Do you have cancer in the upper palate of your mouth? (Hard Palate Cancer) - Let's be aware of this!

Have you ever noticed something unusual, like a sore that doesn't heal, on the hard part of the roof of your mouth, the hard part that we touch when we talk or eat? You probably didn't think much of it. But, cancer that develops on the roof of your mouth, as doctors call it (Hard Palate Cancer) , is something we definitely need to pay attention to. Although this is a relatively rare type of cancer, meaning it makes up a small percentage of oral cancers, it is very important for you and me to be aware of this.

What is Hard Palate Cancer?

Simply put, this is a cancer that develops in the hard part of the roof of our mouth, the bony palate. This palate separates our oral cavity from the nasal cavity (the space inside the nose). This cancer can come in two main types. One is the type called `Squamous Cell Carcinoma` . This develops in the flat cells lining the inside of the mouth. The other is the type of cancer related to the salivary glands `(Salivary Gland Cancer)` .

Think about it, it's like a small problem with the roof of our house that can ruin the whole game. The roof of our mouth is also a very important place for us to talk and eat. That's why we need to take care of it.

This is not a very common cancer. Even in countries like the United States, oral cancer accounts for about 3% of all cancers. Among these, only 1% to 5% are cancers of the upper palate. However, even though it is not common, the impact it has on someone is huge.

What are the symptoms of this disease?

Now let's look at the symptoms we might experience in this situation. You may have experienced one or two of these too.

• A sore on the roof of the mouth that won't heal: This is the main and most common symptom. If it starts out as a small sore and doesn't heal over time, you should be suspicious.
• Bad breath (Halitosis): If you still have a bad smell from your mouth even after brushing and rinsing your mouth, that could also be a sign.
• Feeling like your teeth are loosening: If your teeth just feel a little loose or wobbly.
• For those who wear dentures: If you wear dentures, they may not fit as well in your mouth as they used to, and may feel tight.
• Difficulty swallowing (Dysphagia): A feeling of choking or difficulty swallowing food or drink.
• A lump in the neck: Sometimes you may feel a small lump or lump-like mass on the side of your neck. This may be due to swelling of the lymph nodes.

If you have one or more of these symptoms, please seek medical advice . Don't ignore it.

What causes this cancer?

According to medical researchers, there are two main factors that contribute to the development of this type of cancer:

1. Tobacco use: Smoking cigarettes, cigars, beedis, and smokeless tobacco (e.g., chewing tobacco) are also major causes of this.

2. Alcohol consumption: Frequent and excessive consumption of alcoholic beverages also increases the risk of this cancer.

"In fact, if you drink alcohol while smoking, this risk increases even more."

What complications can occur if left untreated?

If a disease like this isn't treated properly, it won't just stay there. The cancer cells will start to spread.

• It can spread first to the lymph nodes in the neck.
• Then, it can even spread to the nasal passages.
• Cancer cells that have reached the lymph nodes can travel throughout the body and form new tumors, or metastases , in other organs. If that happens, the situation becomes even more serious.

How do doctors diagnose this disease?

When you go to see a doctor, he/she will first ask you about your symptoms. For example:

• "Do you have pain in the roof of your mouth?"
• "Since when did you notice any change in that wound?"
• "Is it getting bigger?"
• "Is the wound bleeding?"
• "Is it hard to swallow?"

In addition, we may also ask about some of your habits:

• "Do you use tobacco (cigarettes, chewing tobacco, etc.)?"
• "How much alcohol do you use?"

Then, the doctor will carefully examine the inside of your mouth and feel the lumps in your neck to see if they are swollen.

What tests are done for this?

After symptoms and an initial examination, several tests will need to be performed to confirm the disease and determine its extent.

1. Biopsy test:

This is the main test to determine whether it is cancer or not. What is done here is to take a small piece of tissue from the lesion or tumor and examine it under a microscope to see if there are any cancer cells. This test is performed by specialist doctors called `Medical Pathologists` . In the case of a cancer of the upper lip, they look at whether the tissue has the characteristics of both `Squamous Cell Carcinoma` and `Salivary Gland Cancer`.

There are several ways to perform a biopsy:

• `Fine Needle Aspiration Biopsy`: A small sample of cells is removed from the tumor using a thin needle and syringe.
• `Punch Biopsy`: A small hole is made in the tumor with a special instrument and a piece of tissue is taken.
• Incisional Biopsy: A small incision is made and a piece of tissue is removed from the tumor with a scalpel.

2. Imaging Tests:

If the biopsy confirms that it is cancer, these tests are then done to see how big the cancer is and how far it has spread.

• `Computed Tomography (CT) Scan`: This can clearly see the size of the cancer, whether it has spread to the skull bone, or whether it has spread to the lymph nodes in the neck.
• `Positron Emission Tomography (PET) Scan` (PET scan): This helps to find out if the cancer has spread not only to the lymph nodes in the neck, but also to distant parts of the body, such as the lungs.

What are the stages of cervical cancer?

Doctors use the information from the tests (biopsy, scans) mentioned above to determine the stage of the cancer. This is called cancer staging . Simply put, it tells you how far the cancer has grown and how far it has spread. The same type of staging system is used for almost all types of oral cancer.

For this, a method called the `TNM` method is used:

• T (Tumor): This refers to the size and location of the tumor. It also looks at how deep the tumor has invaded the tissue (`depth of invasion`).
• N (Nodes): This tells you whether the cancer has spread to nearby lymph nodes, and if so, to what extent.
• M (Metastasis): This refers to whether the cancer has spread ('metastasis') to distant parts of the body (e.g. lungs, liver, bones) from where it started.

Cases of the tumor pronounced with the letter T:

• Tis `(Carcinoma in situ)`: This is the earliest stage. The cancer cells are only in one layer of tissue.
• T1: The tumor is 2 centimeters or less. The depth of invasion into the tissue is 5 millimeters or less.
• T2: The tumor is between 2 and 4 centimeters in size. The depth of invasion into the tissue is between 5 and 10 millimeters.
• T3: The tumor is larger than 4 centimeters, or has grown deeper than 10 millimeters into the tissue.
• T4: The tumor has spread to nearby bones (e.g., the skull, nasal bones).

Key stages in numbers (Stages I-IV):

Now, these main stages are determined by collecting that `TNM` information.

• Stage I: The tumor is at T1 level (less than 2 cm, less than 5 mm deep). It has not spread to the lymph nodes or distant sites.
• Stage II: The tumor is at T2 level (2-4 cm, 5-10 mm deep). It has not yet spread to the lymph nodes or distant sites.
• Stage III: The tumor may be T3 (larger than 4 cm, or deeper than 10 mm), or it may be T1 or T2, but has spread to only one nearby lymph node (which must also be smaller than 3 cm). It has not spread to distant sites.
• Stage IV: This is divided into three parts (IVa, IVb, IVc).
• IVa: The tumor is at the T4a level (spread to surrounding bone, skin, etc.) or has spread to more than one node, or has spread to a large node. But has not spread beyond the nasal cavity.
• IVb: The cancer has spread beyond the skull, or into deeper areas of the neck, such as muscles and tendons, or is at the T4b level (spread to the base of the skull, around the main blood vessels in the neck).
• IVc: The cancer has spread beyond the upper palate and neck bones to distant organs in the body (e.g., the lungs).

This staging process may seem a little complicated, but don't worry. Your doctor will explain everything to you. If there's anything you don't understand, don't be afraid to ask again.

How is this treated?

In most cases, the main treatment for head and neck cancer is surgery to remove the tumor. If the cancer has spread to the lymph nodes in the neck, those nodes may also need to be removed surgically.

There are two main types of surgery:

1. Maxillectomy: This is a surgery to remove a cancerous tumor in the roof of the mouth. Sometimes, a small incision can be made in the roof of the mouth to remove the tumor. However, if the tumor is large, part or all of the roof of the mouth may need to be removed. To fill the gap left by this removal, doctors use a special acrylic plate called a `palatal plate` (similar to a set of artificial teeth). Or, they take tissue from another part of the body (such as an arm or leg) and fill the gap (this is called `flap surgery`).

2. Neck Dissection: Because cervical cancer can spread to the lymph nodes in the neck, and if it does, it can spread throughout the body, doctors sometimes remove some or all of the lymph nodes in the neck.

Possible complications and side effects of treatment

There are some complications that can occur with surgery. It's also good to be aware of these:

• Difficulty speaking, swallowing, and eating: After cleft palate surgery, it may be difficult to chew and swallow food. You may also have difficulty speaking. This may require additional surgery or speech therapy.
• Nerve damage: During surgery to remove a lump in the neck, some of the surrounding nerves may be damaged.

Sometimes, in addition to surgery, radiation therapy or chemotherapy may be given, depending on the stage of the cancer and other factors.

Can this cancer be prevented?

While it's impossible to completely prevent it, there are things we can do to reduce the risk. Let's all be mindful of these:

• Avoid tobacco use: If you smoke cigarettes or use other forms of tobacco, try to quit . If you need help with this, talk to a doctor and find out about programs that are available.
• Limit alcohol: If you drink alcohol regularly, reduce the amount and frequency of your drinking. If you think you have a problem with alcohol, seek medical advice about that as well.
• Healthy diet: Eat a balanced diet with plenty of fruits and vegetables.
• Regular dental checkups: Have your mouth checked by a dentist at least once a year. It is very important to have oral cancer screenings at least every three years for people between the ages of 20 and 40, and annually for people over the age of 40.

Can cervical cancer be cured?

Yes, it can be cured . Especially in the early stages, meaning if the tumor is detected at a young age, there is a high chance of complete cure with surgery. However, if the tumor is large and has spread, treatment is a little more difficult. Also, even if it is cured after treatment, sometimes this cancer can `recur` after many years. That is why it is recommended to continue to go for medical tests.

How do I take care of myself? What to do after treatment?

If you have cancer of the upper lip, you may need help managing side effects (such as difficulty swallowing) after treatment. This can include support from nutritionists and speech therapists.

The most important thing is to go for regular medical checkups . This is essential to check for recurrence of the cancer and to monitor your overall health.

According to the National Comprehensive Cancer Network (NCCN) recommendations, screening should continue for at least 10 years after treatment is complete. Here is the schedule:

• First year: Once every one to three months.
• Second year: Every two to six months.
• From the fifth to the tenth year: Once a year.

What questions should I ask my doctor?

You can ask your doctor some questions like these:

• "Can this tumor be removed surgically?"
• "How will the surgery affect me?"
• "Will the surgery cure me completely?"
• "Will I have to have more than one surgery?"
• "What other treatments will I need?"

Take-Home Message

Hard palate cancer is a rare but potentially serious disease. Tobacco use and excessive alcohol consumption are major risk factors. If you have symptoms such as sores on the roof of your mouth that don't heal, difficulty swallowing, or bad breath, seek medical advice immediately . If detected early, surgery can often cure the condition. It is also important to have regular check-ups after treatment. Take care of your health.

` Hard Palate Cancer, Upper Palate Cancer, Oral Cancer, Squamous Cell Carcinoma, Salivary Gland Cancer, Cancer Symptoms