The most challenging presentation is an oral lesion that appears benign; it is often mistaken for an ulcer, but sometimes this can be an early sign of oral cancer. It is significant to understand that often, tongue cancer and other rare oral malignancies, which can resemble harmless sores, most often lead to delayed diagnosis and treatment. These delays tend to impact the outcome.
Oral cancers, essentially squamous cell carcinomas of the oral cavity, progress rather silently; they manifest as a minor sore or ulcer, and due to this, patients assume that it will heal on its own.
The epidemiological landscape in India suggests that the most common cancer in men is oral cancer, followed by breast cancer in women. Estimates from screening data suggest that tens of thousands of new oral cancer cases are on the rise, often going undiagnosed due to late presentation, even during the advanced stages. These are also majorly seen in middle-aged and older adults, including individuals who are in a habit of consistent tobacco use, such as smoking or chewing betel quid. Therefore, adding a diagnostic complexity.
Here’s how oral cancer mimics an ulcer, and the warning signs to look for:
Persistence: Despite good oral hygiene of the mouth, if the sore or ulcer does not heal in 2-3 weeks.
Change in appearance: Erythroplakia (Red) and Leukoplakia (White) patches, including mixed lesions, present on the tongue or the oral mucosa. This essentially also includes ulcers with irregular and hard borders rather than having shallow bases.
Enlargement of lymph nodes in the neck, which can reflect on regional spread, in turn increasing the urgency to consult a doctor soon.
Apart from these warning signs, additional symptoms that can occur, such as:
Tenderness in the mouth or consistent pain that is not caused by dental issues.
Burning sensations in a particular region, and bleeding.
If the cancer has progressed, then there will be difficulty in chewing or swallowing and moving the jaw.
Unexplained loosening of teeth along with numbness.
Prevention of oral cancer needs a multi-tier approach, such as maintaining a balanced diet that includes fruits and vegetables rich in antioxidants, limited or complete avoidance of alcohol, since it significantly increases the risk. Complete abstinence from any sort of tobacco, such as smoking, chewing khaini, and gutka.
Regular oral care is essential since it will help in detecting precancerous lesions; routine dental screening does help too, significantly for high-risk individuals such as frequent tobacco users.
It is important to be aware when to consult a doctor and not ignore basic signs. It is advised to seek professional help promptly when:
Constant feeling of pins and needles on the tongue and inner cheek.
Slurring of speech and change in voice quality without the presence of throat infection.
Consistent earaches without an infection.
Excessive salivation or dry mouth.
Loss of taste or metallic taste in the mouth.
It is important to be aware of any minor ulcers that can appear harmless. So, do not dismiss the warning signs until they have advanced to a stage of being untreatable. Therefore, it is necessary to understand the features that differentiate between a benign sore and oral cancer. Proactive screening, prevention, and patient awareness are needed to reduce the risk of oral cancer, which, if caught early, can be treated.
By Dr Saravana Periyaswamy, director and senior consultant, Surgical Oncology, SIMS Hospital, Chennai.