells from the lump. Afterwards, these cells are looked closely in the lab to know whether or not any cancer cell is present.


Stage 0

In this phase, the cancer is still within the epithelium and has not grown into any deeper layers. Furthermore, it has not spread to any nearby lymph nodes or any distant sites. This stage is majorly known as carcinoma in situ.

Stage 1

The cancer is slightly bigger, upto 2cm. There is no growth in the nearby
tissues, nearby lymph nodes or distant sites.

Stage 2

The cancer is now even more bigger, 2cm to 4cm in size. It is not
growing in the nearby tissues, and not spreading to nearby lymph nodes
or distant sites.

Stage 3

At this stage, the cancer is now bigger than 4cm in size. Here, the tumor
starts growing into the epiglottis, but has not spread to the nearby
lymph nodes and distant sites.

Stage 4

Here, the cancer can be of any size. It has also grown into the nearby
tissues and also spread to at least one of the lymph nodes. No distant
sites have been affected, nor has the cancer spread beyond lymph


The cancer can be of any size and starts to grow in nearby structures as:

  • For lip cancer:
    o Nearby bone
    o Inferior alveolar nerve
    o Floor of the mouth
    o Skin of the chin or nose.
  • For oral cavity cancer
    o A jawbone or a facebone
    o The tongue’s deep muscle
    o Face skin
    o The maxillary sinus.
  • For oropharyngeal cancer
    o Larynx
    o Tongue muscle
    o Medial pterygoid
    o Hard palate
    o Jaw.
    Now, either of these should be present:
  • Not spreading to the nearby nodes
  • Spreading to 1 lymph nodes (no larger than 3 cm) but not outside of
    the lymph nodes
  • Having no impact on distant sites.


The cancer can be of any size and slightly starts to grow into nearby soft
tissues, with following conditions:

  • Spreading to 1 lymph nodes ( larger than 6 cm) but not outside of
    the lymph nodes
  • Spreading to 1 lymph nodes (no larger than 3 cm) and also outside
  • of the lymph nodes
  • Spreading to more than 1 lymph nodes on the same side, opposite
    sides, or both sides along with growing outside of the lymph nodes
  • Not spreading to distant sites.


The cancer can be of any size in this stage. It also starts to grow in the nearby soft structures. It might or might spread to the nearby lymph nodes, but definitely spreads in the distant sites.

Treatment in Nepal

Many different treatment options can be used to treat oral cancer
effectively in Nepal. Let’s discuss about them:

Surgery in Nepal

In the case of cancer, surgery is the first treatment used. A variety of operations can be performed on patients with oral and oropharyngeal cancers. It is majorly used for early stage cancers that have not spread to nearby nodes. Once the cancer is removed, furthermore surgery might be done to restore the appearance and functioning of the affected areas.

Chemotherapy in Nepal

Chemotherapy is a treatment method which includes anti-cancer drugs.
It may be injected into a vein or taken by the mouth itself, which lets
them enter the blood and reach the maximum part of the body. It can be used in different situations during the process to treat oral cavity cancer as:

  • Adjuvant chemotherapy: given after the surgery
  • Neoadjuvant or induction chemotherapy: given before the surgery
  • For advanced cancer.

Radiation therapy in Nepal

Furthermore, radiation therapy is used with the help of high-energy x-rays so as to destroy cancer cells and slow their growth as well.
Depending upon the stage of the oral cancer, it might be used in many different ways as:

  • Alone
  • After surgery
  • Before surgery
  • With some targeted drug
  • To reduce the symptoms of advanced cancer.

Targeted drug therapy in Nepal

Basically, targeted drug therapy uses the medicines that majorly targets the proteins on cancer cells. These proteins hence help them grow, spread alongside and live for a longer time. Targeted therapy is taken into consideration so as to deal with oral cavity to destroy the cells and slow their growth gradually. Side effects can be a lot different from chemotherapy.

Immunotherapy in Nepal

Immunotherapy can also be used to treat the oral cancer, same as any other treatment options. It is basically a use of medicines that boosts the patient’s immune system in finding and destroying the cancer cells in an efficient manner. It majorly works on some specific proteins which hence enhances the immune response. Compared to chemotherapy, its side effects are less severe.

When to See a Doctor in Nepal?

If you observe any of the above-mentioned symptoms and have a strong feeling that you’ve got cancer, you can go for a checkup with an oncologist in Nepal. You can either see a medical oncologist or a surgical oncologist as per your wish. Your cancer doctor can help you to choose the best treatment for you. The cancer specialist can also help you with everything in each and every step of your treatment procedure.

Dr.Sudip Shrestha
Founder & Executive Chairman Sr. Consultant Medical Oncologist Nepal Cancer Hospital & Research Center

Designation: Founder and Chairman, Senior Consultant Medical Oncologist

Qualification: MBBS, MD, Post Graduate Training in Medical Oncology

Department: Medical Oncology

Special interest: Chemotherapy, Immunotherapy, Targeted Therapy, Precision Medicine

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