What Is Cancer?

Cancer is the process where cells in the body begin to grow uncontrollably. Normal checks and balances in the body (called cell cycle regulators) control the rate at which cells divide and grow. When this control is lost, it is called neoplasia. If the growth (collection of cells) doesn’t have the ability to spread or invade, this is a benign (non-cancerous lesion). If the growth has the ability to invade (blood vessels, jaw bone or nerves) or spread via the lymphatic system then these are malignant grows, also known as a cancer. The name of the cancer will vary depending on the cell that it started from. Cancers that start from the skin are called carcinomas, those from bone or connective tissue (muscle or tendons) are sarcomas and lymphatic tissue are lymphomas. Salivary glands are a little more complicated as they have skin and gland cells so often can be a mix of the two.

What is a tumour?

Firstly, a tumour does not always mean cancer. A tumour is a collection of cells that continue to grow despite them not being required or needed by the body. A tumour can either be classified as benign (which means it doesn’t spread or invade blood vessels, nerves or bone) or malignant (has the ability to spread or invade surrounding structures). A malignant tumour is more commonly known as a cancer.

What is the lymphatic system?

The lymphatic system is composed of very small channels, lymph nodes (or glands) and larger organs such as the spleen. The lymphatic system has two main roles. One is to collect the fluid that has leaked from the blood vessel and the second is to aid in the immune system but filtering infections such as bacteria and viruses. When the lymphatic system is active (or switched on) the glands can become enlarged, sore to touch and warm. As the lymphatic system is important in mopping up or collecting free floating cells, it can often be a pathway for cancers to spread. 

How do cancers spread?

Cancers can spread via 3 different ways. They have the ability to invade which allows them to spread via direct growth. They can also spread via the lymphatic system (called lymphatogenous spread) or via the blood stream (called haematogenous spread). Excluding direct invasion, spread via the lymphatic system is by far the most common for cancers of the head and neck region. This is why Dr. Manzie might talk to you about removing the lymph nodes during your surgery. (LINK TO NECK DISSECTION)

Types of cancer

In the head and neck region, there are a number of different cancers. A cancer can begin from any of the different types of tissue. For more information on each type, please click on the link.

  • Skin cancer

    • There are a number of different skin based cancers. The most common types are a basal cell carcinoma (known as a BCC), squamous cell carcinoma (known as a BCC) or melanoma. Other rarer types may include different merkel cell cancers or sarcomas

    • LINK TO SKIN BASED CANCER

  • Oral (mouth) cancer

    • This includes cancers of the lining of the mouth (squamous cell carcinoma) or the minor salivary glands. It is also possible to have a melanoma on the inside of the mouth though this is much less common.

    • LINK TO ORAL CANCER

  • Salivary gland cancer

  • Lymphoma

  • Sarcomas

What are the symptoms of cancer?

Cancers of the inside or outside of the mouth can present in a number of different ways.

  • Ulcer or non-healing sore: Many patients present with a sore or ulcer that has not healed for many months. The normal healing process for a scratch on the skin or a bite to the lip, cheek or tongue should heal within 2 weeks. Any sore or ulcer that persists after that should be reviewed by your local doctor or dentist and should be considered for a biopsy.

  • Bleeding: bleeding typically accompanies a non-healing sore but may be noticed when rinsing the mouth or on a toothbrush. There are a number of non-cancer causes for bleeding from the mouth but should prompt a review with your doctor or dentist.

  • Pins and needles or numbness: Large cancers may spread to affect the surrounding nerves. This may cause changes in the feeling (pins and needles or numbness), cause facial weakness or alter your taste.

  • Pain: pain is often a late symptom of a cancer. The lack or presence of pain is not a useful indicator

  • Altered speech or swallow: cancers of the floor of mouth, jaw, tongue or throat may cause difficulty swallowing. This may be related to pain or involvement of the muscles or surrounding nerves that are needed to swallow.

  • Swellings of the neck: Cancers can also present as a swelling in the neck. It is common for small cancers of the back of the throat (tonsil or base of tongue) to spread to the lymph nodes (glands) early.

  • No symptoms: many cancers are found on routine examination by your dentist or doctor

Cancer Treatments

There are a number of different treatment options for cancer depending on the type. The treatment options may include:

  • Topical therapy

  • Surgery

  • Radiation therapy

  • Chemotherapy or immunotherapy

Oral cavity (mouth) cancer

Oral cavity (mouth) cancer is treated primarily with surgery. For cancers that are large or aggressive, radiation therapy may also be required. Chemotherapy is used when the cancer is unable to be removed completely or it has spread outside of the lymph nodes (glands) in your neck.

Skin cancer (basal or squamous cell carcinoma)

Skin cancer (basal or squamous cell carcinoma) may be treated in a number of different ways. It might be common for your GP or skin specialist to use topical medications such as Efudex (5-fluorouracil) or Imiquimoid (Aldara) for superficial or pre-cancerous lesions. Surgeons would typically remove this lesions and either perform a local flap (move skin from the surrounding area), skin graft (transfer a small piece of skin) or a free flap (transfer or transplant skin from the arm, leg, back or groin).  For advanced cancers (where they may have spread), you may also need the lymph nodes (glands) removed from the neck to allow for improved accuracy of staging/diagnosis and as necessary treatment.

Melanoma

Melanoma’s starting from the skin or inside of the mouth are initially treated very similarly, however after this their treatment after this can vary. Surgery would involve removal of the lesion and any known disease.

  • Skin based (cutaneous) melanoma’s: it is likely to involve a sentinel node biopsy (sampling of specific glands) which differs from a neck dissection. Skin based melanoma’s have had significant improvements and changes in their management in their last 10 years with the discovery of effect of immunotherapy. This may be started before or after surgery and is prescribed by a Medical Oncologist. There are a large number of ongoing and active studies in this field for which you may be eligible for.

  • Oral cavity (mouth) based melanomas rely on surgery and radiation therapy. Despite having the same name, these melanoma’s do not respond as well to the current immunotherapy options, however you may still be referred to discuss this with a Medical Oncologist.