Lip cancer is a malignant neoplasm originating from the cells of the integumentary epithelium of the red border of the lips.
Lip cancer is within 3% of all malignant tumors (8-9 place). Cancer of the upper lip is much less common than cancer of the lower lip – it occurs in 2-5% of cases of lip cancer, but with all this it has a more aggressive course.
Men suffer from this type of cancer more often than women (more than 76% of cases). The peak incidence occurs at the age of over 70 years. Lip cancer is most common in rural areas.
The reasons
Causes of lip cancer include:
- exposure to sunlight
- frequent exposure to high temperatures
- frequent mechanical injuries
- smoking (especially pipes), chewing tobacco
- chemical carcinogens: compounds of arsenic, mercury, bismuth, anthracite, liquid resins, oil distillation products
- alcohol
- viral infections
- chronic inflammatory processes
Symptoms
Lip cancer always arises from another disease of the lip and never from healthy tissue. Sometimes cancer arises from leukoplakia or a fissure, sometimes from a papilloma or a warty form of dyskeratosis.
Initially, a small seal appears, protruding above the surface of the lip. In the center of the neoplasm, erosion or an ulcer occurs with a granular surface and a roller-like edge. Education has fuzzy boundaries and is gradually increasing in volume. The tumor is covered with a film, the removal of which is painful. Under the film, bumpy growths are visible.
The tumor gradually grows, destroying the surrounding tissues and significantly infiltrating. A secondary infection joins the neoplasm. The infiltrate extends to the cheek, chin, lower jaw. Regional lymph nodes are initially dense, painless and mobile. As metastases grow, lymph nodes increase in volume, neighboring tissues grow and lose mobility. In advanced stages, metastases turn into large decaying infiltrates.
Nutrition is gradually disturbed, tissue decay joins, cachexia develops.
Diagnosis
When diagnosing, carry out:
- examination and palpation of the lips, cheeks and gums, mucous membrane of the alveolar processes of the jaws
- examination and palpation of the submandibular region and neck on both sides
- chest x-ray
- Ultrasound of the lips, neck, abdominal organs (according to indications)
- X-ray of the lower jaw, orthopantomography (according to indications)
- smears-prints for cytological examination (in case of ulceration) or biopsy of the affected area
- biopsy of the lymph nodes of the neck with their increase
Treatment
The choice of treatment method depends mainly on the prevalence of the process (stage) and the type of tumor growth. It is necessary to take into account the age of the patient and the presence of concomitant pathology. Treatment consists in influencing the primary focus and areas of regional metastasis.
In stages I-II, the cure for lip cancer can be achieved by several methods:
The cryogenic method is the impact on the tumor of liquid nitrogen with a boiling point of -196 gr.S. This method is the most effective with a 100% cure, functionally sparing, because. indicated for the elderly and those suffering from severe comorbidities, can be used once on an outpatient basis.
Radiation method – close-focus X-ray therapy (50-65 Gy), interstitial radium therapy (50-70 Gy), electron therapy (SOD 50-70 Gy).
The surgical method is used when the improbability of the use of cryogenic or radiation treatment.
Photodynamic therapy – laser exposure against the background of local or intravenous administration of a photosensitizing product with limited superficial lesions.
Prophylactic 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 prognostic factors (young men, non-keratinizing type of squamous cell carcinoma, infiltrative form of growth).
At stage III without metastases in regional lymph nodes, treatment can be carried out:
Cryogenic method, using cryoapplication, cryoirrigation or their combination. Preventive surgery on the neck is performed according to the same indications as stages I-II.
Neck surgery can be performed simultaneously with cryogenic exposure.
Radiation method (combined radiation treatment in SOD 60-70 Gy). The zone of radiation exposure includes zones of regional metastasis.
Combined method (preoperative gamma therapy in SOD 40-50 Gy for the primary tumor and regional metastasis zones with subsequent surgery.
In case of locally advanced lip cancer without metastases or with solitary metastases in regional lymph nodes (stage IV), combined treatment with subsequent extended surgery and primary or delayed plasty is likely.
Chemotherapy is carried out with platinum products, fluorouracil, methotrexate, bleomycin.
With limited recurrence of lip cancer, surgical or cryogenic treatment is indicated. With widespread relapses, extended surgical interventions with simultaneous plasty are likely.