Lip cancer is a malignant neoplasm of epithelial origin, localized in the area of the red border of the lips. It is a seal or an ulcer, usually located on the lower lip. With the progression, the infection may join. Lip cancer sprouts nearby anatomical formations and makes it difficult to eat. In the later stages, gross cosmetic defects are detected due to tissue destruction and secondary infections. Lymphogenic metastases in lip cancer occur more often than hematogenic ones. The diagnosis is made taking into account the symptoms and additional research data. Treatment – surgery, radiotherapy, chemotherapy.
Meaning
Lip cancer is a fairly common malignant tumor originating from a multilayered squamous epithelium. Taking into account the prevalence, it ranks 10th in the structure of oncological lesions in men and 20th in women. The share of the total number of malignant neoplasms is 1.4% and 0.4%, respectively. Cancer of the upper lip is found less often than tumors of the lower lip and accounts for 2 to 5% of the total number of cases of this pathology. In men, lesions of the lower lip are more often diagnosed, in women – neoplasms of the upper lip. The risk of development increases with age. Nowadays, there is a decrease in the number of cases of pathology. The treatment is carried out by specialists in the field of oncology, dermatology and maxillofacial surgery.
Causes
Among the factors that increase the likelihood of this pathology are repeated mechanical, chemical, temperature and meteorological effects. As characteristic mechanical injuries that contribute to the development of cancer of this localization, researchers indicate permanent damage to the lips with poor-quality dentures or uneven edges of destroyed teeth. The list of repeated thermal effects includes smoking, eating too hot food and drinks.
The chemical factors that provoke lip cancer include smoking and professional contact with some carcinogens. Adverse meteorological effects are excessive ultraviolet radiation, wind, frost and high humidity. Viruses (especially the herpes simplex virus type 1, which causes the appearance of bubbles) and malocclusion play a negative role in the development of lip cancer: distal bite, in which the mouth constantly remains ajar, and mesial bite, in which the lower jaw protrudes forward, and the upper lip does not cover the lower one enough.
Disease is always the result of the transformation of other pathological processes. Obligate precancerous lesions include warty precancerous, limited precancerous hyperkeratosis and Manganotti cheilitis. Facultative diseases that can transform into lip cancer are leukoplakia and keratoacanthoma of the lips, papilloma, chronic cheilitis, post-radiation stomatitis, ulcerative and hyperkeratotic forms of SLE and lichen planus.
Classification
This disease is a type of squamous cell carcinoma. Taking into account the peculiarities of the structure, there are two forms of lip cancer: keratinizing and non-keratinizing. Keratinizing neoplasms account for 95% of the total number of cases of oncological lesions of this anatomical zone. This type is characterized by a relatively favorable course: slow exophytic growth, moderate germination of nearby tissues, late formation of ulcers and rare metastasis.
Non-cancerous lip cancer flows more malignantly. It grows mainly endophytically, quickly affects nearby tissues, ulcerates early and metastasizes more often. Lymphogenic metastases are detected in 5-8% of patients, hematogenic – in 2%. With lymphogenic metastasis, the submandibular and chin lymph nodes, as well as nodes in the jugular vein, are usually affected. With hematogenic spread, as a rule, the lungs suffer. Other organs are rarely involved.
Taking into account the clinical manifestations, there are three types of lip cancer: warty, papillary, ulcerative and ulcerative-infiltrative. Ulcerative forms of lip cancer develop against the background of erythroplakia, differ in a more malignant course.
Taking into account the prevalence of the process , the following stages of lip cancer are distinguished:
- Stage 0 – cancer in situ.
- Stage 1 – the diameter of the tumor does not exceed 2 cm, the lymph nodes are not involved.
- Stage 2 – the diameter of the neoplasm does not exceed 4 cm, the lymph nodes are intact.
- Stage 3 – the diameter of lip cancer does not exceed 4 cm, metastasis with a diameter of no more than 3 cm is detected in one of the regional lymph nodes. This stage also includes lip cancer with a diameter of more than 4 cm in the absence of metastases or a single lymphogenic metastasis with a diameter of no more than 3 cm.
- Stage 4A – the diameter of the tumor is from 2 to 4 centimeters or more, metastases with a diameter of no more than 6 cm are detected in one or several lymph nodes.
- Stage 4B – lip cancer sprouts the base of the skull, the side wall of the pharynx or the pterygoid fossa, one or more metastases with a diameter of no more than 6 cm are found in regional lymph nodes. In addition, this stage includes lip cancer of any size with or without germination of nearby tissues, provided that metastasis with a diameter of more than 6 cm is determined in one or more lymph nodes.
- Stage 4C – hematogenous metastases are detected.
Symptoms
At the initial stages, a seal or an ulcer is found on the lip (usually the lower one). Some patients are concerned about itching. Subsequently, the picture is supplemented by pain and a soft tissue defect in the affected area. Patients have difficulty eating. Possible salivation. As the process progresses, the symptoms become more pronounced. There is an increase in pain syndrome and an aggravation of cosmetic defects. Lip cancer spreads to the oral mucosa, gum, cheek and lower jaw.
An external examination of a patient with exophytically growing lip cancer reveals a dense painless tumor-like formation covered with a grayish-brown crust. The crust is removed with difficulty, lumpy bleeding growths are found under it. With the further development of lip cancer, the growths increase and connect, forming a protruding node resembling a wart or a cauliflower inflorescence. Cracks and ulcers appear on the surface of the node.
In patients with ulcerative lip cancer, an ulcer with raised, uneven, compacted edges and a pitted bottom is found in the area of the red border. Palpation of the edges is painless. Over time, endophytically and exophytically growing lip cancer gradually sprouts nearby tissues. The affected area is dense, painful, the surface is covered with ulcers or growths alternating with unchanged skin or mucous membrane.
With the germination of the bone, the destruction of the lower jaw is possible. With lymphogenic metastasis, an increase and consolidation of lymph nodes is detected. Subsequently, the lymph nodes are soldered to nearby tissues. Infiltrates form in the area of nodes, possibly with ulceration. Small single metastases of lip cancer to the lungs may be asymptomatic. With multiple metastasis, cough, shortness of breath, chest pain and hemoptysis are observed. Patients lose weight. There is a loss of appetite, fatigue and an increase in body temperature.
Diagnostics
The diagnosis is made taking into account complaints, the results of an external examination and additional studies. The oncologist carefully examines and palpates the lips, gums, cheeks and regional lymph nodes. When examining the red border of the lips, skin and mucous membrane, the specialist uses a magnifying glass. A patient with suspected lip cancer is referred for an ultrasound of the lip and radiography of the lower jaw. According to the indications, a panoramic tomography is prescribed. A cytological examination of the material obtained by taking smears-prints from the surface of the ulcer, or a histological examination of the tissues obtained during a biopsy, is carried out.
In lip cancer with lymphogenic metastasis, a lymph node biopsy is performed. To exclude hematogenous metastases, chest x-ray is used, less often – abdominal ultrasound and other studies (taking into account the existing symptoms). Lip cancer is differentiated with hard chancre and precancerous lip diseases: limited precancerous hyperkeratosis, leukoplakia, Manganotti’s cheilitis, papilloma, keratoacanthoma, ulcers with lichen planus and SLE.
Treatment and prognosis
Therapeutic tactics are determined taking into account the stage of oncological lesion. In stage 1 lip cancer, radical operations are performed or (less often) radiotherapy is performed. In stage 2 neoplasms, surgical removal of the node is performed against the background of preoperative radiotherapy. In stage 3 lip cancer, radiotherapy is prescribed to the area of the primary tumor and the affected lymph nodes, the remnants of the neoplasm are surgically removed. Excision of the affected lymph nodes is also possible.
At stage 4 of lip cancer, preoperative chemo and radiotherapy of the tumor and lymph nodes is performed. Then a wide excision of the neoplasm is performed. At stage 4C, palliative chemotherapy and radiotherapy are prescribed. With metastasis to the submandibular lymph nodes, the Vanach operation is performed. In cancer of the lip with multiple, large, immobile metastases in the supraclavicular and jugular lymph nodes, Krail’s operation (excision of the lymph nodes together with the surrounding anatomical formations) is indicated. Sometimes photodynamic therapy is used (with small superficial foci) and cryosurgery (with tumors of stage 1-3 and with recurrent neoplasms).
The prognosis for lip cancer is determined by the form and stage of the oncological lesion, the sensitivity of the neoplasm to radiotherapy, the degree of differentiation of malignant cells, the age and general condition of the patient. The initial stages of lip cancer are considered prognostically favorable. With tumors of 1-2 stages, complete recovery occurs in 97-100% of patients. With stage 3 and limited relapses, complete cure is observed in 67-80% of patients. With stage 4 lip cancer and common relapses, this indicator decreases to 55%.