It is a malignant neoplasm formed from stratified squamous epithelium located in the area of the red border of the lips. Squamous cell carcinoma can be keratinizing (Fig. 1) and non-keratinizing (Fig. 2). In the first case, the tumor grows slowly, outward (exophytic), and in rare cases spreads to other organs, tissues, and the lymphatic system. That is, it rarely metastasizes. Nonkeratinizing squamous cell carcinoma is more aggressive. It is characterized by: metastasis in particular cases, rapid growth, early appearance of ulcers, infiltrative growth (endophytic), infiltration of local tissues.
Picture 1
Figure 2
Causes of lip cancer
Why lip cancer develops, like other types of cancer, is still not known exactly. In most cases, this is preceded by one or another chronic process. The risk group consists of men over 40 years of age. In women, lip cancer occurs in 3-8% of the total number of cases.
Risk factors for this disease include:
- permanent mechanical injuries to the lip due to incorrect dentures, the sharp edge of a carious tooth, or a malocclusion;
- regularly recurring or chronic infection on the lip, for example, cheilitis of a viral or bacterial nature;
- smoking, excessive consumption of too hot food or alcohol;
- constant contact with harmful substances;
- constant hypothermia or overheating.
The hereditary factor is no less significant - if loved ones had a similar disease, then the person has an increased risk of developing it.
Pathogenesis
The spread of the oncological process on the lower lip is due to its anatomical and physiological characteristics, as well as its injury to teeth affected by caries and exposure to carcinogens.
The condition, which is defined as obligate precancer, includes papillomas and focal dyskeratoses . In addition, malignant transformation can occur in diffuse dyskeratosis and keratoacanthoma .
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.
When should a malignant process be suspected?
A long-term pathological process on the skin of the lip without a tendency to cure with active therapeutic measures should always raise suspicion that it is of poor quality. If the “spot” does not respond to local treatment and increases in size, you should immediately consult an oncologist.
The appearance of ulcerations and bleeding, or any thickening where there used to be soft skin, should be alarming. These symptoms can be either single or in combination, but even with a single symptom, the lack of treatment result within 3 weeks can be regarded as a bad sign, which can only be “clarified” by a biopsy of the skin defect. And the sooner it is done, the better.
Stages
The oncologist determines the stage of the disease. This is important for prescribing effective therapy. The stage of the disease must be indicated in the diagnosis. Let's look at the stages using the example of stage III squamous cell carcinoma of the lower lip (T2N1M0). Each sign in the designation has its own role. The letters TNM define the characteristics of a malignant tumor and the stage of cancer:
- T – Tumor, which means tumor size: T1 – no more than 2 cm, T2 – 2-4 cm, T3 – more than 4 cm, T4 – the tumor has grown into surrounding organs;
- N – Nodus. Indicates the degree of damage to the lymph nodes: N0 – lymph nodes are not affected, N1 – enlargement of nearby lymph nodes up to 3 cm, N2 – small lesions in several nodes or a large lesion in one, N3 – enlargement of several lymph nodes by more than 6 cm;
- M - Metastasis. Shows whether the lip tumor has caused the spread of metastases to other organs: M0 – no metastases, M – yes.
Classification of pathology
The type of malignant neoplasms under consideration is represented by two types. The classification of lip cancer involves the separation of keratinizing and non-keratinizing tumors. The first type of neoplasm accounts for up to 95% of clinically registered cases of pathology. Cancer of this type has a favorable course - slow growth, moderate invasion of adjacent tissues, and rare metastasis.
Non-keratinizing lesions of the red border of the lips are more aggressive. The tumor grows rapidly, affects adjacent tissues, and forms numerous foci of metastasis. Lymphogenic metastases develop in the submandibular and mental lymph nodes, hematogenous - in the lungs. Secondary tumors of the first type are detected in 8% of patients, of the second - in 2%.
Diagnostics
The specialist prescribes a series of laboratory and instrumental examinations to the patient. The tumor is visible to the naked eye, so a specialist can make a preliminary diagnosis during a consultation.
But seeing symptoms is not enough - you need to confirm them with examination results. They are also necessary to determine the extent of tumor spread. With the help of diagnostics, it is possible to identify the stages of lip cancer, which is important for prescribing adequate treatment. The doctor also needs to find out about the presence of metastases and damage to the lymph nodes.
The following diagnostic methods help determine the presence of cancer:
- cytology of a sample of cells from the suspicious area;
- blood test for tumor markers;
- MRI and CT of the neck and face;
- X-ray examination of the jaw;
- fluorescent diagnostics.
Diagnostic procedures
The diagnosis is made to the patient taking into account complaints, data from physical methods of examining the lip, oral mucosa using a magnifying glass, as well as the results of instrumental diagnostics. Review the results:
- Ultrasound of the lips and neck area;
- X-rays of the lower jaw;
- cytological examination of fingerprint smears, punctate and scrapings from the primary tumor and nearby lymph nodes.
An extremely informative diagnostic method is the innovative PET-CT (positron emission tomography) method. It is based on the use of radiological methods and the capabilities of the latest computer technologies. This makes it possible to identify micrometastases and assess the response to therapy already administered, and, if necessary, choose the optimal treatment route.
Differential diagnosis should also be carried out with candidiasis, syphilis, and herpetic manifestations. In most cases, identifying a neoplasm is not difficult.
Lip cancer treatment
Depending on the stage of lip cancer pathology identified during the diagnostic process, the doctor prescribes therapy. If metastases and lymph node damage are not observed, doctors limit themselves to local procedures using ultraviolet light, radiation or cold. Otherwise, you have to resort to chemotherapy and radiation therapy.
Chemotherapy
If the initial stage of lip cancer is successfully treated using surgery, then chemotherapy is more effective when the tumor spreads throughout the body. It is used as a temporary way to stop the progression of cancer. Chemotherapy helps when the lymph nodes are affected and there are metastases to other organs. It involves the intravenous administration of special drugs that have a toxic effect on cancer cells.
Surgical method
Using the cryosurgery method, you can significantly improve the prognosis of recovery and minimize the risk of symptoms of lip cancer in the future. The method consists of cooling the tissues and then excising them with a scalpel. Then they are immediately coagulated with an electric, argon plasma or other type of scalpel. The effectiveness of cold lies in the fact that it creates a boundary between pathological and healthy cells, which allows the doctor to remove the affected areas with high precision.
Radiation therapy
Even if the patient has an initial stage of lip cancer, this does not guarantee that the tumor will not begin to spread throughout the body. For this reason, surgery is often combined with radiation therapy. It allows you to destroy cells that may remain after the operation.
Radiation therapy completely destroys pathological lesions without affecting healthy tissue. This effect can be achieved through the use of targeted radioactive radiation.
Diet
Diet during radiation therapy
- Efficacy: no data
- Duration: lifelong / until recovery
- Groceries cost: 2300 - 3800 per week
Diet for cancer
- Efficacy: no data
- Duration: until recovery or lifelong
- Groceries cost: 2500 - 4800 per week
During the treatment of the disease, it is necessary to follow the doctor's advice regarding nutrition. It is important to practice gentle nutrition: it is recommended to eat dishes warm, preferring soft and easily digestible foods.
- It is important to avoid hot drinks, broths, and soups.
- Alcoholic drinks should be excluded.
- It is also not recommended to eat spicy, fried, smoked foods.
- It is necessary to reduce sweets and dairy products to a minimum.
The diet should consist of boiled vegetables, boiled meat, fermented milk dishes, and cereals. Drinking should be plentiful.
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).
Leukoplakia, erythroplakia and dysplasia
Leukoplakia and erythroplakia are terms denoting various changes in the mucous membrane of the oral cavity and pharynx due to smoking, chewing tobacco, trauma to the oral mucosa with a denture
The appearance of a changed white mucous membrane may indicate the presence of leukoplakia in the patient. With erythroplakia, the altered mucous membrane is red in color, may protrude somewhat above the surface and bleed easily.
The severity of the resulting changes in the mucous membrane of the oral cavity and pharynx can only be clarified with the help of a biopsy (taking a piece of tissue for microscopic examination) or scraping of individual cells.
These changes may be harmless and disappear after the cessation of exposure to the causative factor, but may precede the onset of cancer.
This precancerous condition is called dysplasia.
There are minor, moderate and severe degrees of dysplasia. Knowing the degree of dysplasia, it is possible to predict (predict) the likelihood of self-healing, disappearing after treatment, or turning into a malignant tumor.
Without proper treatment, 5% of leukoplakia develop into cancer over a 10-year period.
Erythroplakia is a more serious condition in which almost 50% of cases are diagnosed as cancer after biopsy.
More than 90% of tumors of the oral cavity and oropharynx are squamous cell carcinoma, developing from integumentary (epithelial) cells.
Verrucous (warty) carcinoma is a type of squamous cell carcinoma and accounts for 5% of all oral tumors. This type of cancer is a low-grade tumor that rarely metastasizes, but can spread deeply into surrounding tissues. In this regard, wide removal of the tumor within healthy tissue is recommended.
The minor salivary glands, located in the oral and pharyngeal mucosa, can give rise to various types of cancer, such as adenoid cystic carcinoma, mucoepidermoid carcinoma and low-grade polymorphic adenocarcinoma.
The tonsils and base of the tongue contain lymphoid tissue from which lymphomas (non-Hodgkin's lymphoma/lymphosarcoma and Hodgkin's disease/lymphogranulomatosis) can develop.
Benefits of onco
For more than 30 years, onco has been working for the health and comfort of patients with oncology. During this time, we have developed an ideal efficiency formula, which includes:
- maximum safety;
- exact compliance with domestic and international standards and protocols;
- experienced and competent oncologists, diagnosticians, laboratory technicians and consultants;
- modern and high-tech medical equipment;
- uncompromising comfort and support for patients at every stage of therapy.
The high level of service and quality of services has been repeatedly confirmed by numerous certificates and awards. Most of the doctors working for us have trained in medical institutions in the USA and Europe, learning from the invaluable experience of their foreign colleagues.
In our work, we achieve amazing results not only thanks to modern equipment and a staff of true professionals. Our patients feel safe and comfortable, as all rooms of the oncology center are beautifully designed. The furnishings and interior are imbued with a favorable atmosphere, far from a hospital one. Also available to patients and those accompanying them is a pharmacy, a cozy cafe and a rooftop restaurant with panoramic views.
Two onco buildings have extensive territories; The buildings themselves house many offices, departments and treatment rooms. To prevent you from getting lost, our employee will guide you to the right door. Finding a place for your car will also not be a problem: we have a large parking lot.
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”.
Prevention
It is important to follow some prevention rules to reduce the risk of developing the disease.
Primary prevention includes the following measures:
- Stop smoking pipes and cigarettes.
- Avoid exposure to carcinogens.
- Take care of oral hygiene.
- Protect your face from exposure to ultraviolet rays.
- Do not abuse alcohol.
- People prone to lip diseases need to undergo annual preventive examinations.
The rules of secondary prevention are as follows:
- Treat all dental diseases, as well as dyskeratosis and cheilitis, .
- Those who work in enterprises where carcinogenic exposures are possible should undergo medical examinations more often and, if necessary, treat pre-cancer.
