Stages are used by doctors to outline the advancements and the dissemination of certain cancers. As an example, Stage 4, or IV oral cancer, has cancer in the mouth that moves to one of your body’s lymph nodes, or to another part of the body.
Tumors are a result of out of control cell division, and any cancer that results from anatomy oral is classified as oral cancer. As such, it includes cancer located:
- Beneath or on the tongue
- On the inner surfaces of the cheeks
- On the gums
- On other areas that are Lip
There’s no denying the fact that cancer can originate from any part of the body and later evolve to a different part. It can be referred to as the primary tumor and within the body, one has the metastatic cancer that is described as the cancer that moved from the original tumor to a different body part.
Oral cancer is the form of cancer most diagnosed among India’s 77000 patients in a year.
There are multiple stages for each patient and this article will discuss what stage IV oral cancer and factor of IV. Also, we will discuss cancer in relation to the causes, methods that are used to treat it as well as how it can be avoided.
What is Stage 4 Oral Cancer?
There are several stages of oral cancer, each stage is determined by the progression of the cancer. Note that stage 4 oral cancer is the final stage, as the cancer has already spread from the original location in the mouth to other lymph nodes and tissues in the immediate area or other parts of the body.
Oral cancer stages: The TNM system is used for staging oral cancer:
- T (Tumor): This describes how large the primary tumor is.
- N (Node): Indicates whether the cancer has spread to the lymph nodes near the operation site.
- M (Metastasis): Whether the cancer has spread to other areas of the body.
In stage 4, the tumor is often large, and cancer has spread to the distant lymph nodes or other organs, like the lungs, liver or bones. Stage 4 orophayrngeal cancer is often classified into four sub-stages:
- Stage 4A: The cancer has spread to neighboring tissues or lymph nodes, but has not metastasized to distant parts of the body and remains in the mouth.
- Stage 4B: The cancer has spread to lymph nodes or tissues close by, or has grown into deeper tissues of the mouth or throat.
- Stage 4C: The cancer has metastasized to distant organs.
- Stage 4D: The cancer is inoperable because it is difficult or impossible to remove surgically as a result of the size or spread of the cancer.
Stage IV Oral Cancer Signs and Symptoms
When oral cancer last stage symptoms reaches, they tend are more severe and obvious. The following are signs of an advanced-stage oral cancer:
- Chronic Mouth Pain: A wide range of signs of stage 4 oral cancer is the chronic mouth and jaw pain currently ignored by many people who grow to accept the pain as normal to them. This pain may increase with time and be continuous.
- Swallowing problems (dysphagia): The tumour may press on the throat or oesophagus, causing discomfort or making it difficult to swallow food and/or liquid.
- Mouth Sores or Ulcers: If you have ulcers in the mouth, or open sores on your gums or in the oral cavity that do not heal after having persisted for a few weeks or more, it’s one of the signs of oral cancer. These sores can bleed and bring pain while eating or speaking.
- Voice Changes or Speech Problems: If the disease has reached the throat or voice box it may cause hoarseness, changes in vocal tone, and impaired speech.
- Neck Swelling or Lumps: Swollen lymph nodes or lumps in the neck may be a sign of oral cancer that has spread to the lymphatic system. This puffiness can be painful and uncomfortable.
- Bleeding Or Numbness: Bleeding from the mouth (when you brush or eat) is common from metastatic oral cancer. There can also be a lack of feeling in your mouth, gums, or tongue.
- Unexplained Weight Loss: If the disease advances, patients can also experience drastic unexplained weight loss, from the body attempting to fight back against the cancer, as the patient experiences awkwardness with eating caused by pain or swallowing problems.
- Halitosis (Bad Breath): Chronic bad breath, especially if brushing and flossing don’t resolve it, may signal an infection or even cancer in the mouth.
Staging of Oral Cancer
Stage 4 oral cancers are subdivided into 3 sub categories: IVA, IVB, IVC, which each have particular treatments depending on the subcategory, the overall wellbeing of the patient, as well as personal considerations.
Stage IVA: This stage indicates that the disease has not advanced beyond the primary site and the adjacent lymph nodes. The treatment consists of a combination of surgery, radiation therapy, as well as chemotherapy. As the case is with any other cancer treatment, the oral cancer physician will try to form strategies that are unique to the patient
Stage IV B: This stage indicates that cancer has likely advanced to the sub-structures or lymph nodes. Consequently, treatment may consist of removal of the tumor, radiation therapy, and chemotherapy, as well as the new wave of targeted therapies. The physician is responsible for the overall consequences of each treatment; thus, with their participation, rational treatment decision should be taken.
Stage IV C: This advanced stage of cancer is when the disease has spread to other organs, including the lungs, the liver, or bones. For stage IVC oral cancer, the objectives of treatment are symptom control, as well as the total improvement of life and the prolongation of life. These, along with participation in clinical trials, may consist of chemotherapy, oral cancer immunotherapy, as well as other palliative methods.
Risk Factors for Oral Cancer
What raises the risk? There are a number of risk factors for oral cancer- perhaps more so than you might think.
- Smoking: Smoking or chewing tobacco is the number one cause of oral cancer. Smokers are at a very high risk for mouth, lip, and throat cancer.
- Heavy Alcohol Consumption: Heavy drinking -- especially if combined with smoking -- has long been linked with oral cancer.
- Human Papillomavirus (HPV): Some types of HPV, including HPV-16, are linked to a higher risk of oral cancer.
- Bad Oral Hygiene: Chronic irritation or infections to the mouth, including poor dental care and ill-fitting dentures can also escalate the risk of mouth cancer.
- Age and Sex: Oral cancer is a disease of middle-age and the elderly, occurring most often in people aged 50 years or older, with men being twice as susceptible as women.
- Diet: A diet that is low in fruits and vegetables and high in processed foods, or a diet high in animal fat, may increase the risk of developing oral cancer.
What Are the Options for Treating Stage 4 Oral Cancer?
Stage 4 oral cancer treatment is also more complicated and multi-disciplinary. The aim of treatment is to treat symptoms, to control the cancer’s advancement and to enhance the quality of life of the patient. The other treatments for stage 4 mouth cancer include the following:
- Operation : In some cases, surgery to cut out the tumor and other affected tissue or lymph nodes near the cancer may be possible. But if the cancer has spread too wide, surgery will be impossible. Operation is a little more frequent for stage 4A or 4B oral cancers.
- Radiation Therapy: The use of high-energy radiation to kill cancer cells. It can function as a first intervention or a supplement to surgery, especially if the tumor is unresectable. And radiation may assist in easing pain and in shrinking tumors.
- Chemotherapy: In chemotherapy uses powerful drugs that are used to kill cancer cells in all parts of the body. It is commonly administered along with radiation therapy to patients with stage III-IV oral cancer, particularly if the cancer has spread to remote areas of the body.
- Targeted Therapy: A treatment that uses drugs to target specific molecules (such as proteins) involved in the growth and spread of cancer cells. Those therapies can do a good job of slowing the growth of a cancer, particularly if a patient has certain gene mutations.
- Immunotherapy: Immunotherapy enhances the body’s immune system so that it can fend off cancer. It's a new approach for patients who are living with advanced oral cancer and who do not respond well to other treatments.
- Palliative Care: Designed for those who have late-stage cancer and for whom curative treatment is not an option, palliative care focuses on quality of life by controlling symptoms and pain.
Coping With Stage 4 Oral Cancer
Hearing your doctor say they suspect stage 4 oral cancer can be very difficult emotionally for both you and your loved ones. This is a journey you don’t have to travel all by yourself. Here are a few methods for dealing with the emotional issues:
- Gather Support: Talk to your close friends and family. Talk to support groups which can help you emotionally. There are support groups’ websites and other online forums, which offer support to people with similar issues.
- Stay Informed: There is literature around the disease and its treatment and the possible side effects. There is a lot of health information online; be sure you are using the correct and reliable sources. Living Well: Balanced nutrition, physical activities and especially, adequate sleep are important for enhancement of your health and can aid you when going through treatment.
- Keep Lifestyles Healthy: Eating well, exercising, and having enough passive time, all contribute to your overall well-being and support your body during treatment.
- Communication of Concerns: People experience cancer differently. There can be a lot sadness, fear and anger, anxiety, and many other feelings all at the same time. There is a lot of cancer associated with trauma and anger, so many people find that a therapist who works with cancer is a good choice. Having a person to talk to, especially in a comfortable and understand place can ease the strong emotional feelings.
- Engage in Relaxation Techniques: Slow methods such as deep breathing, yoga, meditation and even using your hands to make art can assist in reducing stress.
Prognosis and Survival Rates
The prognosis of stage 4 oral cancer is usually dismal, usually with a survival rate of 30-40% at 5 years. But survival rates can change based on many factors, such as the location of the cancer, the person’s overall health, treatment options and how well the cancer responds to treatment.
Early diagnosis is the key to a better prognosis. Those with stage 4 oral cancer who are treated right away might have improved symptomatic control and longer overall survival. But when the cancer has metastasized, or spread to other organs, the odds of surviving the cancer diminish.
Conclusion
Oral cancer, particularly in stage 4 is a complicated and life-threatening disease and requires urgent medical treatment. Although the prognosis is more difficult at this point however, advancements in treatment as well as early detection of symptoms can improve the outcome and the quality of life.
The ability to recognize symptoms, diagnose them quickly and professional medical attention are vital. If you or someone close to you suffer from symptoms or concerns, speaking with a physician can be the most beneficial thing you do.
Dr. Pooja Babbar, an experienced Medical Oncologist in Gurgaon with over 15 years of experience provides comprehensive care and advice for patients fighting last stage oral cancers. Her patient first approach ensures each patient receives the care and treatment they require.
