Treatment of lip cancer
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Causes causing pathology
The development of lip cancer is not the result of a single cause, but rather the result of a combination of several adverse factors that lead to damage to epithelial cells and their malignant transformation. Understanding these risk factors allows you to prioritize your treatment and take timely preventative measures.
- Tobacco smoking. Carcinogenic tars, nicotine, and combustion products, when directly exposed, irritate the mucous membrane and vermilion border of the lips, causing chronic inflammation and keratinization of cells (hyperkeratosis). Unfiltered cigarettes are especially dangerous. Chewing tobacco is no less harmful. In this case, carcinogens also come into direct contact with the mucous membrane.
- Alcohol abuse. Ethyl alcohol increases the permeability of mucous membranes, facilitating the penetration of other carcinogens into cells. Regular consumption of strong alcoholic beverages leads to atrophy of lip tissue, significantly increasing the risk of tumor development. The combination of smoking and alcohol greatly enhances the carcinogenic effect.
- Prolonged intense sun exposure. Exposure to ultraviolet radiation. Regular sun exposure is the most significant risk factor for people working outdoors, such as farmers, construction workers, and sailors. Ultraviolet B rays damage the DNA of cells in the basal layer of the epidermis, suppress local skin immunity, and trigger photoaging processes, which can ultimately lead to inflammation—actinic cheilitis—and subsequent malignant transformation.
- Mechanical Damage. Constant trauma to the lip creates a background for chronic inflammation, which can lead to swelling. This can be caused by poorly fitting dentures, sharp edges of crowns or broken teeth, the bad habit of biting or licking lips, chemical burns at work, or thermal burns from smoking, or regularly consuming excessively hot foods and drinks.
- Human papillomavirus. Certain oncogenic strains of the virus (particularly HPV-16 and HPV-18) play a role in the development of oral and lip cancer. The virus integrates its DNA into the host cell's genome, disrupting the normal cell division cycle and promoting malignant transformation.
- Occupational hazards and environmental pollution. Working in conditions of contact with carcinogenic substances, such as arsenic compounds, mercury, and petroleum products, increases the overall risk of developing cancer, including cancer of the oral cavity.
It is important to understand that the presence of one or even several risk factors does not necessarily mean the development of the disease, but it indicates the need for a more attentive attitude to one’s health and regular preventive examinations.
Pre-cancerous conditions
Lip cancer rarely occurs in completely healthy tissue. In most cases, it is preceded by so-called precancerous conditions—chronic diseases and changes in the mucous membrane or vermilion border of the lips—that have a high risk of developing into a malignant tumor.
- Leukoplakia. This is an optional precancerous condition characterized by increased keratinization of the mucous membrane due to chronic inflammation. It appears as whitish or grayish spots that do not clear when scraped. Cracks and erosions may develop within the white spots. This form is the most dangerous in terms of malignancy.
- Bowen's disease. This is an obligate precancerous condition that is an intraepidermal carcinoma—cancer in situ. Malignant cells arise and spread within the epidermis without penetrating the basement membrane into the underlying tissue. Visually, it appears as a single, irregularly shaped spot with clear, raised edges. Its surface may be scaly, crusty, or oozing. Removal of the crusts reveals a granular, velvety surface. The lesion grows slowly and can persist for years.
- Manganotti's cheilitis. This is an obligate precancerous condition, typical of older men. It manifests as one or more smooth, bright red erosions or oval-shaped ulcers. An important diagnostic feature is that the erosion is not crusted and does not bleed spontaneously, but may bleed when injured. It may periodically epithelialize and then reappear in the same location.
- Keratoacanthoma. A benign epithelial tumor that occurs on exposed skin, including the junction of the vermilion border of the lips and the skin. It is characterized by the rapid growth of a dome-shaped nodule with a crater-like depression in the center filled with keratinized cells. After a phase of active growth, spontaneous resolution often follows, with scar formation.
- Hyperkeratosis. This is not an independent disease, but a pathological process underlying many precancerous conditions. Hyperkeratosis is characterized by excessive thickening of the stratum corneum. The skin constantly peels. Hardening and roughness may form on the lips.
Clinical picture
Early signs:
- Formation of a lump or nodule. A small, painless, pea-shaped lump can be felt under the mucous membrane or on the vermilion border of the lip. It may be yellowish or whitish in color and gradually increases in size.
- The appearance of an ulcer, crack, or erosion. An area with a breach in the surface integrity appears, which takes a long time to heal. Its edges may be raised, forming a ridge, and the base is often covered with a grayish or brownish crust, which bleeds when removed.
- Peeling and tightness. The lip area begins to peel constantly, causing a dry, burning sensation that isn't relieved by moisturizers.
- Changes in the appearance of the lips. A small red, white, or dark spot may appear, along with roughness, persistent swelling, or loss of the clear border between the vermilion and the skin. Increased salivation. Irritation caused by an ulcer or lump can reflexively increase salivary gland activity. This is a nonspecific symptom, but when combined with other signs, it should raise concern.
Late symptoms:
- Increase in the size of the tumor. A small ulcer or nodule turns into a large, bumpy nodule or a deep ulcer with jagged edges.
- Bleeding and infection. The tumor becomes easily damaged and begins to bleed at the slightest touch, while eating, or talking. The ulcer often becomes infected, leading to the appearance of purulent discharge.
- Severe pain. As the tumor grows deeper, constant, intense pain develops, which can radiate to the ear, temple, or neck. The pain interferes with normal speech and eating.
- Loss of sensation. Numbness, tingling, or crawling sensations on the lip and chin indicate tumor damage to the nerve endings. Enlargement and hardening of regional lymph nodes. This is one of the main signs of metastasis. The submental and submandibular lymph nodes enlarge first, followed by the cervical ones.
- Functional impairments. These may include unclear articulation due to lip deformity, as well as difficulty chewing and swallowing food.
- General symptoms are signs of cancer intoxication. Advanced pathology is characterized by persistent weakness, fatigue, low-grade fever, loss of appetite, and anemia.
Classification
To determine treatment strategies and prognosis, doctors use a unified classification system that takes into account the tumor structure and its extent within the body.
About 95% of all malignant tumors of the lip are squamous cell carcinoma, which originates from the cells of the stratified squamous epithelium of the red border. Within this type, two main types are distinguished:
- Keratinizing, or differentiated. Tumor cells retain the ability to keratinize, like normal skin cells. They form specific structures – keratin clusters. This type of tumor grows relatively slowly and is less aggressive. It has a delayed onset of regional and distant metastases, which leads to a more favorable prognosis for the patient.
- Nonkeratinizing, or poorly differentiated. The tumor cells are heavily altered. They lose their ability to keratinize and are virtually untraceable. This type of cancer is more aggressive. It is characterized by rapid infiltrative growth and metastasizes earlier to lymph nodes and other organs, which worsens the prognosis.
Diagnosis of pathology
Diagnosing lip cancer is always a comprehensive approach aimed not only at confirming the malignant nature of the tumor, but also at accurately determining the extent of its spread.
Primary diagnostic methods include examination and palpation. The doctor evaluates the condition of the vermilion border of the lips, paying particular attention to:
- The nature of the changes is the presence of seals, ulcers, cracks, plaques, peeling
- Borders and shape of the neoplasm, its symmetry, clarity of contours, size
- Lip color – presence of whitening, redness, hyperpigmentation
- Condition of surrounding tissues: swelling, inflammation, presence of crusts or oozing
By palpation, the doctor determines the tumor's density, its mobility relative to the underlying tissue, and tenderness. They also carefully palpate the submental, submandibular, parotid, and cervical lymph nodes.
Next, the patient with suspected cancer undergoes a biopsy followed by histological examination. This is the only method that can confirm or refute the diagnosis with 100% accuracy.
Under local anesthesia, the doctor completely excises or removes a tissue core from the most suspicious area with a special instrument, including some healthy tissue. The resulting sample is sent to the laboratory, where it is processed, thinly sectioned, stained, and examined under a microscope. Histological examination allows us to determine and confirm:
- Malignancy of the process
- Histological type of tumor
- Degree of cell differentiation
- Depth of invasion into surrounding tissues
To determine the stage of the disease, additional imaging techniques may be required, such as ultrasound, CT, MRI, and PET-CT. These allow for the assessment of lymph nodes and the detection of even distant metastases.
Treatment Methods
Lip cancer is a local manifestation of the oncological process, which, in the absence of timely treatment, poses a serious threat to life due to the ability to metastasize.
The treatment strategy is developed strictly on an individual basis and depends on the stage of the disease, the histological type of the tumor, its location, the patient's age, and the presence of comorbidities. The main principle is a comprehensive approach, often combining several methods to reduce the risk of recurrence.
Surgical treatment
Surgical removal of the tumor is the primary and most radical treatment for lip cancer, especially in the early stages. The goal is complete excision of the tumor within healthy tissue.
Types of operations:
- Wedge resection with reduction of the edges of the lip
- Excision with reconstruction on a cheek flap with the transfer of a tissue fragment from the cheek to restore the shape and function of the lip
- Mohs micrographic surgery with layer-by-layer removal of malignant neoplasms
- Lymph node dissection with removal of cervical lymph nodes
Radiation therapy
This method uses high-energy radiation to disrupt the DNA of cancer cells and destroy them. It can be used alone or in combination with surgery. It is typically prescribed after surgery to destroy any remaining cancer cells, reduce the risk of recurrence, and in the presence of unfavorable factors.
Types of radiation therapy:
- External, or remote, radiation. Radiation is generated by a linear accelerator and directed through the skin to the tumor and areas of regional metastasis. Modern methods allow for targeted irradiation of the tumor while minimizing the impact on healthy tissue.
- Brachytherapy, intracavitary or contact. A radioactive source in the form of an applicator or needles is placed directly into the tumor or in close proximity to it. This allows for a high dose of radiation to be delivered to the target with minimal impact on surrounding organs. It is often used specifically for lip cancer.
Chemotherapy
This type of conservative therapy involves the use of cytostatic drugs that destroy rapidly dividing cells or stop their growth. It is rarely used as a stand-alone treatment for lip cancer.
Chemotherapy is used in combination with radiation therapy for locally advanced, inoperable tumors. Chemotherapy drugs increase the sensitivity of cancer cells to radiation, which increases the effectiveness of treatment.
In metastatic and recurrent cancer, this type of treatment is used systemically to control the spread of the disease, reduce the size of metastases and relieve symptoms.
Targeted therapy
This is a modern treatment method that uses specialized drugs that target specific molecular targets present in cancer cells and drive their growth. Most often, targeted drugs act on the epidermal growth factor receptor (EGFR), which is expressed in many squamous cell carcinomas of the head and neck. They block the signals that trigger tumor growth.
Targeted therapy is used for metastatic cancer that is resistant to standard chemotherapy. It is usually used in combination with chemotherapy or radiation therapy.
Immunotherapy
This is the most advanced method that doesn't attack the tumor directly. Atypical cells are targeted through the patient's own immune system. It is activated by specialized drugs, allowing the body to recognize and destroy cancer cells.
Checkpoint inhibitors—monoclonal antibodies that block the PD-1/PD-L1 proteins—are used for treatment. These proteins help the tumor camouflage itself from immune T cells. Immunotherapy is prescribed to patients with recurrent or metastatic lip cancer when previous treatment has been ineffective.
Palliative care
In the later stages, when multiple distant metastases form and radical treatment is not feasible, the main goal of therapy becomes not fighting the disease, but maintaining the patient's quality of life and alleviating symptoms.
Palliative care includes:
- Pain relief – the WHO three-step pain relief scheme is used
- Nutrition correction – a nasogastric tube or gastrostomy may be installed to provide the body with nutrients when normal food intake is impossible
- Psychological support
- Palliative radiation or chemotherapy to shrink the tumor and relieve associated symptoms
Recovery period after treatment
Rehabilitation after radical treatment for lip cancer is aimed at eliminating the physical consequences of therapy and promoting psychological and social adaptation. The primary goal is to maximally restore the anatomy, function, and aesthetics of the maxillofacial region.
The primary goal after extensive resections is to restore the integrity and shape of the lip. After a wedge resection, the lip is reconstructed immediately, carefully aligning the wound edges. Modern suturing techniques minimize the visibility of the scar. For extensive defects, complex techniques using skin flaps are used. Sometimes, reconstruction is performed in several stages to achieve optimal functional and aesthetic results.
After surgery, numbness in the lower lip and chin may occur, which usually gradually subsides over several months. To speed up the process, physical therapy and B vitamins, which have a neurotropic effect, may be prescribed.
To prevent tissue infection after suturing, it is extremely important to maintain good hygiene. Soft toothbrushes, irrigators, and antiseptic mouthwashes can be used for oral care.
Surgery and radiation therapy can temporarily impair lip mobility and articulation. To ensure rapid recovery, functional rehabilitation with a speech therapist is performed. Exercises begin immediately after the sutures are removed and the wound has healed.
The main areas of work of a speech therapist:
- Articulatory gymnastics is a special set of exercises to strengthen the muscles of the lips, cheeks, and tongue, improving their mobility and coordination
- Correction of dysarthria – work on the clarity of pronunciation of sounds, especially labial and labiodental sounds
- Restoring symmetry and natural facial expressions
Lips and the healing process can make eating difficult, so the patient often requires dietary adjustments. Soft, pureed, or mashed foods are recommended, eliminating the need for vigorous chewing. Ensuring adequate nutritional intake is also important for recovery.
Another important aspect of rehabilitation is psychological support and social adaptation. Changes in appearance due to treatment and dysfunction of the maxillofacial structures have a negative psychological impact. Working with a clinical psychologist or psychotherapist can help you accept your body's changes, cope with anxiety and depression, and more quickly return to your normal social life.
Questions and Answers
Is this disease fatal?
Is lip cancer treatment painful?
How will my appearance change after surgery?
After resection of small tumors, the scar is virtually invisible, as surgeons place incisions along the natural contours of the lip. After extensive surgeries, lip restoration is performed immediately using reconstructive plastic surgery techniques. Although swelling and a scar will remain immediately after surgery, the appearance will improve significantly over time.
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General characteristics of the disease
A malignant tumor characteristic of lip cancer, it is usually formed predominantly by cells of the stratified squamous epithelium. Contrary to its common name, in the vast majority of cases (approximately 95%), the disease affects the lower lip. The upper lip and corners of the mouth are affected significantly less frequently, due to anatomical and functional differences. The lower lip is more susceptible to the negative impact of external factors.
The pathogenesis of the disease is based on the process of malignant transformation of normal cells. Under prolonged exposure to adverse factors, various mutations occur in their DNA. Damage to the genome leads to uncontrolled cell division, loss of normal cell functions, and the ability to undergo apoptosis—programmed cell death that acts as a protective mechanism. Gradually, a tumor nodule forms, which invades surrounding tissue and can metastasize—spread through the lymphatic and blood vessels. The submandibular and submandibular lymph nodes are typically the first to be affected.
From an epidemiological perspective, lip cancer is considered a disease of older men. They suffer from this pathology 3-7 times more often than women. The peak incidence occurs in the age group over 60-70 years.
Experts attribute this to the higher prevalence of risk factors among men, such as smoking, outdoor work, and alcohol abuse. However, recently, there has been a trend toward younger age groups and an increase in cases among women, which is explained by changing behavioral habits, including the rise in female smoking and the popularity of indoor tanning.