Lip cancer

Lip cancer is a tumor of malignant origin originating from the epithelial layer of the red border of the lips. The term "red border" refers to the border area, the place where the skin turns into a mucous membrane, permeated with many blood vessels and nerve endings. Despite the relatively small share in the overall structure of oncological tumors (about 1.4%), neoplasia is one of the most frequent among the male population of the older age group.

It occurs mainly in men - 5.8/100 thousand. population against 1.6 in women. Most of these diseases (96-97%) are cancer of the lower lip. There are no satisfactory explanations for the spread of this localization. It is believed that the tissue specificity of the lower lip, in which there are significantly fewer sebaceous glands compared to the upper lip, is the leading cause of its weak protection against the negative effects of environmental factors. This is also due to a small amount of natural lubricant for its protection, under the condition of greater activity and mobility.

Cancer of the upper lip occurs mainly in women, its share is only 3-4%.

Increased incidence rates are noted in people after 55-65 years of age (it is accepted to be counted among the diseases of old age) and is relatively rare in middle-aged people. A malignant tumor of the lip is characterized by slow development, germination in the surrounding tissues and late metastasis. Cancer on the lip has a weak tendency to spread the tumor process, it is manifested mainly by local changes. This type of neoplasia is characterized by a lower malignancy of the process compared to oncological tumors of other localizations in the oral cavity.

Etiology and factors leading to lip cancer

• Influence of climate-meteorological factors that negatively affect mucous membranes and human skin (solar insolation, low and high humidity, air temperature, sudden changes in such parameters). There is a direct relationship between the level of morbidity and the geographical latitude of residence, which is due to the high level of insolation (solar radiation).
• Long-term and frequent mechanical traumatization of the epithelial layer of the lips: damage by dentures, cuts during shaving, piercing of the upper/lower lip, atrophic skin processes in the elderly.
• Periodically, there are large lesions of the lips caused by the herpes virus, papillomas.
• Smoking, especially with the use of a smoking pipe and low-grade varieties of tobacco, chewing dry herbal mixtures, abusing low-quality alcoholic beverages, eating very spicy, spicy and hot food.
• Background pathological processes: cracked lips, flat leukoplakia, chronic ulcers, cheilitis.
• Unsatisfactory condition of the oral cavity: presence of carious teeth.
• Occupational hazards: work in close contact with chemical carcinogens.

Classification

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

By histological structure, the following types are distinguished:

• Squamous cell carcinoma of the keratinized epithelium grows slowly, protruding outwards, with little spread to surrounding tissues. Characteristic is the late appearance of ulcers, metastases in isolated cases.
• Squamous non-keratinizing cancer rapidly grows deep into the lip with active spread to surrounding tissues, rapid ulceration and frequent metastases to adjacent tissues.

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

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

• 1 – a tumor with a diameter of up to 2 cm, lymph nodes are not involved in the process.
• 2 – the neoplasm reaches 4 cm, without the involvement of lymph nodes.
• 3 – the dimensions are also 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 into adjacent tissues.
• 4c – spread to distant tissues and organs.

Lip cancer: symptoms

The appearance and development of the oncological process is usually preceded by precancerous, benign diseases and negative background conditions of the border skin, which form the first symptoms of lip cancer. Much less often, a malignant process develops on unchanged tissues.

What lip cancer looks like

New formations are located mainly in the places of the red border with localization of tissue defects between the corner and the center of the lower lip. The most common signs of lip cancer:

• formations of a dense consistency, covered with a crust;
• shallow ulcers with thickened edges, which are not accompanied by symptoms.

Rarely, the initial stage of lip cancer is accompanied by itching. Then, in its appearance, and instead of lip enlargement, there are tissue defects, ulcers with the presence of an infiltrate at the base (clot of cellular elements with blood and lymph), which are accompanied by pain and swelling. Such eroded surfaces with infiltrate appear more often after the removal of keratinized masses. Papillary growths often appear in the erosion zone, bleeding even with any minor injury. A stronger pain syndrome is characteristic of the ulcerative-infiltrative form. The presence of an infiltrate is one of the most important signs of calcification of the process.

As the cancerous process spreads, sprouting into adjacent tissues, the symptoms become more pronounced. Appear:

• bad breath;
• violation of voice timbre;
• drooling;
• soreness in the throat;
• bluish color of the mucous membrane;
• difficulty eating;
• increased pain;
• the function of the lower jaw suffers and cosmetic defects increase.

Adjacent lymph nodes are tightly fused with the tissues surrounding them and compacted, general negative symptoms increase (weakness, fatigue, exhaustion). In the vast majority of cases, when the tumor grows and spreads, the disease process is accompanied by tissue decay, and a secondary infection of bacterial origin is added.

If you suspect lip cancer, the signs indicate the development of oncology, it is important to quickly consult a doctor who will prescribe the necessary examination.

Diagnostic procedures

The diagnosis is given to the patient taking into account the complaints, the data of physical methods of examination of the lip, the mucous membrane of the oral cavity using a magnifying glass, as well as the results of instrumental diagnostics. The results are considered:

• Ultrasound of the lip and neck area;
• X-rays of the lower jaw;
• cytological examination of smears-imprints, punctate and scrapings from the primary tumor and the nearest lymph nodes.

An extremely informative diagnostic method is the innovative PET-CT (positron emission tomography) method. It is based on the use of the radiological method and the capabilities of new computer technologies. This makes it possible to identify micrometastases and evaluate the response to the already performed therapy, and, if necessary, to choose the optimal course of treatment.

Differential diagnosis should also be carried out with candidiasis, syphilis, and herpetic manifestations. In most cases, the definition of a neoplasm does not cause difficulties.

Treatment

The leading therapeutic methods are radiation and surgical methods. Chemotherapeutic action is carried out mainly in the treatment of the disease in the later stages. Neoplasms of insignificant size, in the absence of metastases, can be treated by a functionally gentle method of cryogenic exposure with liquid nitrogen. This method is quite effective, especially in people with concomitant diseases. Short-focus X-ray therapy (radiation method) is also effective in the initial stage of the disease.

Surgical resection of neoplasms on the lip is performed in patients in the absence of metastases or with excision of salivary glands, cervical tissue and adjacent lymph nodes if they are present. If distant metastases are detected, a course of systemic chemotherapy with platinum drugs is prescribed. Later, plastic surgery is performed to restore the lips and other parts of the face. Permanent treatment for stage 1 lip cancer is achieved in 95-98%, stage 2 - in 62-75%, stage 3 - 32-40%.

Prevention

The prevention of oncology of the upper and lower lip is based on a set of simple measures:

• Complete refusal of smoking, use of chewing mixtures that irritate the mucous membrane. Lip cancer from smoking occurs in 35% of cases. Fabrics are exposed to various substances contained in tobacco, as well as hot cigarette smoke, which contributes to the drying and loss of moisture of the mucous membrane of the lips with the development of microcracks. In the process of smoking, when tobacco combustion products interact with saliva at extremely high temperatures, substances with a carcinogenic effect are formed. These are polycyclic hydrocarbons, 3,4-benzpyrene, anthracene, as well as radioactive polonium contained in tobacco smoke. You should know that the concentration of carcinogens increases when you take a deep drag and smoke a cigarette to the end.
• Timely treatment of various background diseases of the mucous membrane and skin of the lips, precancerous changes.
• Elimination of negative natural factors (solar insolation, cold) and the influence of industrial factors (high temperature, contact of facial skin with carcinogens). Use of lip protection products, indifferent hygienic ointments.
• Careful observance of oral hygiene, timely and adequate prosthetics.
• All patients who have undergone lip cancer should be registered with an active periodic examination.

A special role in prevention is given to educational work aimed at creating high oncological alertness of the population and knowledge about how lip cancer begins. This is due to the fact that despite the availability of observing any processes on the lips, most people are not alerted to the appearance of rashes and seals, small ulcers in this area, which they attribute to the usual manifestations of herpes and colds. And since the onset of the disease occurs without pronounced symptoms, many patients who already have lip cancer (the initial stage of the oncological process) miss the right moment and turn to specialists for advice late. Therefore, at the appearance of the first suspicious seals, which do not pass after 2 weeks of therapeutic measures, but on the contrary, even progress, you must consult a doctor without delay.

Do not forget that it is the stage of lip cancer and timely treatment that determine a favorable prognosis. Early diagnosed lip cancer, the first signs of which may even be absent, is well treatable. In many ways, this is due to the locality of the tumor, which facilitates the treatment process as long as it does not go beyond the mucous and submucosal layers.

The prognosis of survival worsens significantly in the presence of multiple metastases in the surrounding tissues. Usually, the working capacity of patients is restored after treatment. However, it is often necessary to change the former work, especially if it is associated with a long stay in conditions of insolation, cold or hot air, frequent contact with carcinogenic agents.