Lip Cancer is typically caused by tobacco and alcohol consumption and low melanin. Lip cancer symptoms include sores, discoloration, and tingling around mouth.

Lip Cancer

Humza Khizer

Overview

Lip cancer is a type of oral cancer that can occur anywhere along the upper and lower lip. However, it is more common on the lower lip. While the global incidence of lip cancer is low<a href="#accordion">[1]</a>, it is the eighth most common malignancy.

In Pakistan, it is a major threat to public health<a href="#accordion">[2]</a>, as lip cancer is the second most common malignancy in Pakistan and accounts for 15% of all new cancer cases<a href="#accordion">[3]</a>. Most cases of lip cancer in Pakistan are reported in middle-aged and older age groups. However, in recent years, there has been an increase in the incidence of younger individuals. More than 90% of the cases of lip cancer reported are squamous cell carcinomas<a href="#accordion">[4]</a>.&nbsp;

Oral squamous cell carcinoma (OSCC) is a locally invasive, cancerous tumor that may occur anywhere within the oral cavity. The tumor rarely spreads to distant sites in the body, but given the local invasiveness of the cancer, it is vital to identify and treat the condition early. Lip cancers have a multifactorial etiology with genetic and environmental influences, but over 95% of individuals diagnosed with oral squamous cell carcinoma either smoke tobacco, drink alcohol, or both. Early lesions are usually asymptomatic. Thus, early detection by screening is necessary to prevent fatal diseases.&nbsp;

In addition, there is overwhelming evidence that the majority of the cases of lip cancers are attributable to smoked and chewed tobacco, alcohol, betel nut, and betel quid consumption. A case-control study further highlights that human papillomavirus is also a cause of lip cancers, especially in the Western World<a href="#accordion">[5]</a>. Though, its prevalence still needs to be investigated in Pakistan. Tobacco and alcohol are both well-documented risk factors for lip cancer in Western countries, whereas tobacco, areca nut, and betel quid have higher carcinogenic influences in Asian countries.&nbsp;

&nbsp;

Given religious and cultural influences, alcohol is not as openly available in Pakistan. Though, on the other hand, betel quid (Pan) and areca nut chewing is a culturally supported habit in Pakistan. In addition to the easy and cheap availability of betel quid and areca nut, they are addictive, and their toxic effects can lead to OSCC. Their use is popular in all age groups including primary school children in Pakistan<a href="#accordion">[6]</a>. Similarly, cigarette smokers have a 27-fold higher chance of developing OSCC compared to non-smokers<a href="#accordion">[7]</a>. In addition to this, poor oral hygiene, gutka, and pan masala also have carcinogenic (cancer-causing) potential. Epidemiological studies have further shown that hot and spicy foods are also irritants that can lead to the development of oral cancer. Moreover, deficiencies of vitamins A, C, and E are also associated with the risk of non-cancerous lesions transforming into cancerous lesions<a href="#accordion">[8]</a>. 
&nbsp;

Signs And Symptoms

In many cases, lip cancers may not have any symptoms. Dentists are often the first to notice lip cancers during routine dental examinations. However, if you have a lip sore or lump on your lip, it does not necessarily mean that you have lip cancer. Though, if a lesion persists for more than 2 weeks, seek medical help immediately. If you notice any unusual changes, lumps, or sores in your oral cavity, your doctor will conduct an oral screening exam. It is important to discuss any symptoms with your dentist or doctor for good outcomes of the disease.&nbsp;

 
Signs and symptoms of lip cancer may include:&nbsp;

<ul>
	<li>A sore, lump, ulcer, blister, or lesion on the mouth, eroded areas around the lips, gums, or inside the mouth</li>
	<li>Red or white patches on the lip or in the mouth&nbsp;</li>
	<li>Pain or bleeding on the lips or in the mouth&nbsp;</li>
	<li>Swelling in the jaw&nbsp;</li>
	<li>Numbness, loss of feeling, pain, or tenderness in any area of the face</li>
	<li>Sores on the face, neck, or mouth that bleed easily and do not heal within two weeks</li>
	<li>Feeling that something is caught in the back of the throat</li>
	<li>Difficulty moving the jaw or tongue while chewing, swallowing, or speaking</li>
	<li>Chronic throat pain and hoarseness&nbsp;</li>
	<li>Ear pain&nbsp;</li>
	<li>Unexplained weight loss&nbsp;</li>
	<li>Change in the way your teeth or dentures fit 
	&nbsp;</li>
</ul>

Causes

While researchers are not exactly sure about what causes lip cancers, several factors increase the risk. In Pakistan, the risk of developing cancer is higher in tobacco, areca nut, and betel quid users, followed by gutka. However, gutka users are found to have a higher risk of developing buccal mucosa cancer as well. Most lip cancers are linked to tobacco use. The causes of lip cancer are as follows:&nbsp;

<ul>
	<li>Smoking and chewing tobacco</li>
	<li>Heavy use of alcohol&nbsp;</li>
	<li>Excessive sun exposure&nbsp;</li>
	<li>Human papilloma virus&nbsp;</li>
	<li>A weak immune system&nbsp;</li>
	<li>Having fair skin&nbsp;</li>
	<li>Age over 40 years&nbsp;</li>
	<li>Male gender 
	&nbsp;</li>
</ul>

Diagnosis

In many cases, dentists are the first to spot lip cancer during routine exams and cleaning. If your doctor or dentist suspects lip cancer, they may recommend the following diagnostic tests:&nbsp; 
&nbsp;

<ul>
	<li>Physical examination of the mouth, face, and neck to check for signs of cancer</li>
	<li>Complete blood count&nbsp;</li>
	<li>Soft tissue biopsy&nbsp;</li>
	<li>Imaging tests, including computed tomography (CT) scan, PET scan, and magnetic resonance imaging (MRI)</li>
	<li>Endoscopy if the doctor suspects that the cancer has spread beyond the lip. In this procedure, a flexible camera is passed down the throat to look for signs of cancer. 
	&nbsp;</li>
</ul>

<h5 dir="ltr">Stage 0&nbsp;</h5>

<ul>
	<li>Stage 0 means that the cancer is in situ, meaning that it is at a very early stage. The cancer cells are contained within the mouth, and it has not spread. If the cancer is not treated, the risk of it developing into an invasive cancer is high.&nbsp;</li>
</ul>

&nbsp;

<h5 dir="ltr">Stage 1</h5>

<ul>
	<li>Stage 1 is the earliest, and the cancer is 2 cm or smaller. The cancer has not spread to nearby tissues, lymph nodes, or other organs.&nbsp;</li>
	<li>(T) Tumor, (N) nodes, and (M) metastasis staging system: T1, N0, M0</li>
</ul>

&nbsp;

<h5 dir="ltr">Stage 2</h5>

<ul>
	<li>The cancer is larger than 2 cm, but no larger than 4 cm. The cancer has not spread to nearby lymph nodes or organs.&nbsp;</li>
	<li>TNM staging: T2, N0, M0</li>
</ul>

&nbsp;

<h5 dir="ltr">Stage 3</h5>

<ul>
	<li>The cancer is larger than 4 cm and the cancer has spread to one lymph node in the same side of the neck. The lymph node is 3 cm or smaller.&nbsp;</li>
	<li>TNM staging: T1, 2 or 3, N1, M0</li>
</ul>

&nbsp;

<h5 dir="ltr">Stage 4a&nbsp;</h5>

<ul>
	<li>The tumor can be of any size&nbsp;and has spread to the palate or lower jaw, floor of the mouth, or skin of the face. It may have spread to one or more lymph nodes. The lymph node may be 6 cm or smaller in size.&nbsp;</li>
</ul>

<h5 dir="ltr"> 
Stage 4b</h5>

<ul>
	<li>The tumor has spread to nearby areas, for example, the muscles, nerves, blood vessels, or the base of the skull. The cancer may have spread to a lymph node in the neck that is larger than 6 cm.&nbsp;</li>
	<li>TNM staging: any T, N3, M0 or T4b, any N, M0</li>
</ul>

&nbsp;

<h5 dir="ltr">Stage 4c&nbsp;</h5>

<ul>
	<li>In this stage, the cancer has spread to other parts of the body, for example, the lungs, liver, or bones, known as distant metastasis.</li>
	<li>TNM staging: any T, any N, M1 
	&nbsp;</li>
</ul>

Treatment

Lip cancer can be treated with several approaches. The best treatment approach depends on the size and stage of the cancer.&nbsp;

&nbsp;

Surgery:&nbsp;The surgeon will remove the cancerous lesion and repair the lip. if the tumor is large, the surgeon may suggest reconstructive surgery to restore the appearance of your lip.&nbsp;

Radiation Therapy: In&nbsp;radiation therapy, powerful X-ray beams are used to target and kill the cancer. It may either be used as a standalone therapy or be recommended after surgery to eliminate the remaining cancer cells.&nbsp;

Chemotherapy: Chemotherapy drugs are given either in pill form or through a vein to kill the cancer cells. In some cases, the chemotherapy is combined with radiation therapy. Chemotherapy may also be recommended to ease symptoms if cancer has spread to different parts of your body and there is no other treatment available.&nbsp;

Targeted Drug Therapy:&nbsp;Targeted drug therapy is usually combined with chemotherapy and targets certain genes and proteins of cancer cells.&nbsp;

Immunotherapy: Immunotherapy focuses on boosting your own body&rsquo;s immune system and helps it fight off cancer cells. The therapy may be standalone or in combination with other can treatments. Immunotherapy is typically used for lip cancer when the cancer is at an advanced stage, and there are no other treatment options.

&nbsp;

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These include:

<ul>
	<li>Smoking or chewing tobacco</li>
	<li>Chewing betel quid, gutka, betel, or areca nuts</li>
	<li>Excessive exposure to the sun&nbsp;</li>
	<li>Fair skin&nbsp;</li>
	<li>A weak immune system 
	&nbsp;</li>
</ul>

These include:

<ul>
	<li>Don&rsquo;t use any form or type of tobacco, areca or betel nut, betel quid, or gutka.</li>
	<li>Limit the amount of alcohol you drink, or don&rsquo;t drink at all.</li>
	<li>Protect yourself from UV light exposure.</li>
	<li>Limit your risk of HPV infections.</li>
	<li>Eat a healthy, well-balanced diet.</li>
	<li>Have your dentures fitted correctly. If your dentures are ill-fitting and rub against the inside of your cheeks and tongue, it can cause changes to the cells of the mouth. and increase the risk of cancer over time.&nbsp; 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Lip cancer is a highly prevalent type of oral cancer in Pakistan that can occur along the upper and lower lip.&nbsp;</li>
	<li>In Pakistan, the risk of developing cancer is higher in tobacco, areca nut, and betel quid users, followed by gutka.</li>
	<li>Treatment for lip cancers includes surgery, radiotherapy, chemotherapy, targeted drug therapy, and immunotherapy.</li>
	<li>Currently, there is no screening test or program for oral cancers in Pakistan.</li>
</ul>

[1] Moore, S.R., Johnson, N.W., Pierce, A.M. and Wilson, D.F., 1999. The epidemiology of lip cancer: a review of global incidence and aetiology. Oral diseases, 5(3), pp.185-195.

[2] Akram, S., Mirza, T., Mirza, M.A. and Qureshi, M., 2013. Emerging patterns in clinico-pathological spectrum of oral cancers. Pakistan journal of medical sciences, 29(3), p.783.

[3] Ferlay, J., Shin, H.R., Bray, F., Forman, D., Mathers, C. and Parkin, D.M., 2010. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International journal of cancer, 127(12), pp.2893-2917.

[4] Choi, S. and Myers, J.N., 2008. Molecular pathogenesis of oral squamous cell carcinoma: implications for therapy. Journal of dental research, 87(1), pp.14-32.

[5] Chaturvedi, A.K., 2012. Epidemiology and clinical aspects of HPV in head and neck cancers. Head and neck pathology, 6(1), pp.16-24.

[6] Shah, S.M.A., Merchant, A.T., Luby, S.P. and Chotani, R.A., 2002. Addicted schoolchildren: Prevalence and characteristics of areca nut chewers among primary school children in Karachi, Pakistan. Journal of paediatrics and child health, 38(5), pp.507-510.

[7] Jerjes, W., Upile, T., Radhi, H., Petrie, A., Abiola, J., Adams, A., Kafas, P., Callear, J., Carbiner, R., Rajaram, K. and Hopper, C., 2012. The effect of tobacco and alcohol and their reduction/cessation on mortality in oral cancer patients. Head & neck oncology, 4(1), pp.1-5.

[8] Lucenteforte, E., Garavello, W., Bosetti, C. and La Vecchia, C., 2009. Dietary factors and oral and pharyngeal cancer risk. Oral oncology, 45(6), pp.461-467.

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