Oral cancer is coming?.. Forewarned is forearmed!

• Risk factors for developing lip cancer
• Pathomorphology
• Diagnosis of lip cancer
• Prognostic factors
• Clinical picture
• Lip cancer treatment
• Disease prognosis
• Rehabilitation
• Prevention of lip cancer

Lip cancer is a malignant tumor of the stratified squamous epithelium of the red border of the lower and upper lips. Cancer of the upper lip in relation to cancer of the lower lip is 2-5% and is observed more often in women.

In the structure of incidence in relation to all malignant tumors, lip cancer is 1.8% in men and 0.53% in women. Among the CIS countries, this figure is the highest in Tajikistan: 2.7% for men and 1.5% for women, the lowest is for men in Azerbaijan - 0.6% and women in Armenia - 0.4%.

The standardized incidence rates for lip cancer in Russia in 2000 for men were 5.7; for women – 1.6; and the average age of sick men is 64.6 years; women – 72.3 years. During the period from 1990 to 2000, the incidence of lip cancer decreased from 7.5 to 4.6 in men and from 1.1 to 0.73 in women per 100 thousand inhabitants of Russia.

Risk factors for developing lip cancer

In almost all patients, the appearance of lip cancer is preceded by various background processes and precancerous conditions of the lip mucosa. The etiological factors causing lip cancer are:

• Long-term exposure to adverse meteorological factors (solar radiation, wind, sudden fluctuations in air temperature, ionizing effects).
• Exposure to carcinogenic substances of endogenous and exogenous nature.
• Bad habits: smoking, alcohol, chewing various mixtures (us, betel, etc.).
• Injuries to the red border of the lips: mechanical: carious teeth, sharp edges of tooth roots, tartar, incorrectly made dentures, biting the lip, pressure from a tube, mouthpiece, cigarette or cigarette;
• chemical carcinogens of tobacco: compounds of arsenic, mercury, bismuth; anthracite, liquid resins, petroleum distillation products from persons of relevant professions;
• thermal: burns from hot food, cigarettes.

Depending on the pathological changes in the red border, precancerous diseases with a high frequency of malignancy (15-30%) are obligate and with a low frequency of malignancy (6-10%) - facultative, as well as background processes.

Obligate precancers: warty precancer, limited hyperkeratosis, Manganotti cheilitis.

Optional precancers: verrucous leukoplakia, keratoacanthoma, cutaneous horn, papilloma with keratinization, erosive-ulcerative and hyperkeratotic forms of lupus erythematosus and lichen planus, post-radiation cheilitis.

Background processes: flat leukoplakias, chronic ulcers and fissures of the lips, atmospheric and actinic cheilitis.

Treatment of cheilitis, lupus erythematosus and lichen planus is medicinal with mandatory microscopic monitoring if there is no effect.

Treatment of other pathological changes is carried out by cryogenic, surgical, laser and photodynamic therapy.

Stages

There are four stages of lip cancer.

1. The size of the neoplasm is small and does not exceed 2 centimeters; the malignant tissue is concentrated within the lip. Lymph nodes are not affected, there are no metastases.
2. The pathological tissue increases in size up to 4 centimeters, but the lymph nodes are not affected and there are no metastases.
3. The tumor exceeds 4 centimeters in diameter and affects one or two regional lymph nodes.
4. Malignant tissue spreads to the jaw bones, tongue, maxillary sinus, or penetrates the masticatory muscles and pterygoid process, reaches the carotid artery and grows into the base of the skull.

Pathomorphology

Depending on the type of tumor growth, papillary and warty, as well as ulcerative and ulcerative-infiltrative forms of lip cancer are distinguished.

In 95% of cases it is squamous cell keratinizing cancer, in 5% it is squamous cell non-keratinizing cancer, characterized by a more malignant course (infiltrative growth and early metastasis to regional lymph nodes).

Depending on the prevalence of the tumor process, the stage of cancer is determined - from 0 to IV, which is taken into account when developing a treatment plan and assessing the prognosis (outcome) of the disease.

Make an appointment

Do not delay your visit to a specialist - the sooner the disease is detected, the higher the chances of a full recovery. Onco works on weekends and holidays, so you can schedule a consultation at any time. To do this, use the method most convenient for you:

• call us at our contact number;
• use the online form on the website.

We are located at 2nd Tverskoy-Yamskaya lane, 10, not far from the metro stations “Belorusskaya”, “Novoslobodskaya”, “Mayakovskaya”, “Mendeleevskaya” and “Chekhovskaya”.

Diagnosis of lip cancer

In 2000 in Russia, 16% of patients with lip cancer were diagnosed in stages III-IV.

Reasons for delayed diagnosis: lack of oncological alertness among doctors of the general medical network, insufficient sanitary and educational work in a number of regions with a low culture of the population and, in connection with this, late access to a doctor.

If there are pathological changes on the red border, a mandatory set of diagnostic measures should include:

• study of complaints and history of the disease (duration of changes, dynamics, effectiveness of treatment);
• examination and palpation (palpation) of the lesion and regional (nearby) lymph nodes;
• taking fingerprint smears or scrapings from the surface of ulcerations, cracks, and punctate lip seals without signs of ulceration for microscopic examination. If necessary, a biopsy (taking a piece of tissue) should be performed to clarify the diagnosis.
• ultrasound examination (ultrasound) of the lymph nodes of the neck;
• differential diagnosis with tuberculosis and syphilis.

When the diagnosis of lip cancer is confirmed, an X-ray examination of the chest organs, general clinical and laboratory examination (ECG, blood tests, urine tests, etc.) are performed.

Classification

To understand how to identify lip cancer, consider the types of this disease.

Based on their histological structure, the following types are distinguished:

• Squamous cell carcinoma from keratinizing epithelium grows slowly, with protrusion outward, and slight spread to surrounding tissues. Characterized by late appearance of ulcers, metastases in rare cases.
• Squamous cell non-keratinizing cancer rapidly grows deep into the lip with active spread to surrounding tissues, rapid occurrence of ulcers and frequent metastases to adjacent tissues.

Lip cancer most often metastasizes to neighboring lymph nodes, bone tissue of the lower jaw, glands, and less often to lung tissue. Neoplasia of the lower lip spreads through the lymphatic system or by growing into the jaw bone. The process is largely determined by the dimensions of the primary tumor. Thus, metastases to adjacent tissues of the neck develop in 55% of patients when the tumor reaches a diameter of 3 centimeters or more. The frequency of metastases in tissues, lymph nodes and organs outside the neck does not exceed 3%.

According to the clinical course, warty, papillary and infiltrative-ulcerative cancer of the upper or lower lip are distinguished. The prevalence of the oncological process is determined by stage classification:

• 1 – tumor with a diameter of up to 2 cm, the lymph nodes are not involved in the process.
• 2 – neoplasm reaches 4 cm, without involvement of lymph nodes.
• 3 – the dimensions are still 4 cm, there are metastases in the adjacent lymph nodes up to 3 cm in size.
• 4a – size from 4 centimeters, metastases in the lymph nodes do not exceed 6 cm.
• 4b – the process grows into the wall of the pharynx and the base of the skull, metastasizes to adjacent tissues.
• 4c – spread to distant tissues and organs.

Prognostic factors

Prognosis (outcome) factors for lip cancer are:

• prevalence of the process (size of the primary tumor, presence of metastases);
• clinical and anatomical form of cancer growth (exophytic forms proceed more favorably);
• morphological type of cancer (the non-keratinizing type is more aggressive);
• nature of tumor growth (primary or recurrent);
• age (patients under 40 years of age have a more malignant course).

The prognosis for lip cancer is generally favorable.

A worsening prognosis is associated with locally widespread infiltrative growth and significant regional and distant metastasis.

Causes

As with most diseases in oncology, no one knows the exact cause that affects cell mutation and uncontrolled growth, resulting in lip cancer. As a rule, cancer occurs as a result of the patient’s genetic predisposition and the negative impact of external factors.

Risk factors that may affect the development of a malignant tumor of the lip:

• genetic predisposition;
• smoking;
• alcohol abuse;
• UV radiation.

Clinical picture

Symptoms of lip cancer are varied and are determined by previous precancerous diseases and the morphological type of tumor.

In the early stages, a small roller-like rim appears around the edges around the compaction or erosion, which indicates a malignant process.

Papilloma, cutaneous horn, focus of verrucous leukoplakia, warty or nodular precancer develop into exophytic forms of cancer. The process lasts a long time, the infiltration of the underlying tissues increases gradually.

Destructive forms of dyskeratosis, Mangannotti cheilitis, and other ulcerative processes develop into endophytic forms of cancer - ulcerative and ulcerative-infiltrative.

In later stages, the boundaries between the clinical and anatomical forms of cancer are blurred. If untreated, the bottom of the ulcer reaches the muscle layer, tumor infiltration spreads to the entire lip, chin tissue, floor of the mouth, cheeks, and lower jaw.

Tissue breakdown intensifies, secondary infection occurs, nutrition is disrupted, and exhaustion develops.

Lip cancer is characterized by lymphogenous metastasis.

Metastases can develop on both sides (25%). Metastasis of cancer of the lower lip at stage I is observed in 2-6% of cases, at stage II - in 15-20%, at stage III - in 35% and at stage IV - in 70% of cases.

Distant metastases of lower lip cancer are rare (2%), mainly to the lungs.

Cancer of the upper lip, as a rule, is more malignant due to the characteristics of lymph circulation and metastasis.

Symptoms

The entire process of development of cancer affecting the lips can be described as follows:

• lip tissue thickens;
• it progressively increases, ulceration appears in the center of the tumor;
• it becomes crusty on top, and raised ridges form along the edges of the ulcer.

It is these external symptoms that appear at the beginning and give reason to suspect malignant development. In most cases, the lump is localized away from the center and corners of the mouth - tumors rarely occur in these places.

In addition to external signs, the patient develops symptoms of a general deterioration of his condition:

• constant weakness;
• slight loss in body weight;
• decreased appetite;
• frequent headache;
• temperature up to 37.8 °C for a long time.

It is worth noting that general symptoms may be the only manifestation of the disease at the initial stage. Externally, the tumor may not yet show itself. And only with the progression of the disease external signs appear. They are also accompanied by other symptoms:

• pain in the affected area;
• severe itching of the skin;
• discomfort and pain when eating.

Lip cancer treatment

The choice of treatment method depends mainly on the extent of the process (stage) and the type of tumor growth.

It is necessary to take into account the patient's age and the presence of concomitant pathology. Treatment consists of influencing the primary focus and areas of regional metastasis.

In stages I-II, cure for lip cancer can be achieved by several methods:

The cryogenic method is the effect of liquid nitrogen with a boiling point of -196 degrees C on the tumor. This method is the most effective with 100% cure, functionally sparing, because indicated for elderly people and those suffering from severe concomitant pathologies; it can be used once on an outpatient basis.

Radiation method – close-focus X-ray therapy (50-65 Gy), interstitial radiation therapy (50-70 Gy), electron therapy (SOD 50-70 Gy).

The surgical method is used when it is impossible to use cryogenic or radiation treatment.

Photodynamic therapy is laser exposure against the background of local or intravenous administration of a photosensitizing drug for limited superficial lesions.

Preventive surgery on the neck in stages I-II is indicated only if there is no possibility of dynamic observation by an oncologist in patients with unfavorable prognosis factors (young men, non-keratinizing type of squamous cell carcinoma, infiltrative growth form).

In stage III without metastases in regional lymph nodes, treatment can be carried out:

Cryogenic method , using cryoapplication, cryo-irrigation or a combination thereof. Preventive surgery on the neck is performed for the same indications as stages I-II.

Neck surgery can be performed simultaneously with cryogenic exposure.

Radiation method (combined radiation treatment at 60-70 Gy). The zone of radiation exposure includes areas of regional metastasis.

Combined method (preoperative gamma therapy with a dose of 40-50 Gy on the primary tumor and areas of regional metastasis, followed by surgery.

For locally advanced lip cancer without metastases or with single metastases in regional lymph nodes (stage IV), combined treatment followed by extended surgery and primary or delayed plastic surgery is possible.

Chemotherapy is carried out with platinum drugs , fluorouracil , methotrexate , bleomycin .

For limited recurrences of lip cancer, surgical or cryogenic treatment is indicated.

In case of widespread relapses, it is possible to perform extended surgical interventions with simultaneous plastic surgery.

Treatment under a medical policy

You can receive FREE medical care at the Oncology Center under the State Guarantee Program of Compulsory Medical Insurance (Compulsory Medical Insurance) and High-Tech Medical Care.

The service is valid for all Russian citizens.

To find out more details, as well as for what nosologies and services this program works, please call +7, or you can read in more detail here.

The multidisciplinary oncology clinic “Sofia” gives patients the opportunity to undergo a course of therapy within the framework of the compulsory medical insurance policy. This is a special quota program that provides free medical services financed from federal and local budgets. Within its framework the following can be performed:

• PET/CT;
• radiation therapy;
• chemotherapy;
• IHC;
• surgery.

Medical services under compulsory medical insurance are available to all citizens of Russia. First of all, patients with a diagnosis that poses a serious threat to their life can count on free therapy.

By contacting us for medical assistance under compulsory medical insurance, you can significantly shorten the path to obtaining a quota. Our therapist or oncologist will prepare a statement with a confirmed diagnosis and the results of earlier studies. This document must be submitted to the regional health authority along with:

• an application for cancer treatment under the compulsory medical insurance policy;
• Russian passport and insurance policy;
• SNILS;
• consent to the processing of personal data;
• pension certificate (for pensioners).

Prevention of lip cancer

• Preventive examinations of the population, clinical examination of persons constituting a high-risk group, sanitary and educational work.
• Carrying out hygienic measures, sanitation of the oral cavity, adequate prosthetics.
• Treatment of underlying diseases, precancerous changes in the mucous membrane: the use of indifferent ointments and hygienic lip protection products in persons whose profession is associated with harmful effects on the lips and are exposed to prolonged adverse meteorological factors;
• giving up bad habits (smoking, eating chewing mixtures that irritate the mucous membrane of the lips) and eliminating harmful environmental factors;
• normalization of gastrointestinal tract function, increased immunity.