Cancer is the uncontrolled growth of cells that invade and damage surrounding tissues. Cell growth serves to form new cells as the body needs. When old cells age or get damaged, they die and are replaced with new cells. However, sometimes this replacement process is flawed and doesn't proceed as it should.

Abnormally growing cells form tumors or tissue lumps, which can be cancerous or benign. Metastasis can occur when cells attack the skin, mouth, brain, and other organ tissues.

Oral cancer is a cancer disorder affecting the inside or cavity of the mouth. Areas that can be targeted include lip cancer, tongue, palate, jaw, mouth base, oropharyngeal, salivary glands, maxillary sinus, and cancers occurring in the anterior mucous membrane.

Oral cancer, also known as mouth cavity cancer, has symptoms similar to throat inflammation and canker sores. This malignancy attacks the mouth and around it, ranging from the lips, tongue, gums, to the roof of the mouth.

This cancer can appear as common issues on the lips or mouth like white spots or bleeding wounds. The difference between non-cancerous issues and potential cancer is that these symptoms do not disappear. If untreated, cancer in the mouth can spread throughout the mouth and throat to other areas in the head and neck.

The World Health Organization (WHO) noted that lip and mouth cavity cancer is one of the 15 most common cancers worldwide, with nearly 180,000 deaths each year. In 2013, Riskesdas showed increasing cancer prevalence data in Indonesia with age, and the highest prevalence was at age ≥75 years. The abnormalities and deaths caused by oral cancer are still high.

The prevalence of cancer increases with age, and the highest prevalence is at age ≥75 years (5%). The 2013 Riskesdas proportion of chewing tobacco showed a proportion of 3.9% for men and 4.8% for women (Health Research and Development Agency, 2013). The abnormalities and deaths from oral cancer remain high. Several reasons given are primarily due to a lack of early detection and identification in high-risk groups, as well as failure to control primary lesions and cervical lymph node metastases.

Canker sores could be a symptom of oral cancer, the tongue is part of the mouth cavity, so there's also a term for mouth cavity cancer that can attack the tongue, palate, gums, cheeks, mouth base, space behind teeth, but this cancer typically affects adults more.

Many people are unaware they have mouth cavity cancer due to similar symptoms to canker sores. Almost everyone has experienced canker sores. The pain can make it difficult to eat and even speak. However, there are unusual canker sores that could be signs of oral cancer.

Typical canker sores can heal on their own within two weeks to a month without treatment or will heal with treatment. If the canker sore persists in the same place in the mouth for more than a month and doesn't heal, even though it looks like a canker sore, over time it becomes an ulcer. This should be a warning as it can trigger cancer.

Recognizing early differences in symptoms will facilitate treatment and not delay handling. The quicker the treatment, the relatively lower the cost.

Oral cancer can be caused by abnormal growth of tissues in the mouth, occurring due to genetic mutations in those cells. However, the cause of this genetic mutation is not yet known for certain.

So far, the cause of this DNA mutation is unknown. However, cancer in the mouth can occur when cells in the lips or mouth undergo changes (mutations) in DNA. When disturbed, the mutation change tells cells to keep growing and dividing when healthy cells should die. The accumulation of cancer cells in the mouth can form tumors. If not addressed immediately, the spread can occur in adjacent areas.

Several factors are believed to increase the risk of oral cancer, including heredity and age (over 50 years). Some behaviors and diseases also believed to increase the risk of oral cancer are: • Smoking • Consuming alcoholic beverages • Often chewing betel nut • Rarely consuming vegetables and fruits • Not maintaining oral hygiene, e.g., letting cavities go untreated • Frequent exposure to sunlight, like field workers

Diseases that are suspected of increasing the risk of oral cancer are: • HPV infection • Mouth herpes infection • Diseases that can reduce immunity, e.g., HIV/AIDS • Certain genetic diseases, like Fanconi anemia or congenital dyskeratosis

Oral Cancer Symptoms In some people, changes in mouth tissue due to oral cancer may go unnoticed, as they are considered harmless. However, there are signs of change to be aware of, including: • Canker sores that don't heal for weeks • Canker sores accompanied by bleeding • Red or white patches in the mouth • Lumps or thickening in the mouth wall or gums that don't go away • Loose teeth for no apparent reason • Pain in the mouth or ear

Besides changes in the tissues inside the mouth, symptoms that can be felt by oral cancer patients include: • Pain in the mouth • Difficulty or pain when swallowing or chewing • Jaw feels stiff or hurts • Throat pain • Voice changes or speech mannerisms (e.g., lisping) • Difficulty speaking

For advanced-stage oral cancer, symptoms are not only inside the mouth. In this stage, cancer cells have spread, causing lumps in the neck due to swollen lymph glands.

Prevention of Oral Cancer Oral cancer cannot be fully prevented, as its cause is unknown. However, patients can take simple steps to reduce the risk of oral cancer: • Do not smoke • Avoid alcoholic beverages • Increase consumption of vegetables and fruits • Maintain oral hygiene by regularly brushing teeth • Regularly check dental health, at least once a year • Avoid excessive sun exposure to the lips • Regularly visit the dentist to check for abnormalities in the mouth as indicators of oral cancer or pre-cancer changes.

Author: Ira Puspita Sari, S.Tr. A.K (Technical Manager Laboratory Clinic PRAMITA Branch Cirebon)