Lip cancer: symptoms, first signs, what the initial stage looks like

Lip cancer is a malignant neoplasm that consists of elements of the integumentary epithelium of the red border of the lips. A tumor on the upper lip appears rarely. Over time, lip cancer spreads to the bones of the lower jaw. Atypical cells are transported with lymph to the lymph nodes, resulting in the appearance of new malignant foci.

Doctors at the Yusupov Hospital carry out early diagnosis of lip cancer using modern research methods. Oncologists provide radiation therapy and perform gentle surgical interventions. In the later stages of lip cancer, complex therapy is used. Early diagnosis of a malignant lip tumor and adequate therapy can not only save the patient’s life, but also avoid cosmetic defects after surgery.

General information

Lip cancer is a malignant tumor process in which a malignant formation develops that grows from the epithelium of the red border of the lips. In this case, the mucous membrane and skin are affected. Most often - in about 90% of cases - the lower lip is affected. The main danger of this process is that after a certain time, metastases spread to the bones of the lower jaw.
In addition, with the lymph flow, damaged cells enter the lymph nodes, which leads to the development of new foci of the malignant process. If cancer of the lower lip develops, its border is first affected, on which a crack, swelling or ulcer appears. Most often, a tumor on the lower lip develops in people after 60 years of age. More common in men. However, statistics show that recently the incidence of the disease has decreased.

Cancer of the upper lip is much less common, but when the upper lip is affected, the pathological process is more aggressive. Accordingly, the risk of metastasis is higher, which is associated with the location of the tumor closer to the nasal cavity, where the blood flow system is actively developed.

In this condition, it is often difficult for a person to eat, and in the later stages, due to infection and tissue destruction, pronounced cosmetic defects are noted.

Treatment is carried out using chemotherapy , radiation therapy , and other methods. You can learn more about the symptoms of the pathology, its diagnosis and therapy from this article.

Treatment of lip cancer

How to treat lip cancer? When treating the disease, oncologists at the Yusupov Hospital take into account many different factors: the patient’s age, histological type of tumor, features of the spread of the tumor. Doctors at the Oncology Clinic provide multidisciplinary treatment for lip cancer:

Surgical interventions;
Radiotherapy;
Chemotherapy.

Regardless of the chosen technique, they affect the lesion or tumor, areas of regional metastasis. For grades I and II of lip cancer, radiation treatment is performed, which includes external radiotherapy and surgery.

Treatment in the initial stages

Squamous cell carcinoma of the lower lip is a common complex tumor process. Its treatment consists of two stages: removal of the main focus and the fight against metastases that have spread to neighboring tissues and organs. Radiation treatment can suppress the development of a tumor focus. The radiologist selects the method of radiation therapy individually, depending on the size of the tumor, stage of the disease, and age of the patient.

Removal using the Krail method

In the initial stage of the tumor, surgeons perform a wedge-shaped excision of the entire thickness of the lip under local anesthesia. In order to remove a defect on the lip, plastic surgery is performed - skin flaps are transferred from the patient's cheek. Removal of the lesion is performed using the Krail technique. The operation is performed at the first and second stages of lip cancer, when the tumor has not spread to nearby tissues. Surgical excision of carcinoma makes sense in the absence of metastases.

The decision to remove a lymph node is made by an oncologist surgeon if the primary tumor process has already been cured or if the lymph node is removed along with the removal of the main lesion. In some cases, surgeons remove the primary cancerous tumor, the affected lymph nodes and the vessels that connect them. The scope of the operation is determined collectively by the clinic's oncologists.

Due to the fact that metastasis can occur in a cross way, the lymphatic apparatus of the suprahyoid region on the left and right is removed. If the oncologist sees that there are cancer metastases in certain lymph nodes, he decides to remove them, and those that are located along the lymph outflow.

Treatment tactics for lip cancer depend on the stage of the disease:

Preventive surgery at stages I and II of lip cancer is carried out exclusively in cases where it is not possible to control the dynamics of the disease and there are unfavorable prognoses regarding the spread of cancer;
At stage III, in the absence of metastases, treatment is carried out using a combined effect on the lesion and adjacent areas;
In case of spread of cancer cells and the presence of single metastases in the lymph nodes, oncologists at the Yusupov Hospital perform combined treatment of lip cancer with subsequent surgery, plastic surgery and surgical correction of the lips;
In stage IVC, palliative chemoradiotherapy is performed.

Candidates and doctors of medical sciences use innovative methods of treating lip cancer. The presence of modern equipment and competent medical personnel who are attentive to all the wishes of patients allows us to achieve good results in the treatment of lip cancer for many years. Lip cancer, treated in the early stages, is cured in 97-100% of cases. At stage III, 67-80% of patients can be cured. In the fourth stage of cancer and repeated relapses, complete recovery occurs in 55% of cases.

Pathogenesis

The spread of the oncological process on the lower lip is due to its anatomical and physiological characteristics, as well as its injury to teeth affected by caries and exposure to carcinogens.

The condition, which is defined as obligate precancer, includes papillomas and focal dyskeratoses . In addition, malignant transformation can occur in diffuse dyskeratosis and keratoacanthoma .

When should a malignant process be suspected?

A long-term pathological process on the skin of the lip without a tendency to cure with active therapeutic measures should always raise suspicion that it is of poor quality. If the “spot” does not respond to local treatment and increases in size, you should immediately consult an oncologist.

The appearance of ulcerations and bleeding, or any thickening where there used to be soft skin, should be alarming. These symptoms can be either single or in combination, but even with a single symptom, the lack of treatment result within 3 weeks can be regarded as a bad sign, which can only be “clarified” by a biopsy of the skin defect. And the sooner it is done, the better.

Classification

The disease is divided into several types depending on different characteristics.

Considering the structure of the tumor, which is classified as squamous cell carcinoma, the following types are distinguished:

Keratinizing cancer is observed in 95% of cases of malignant lesions of this organ. The course in this case is more favorable: slow exophytic growth and moderate germination are noted. Metastases rarely form, and ulcers appear late in the development of the disease.
Non-keratinizing cancer - with this form the prognosis is less favorable. Tissues located nearby are affected quickly, ulcers form early, and metastases often develop. According to statistics, 5-8% of patients are diagnosed with lymphogenous metastases, when a malignant process develops in the mental and submandibular lymph nodes, in the area of the jugular vein. In 2%, hematogenous metastasis is noted. In this case, metastases develop in the lungs.

Considering the symptoms that appear during the development of the disease, the following forms are distinguished:

warty - manifests itself against the background of diffuse productive dyskeratosis;
papillary;
ulcerative and ulcerative-infiltrative - these forms are the most malignant.

There are also several stages of lip cancer:

The first (initial stage) - at this stage the size of the formation is no more than 2 cm, the lymph nodes are not affected. The formations are dense and covered with a crust.
Second , the tumor reaches no more than 4 cm, the lymph nodes are not affected.
Third - the formation reaches no more than 4 cm, while the nearby lymph node may already be affected by metastases .
4A – the size of a dense formation is no more than 4 cm. In this case, metastases in the lymph nodes can reach 5 cm. They spread to other organs and tissues.
4B – the formation spreads to the pharynx, base of the skull, large metastases appear. The disease spreads through both the blood and lymphatic routes.
4C - the tumor not only grows into the pharynx and base of the skull, but metastases develop and are transferred through the bloodstream.

How to treat

Recommendations for the treatment of lip cancer are based not on clinical studies, as is customary for the vast majority of malignant tumors, but on decades of practical experience. It so happens that, due to the rarity of the disease, no randomized clinical trials have been conducted anywhere in the world. The choice of treatment is determined by the size of the primary tumor and, of course, the expected cosmetic defect. Even a small lip tumor changes a person’s quality of life much more than all other cancers. It is too noticeable, as is the scar that remains after its removal.

When treating cancer, it is important that there are no malignant cells in the surgical wound, so the tumor must be retreated in all directions. The lip itself is small, so even with a tumor measuring 5 mm, a postoperative scar of several centimeters will remain. Only after treatment of very small and superficial tumors do minor defects remain. Unfortunately, it is impossible to treat the patient in such a way that there are no defects left at all, therefore, when choosing a treatment method, they are guided by the least functional deformation and the minimum undesirable aesthetic result.

In this situation, the determining factor will be the decision of the patient who chooses the treatment option that will result in the least severe psychological consequences for him. Surgical treatment is preferable based on results, but radiation therapy, if possible, will leave fewer “traces.” With a large and superficial tumor of the lower lip, for example, a good result is likely after radiation therapy, which cannot be achieved if the cancer grows in the jaw bone. In this situation, the treatment option would be surgery.

Squamous cell skin cancer is very responsive to chemotherapy, but how lip cancer will react to cytostatics in each specific case can only be assumed, since serious and reliable studies of the effectiveness of drug therapy in this localization have not been conducted. However, for large inoperable tumors and relapses after excision, combined chemoradiation treatment has a good effect. If there are metastases to the nearest lymph nodes, the question of radical removal of regional lymphatic collectors with subcutaneous fat is raised.

Treatment of cancer in this location is purely individual, because the reconstructive possibilities of restoring lost lip volume and microsurgical leveling of the postoperative defect tend to zero. However, in most cases the patient has every chance of recovery. In case of lip cancer, it is very important to get to a good oncologist surgeon in time.

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Causes

There are a number of factors that increase the likelihood of developing this disease:

Mechanical – constant injury from the edges of teeth or poor-quality dentures.
Temperature - addiction to too hot drinks and food, smoking.
Chemical - smoking, contact with certain carcinogens, chewing certain mixtures.
Meteorological - the influence of wind, frost, humidity, excessive ultraviolet radiation.

In addition, some viruses can be provoking factors, in particular the herpes . Among these factors are also called malocclusions.

A malignant tumor of the lip always develops as a consequence of the transformation of other pathologies. Precancerous conditions are:

limited precancerous hyperkeratosis ;
warty precancer;
cheilitis Manganotti.

In addition, the following diseases can develop into a malignant tumor:

keratoacanthoma;
leukoplakia;
chronic cheilitis ;
post-radiation stomatitis ;
ulcerative and hyperkeratotic forms of lichen planus ;
papilloma.

According to observations, this disease often develops in rural residents of the southern regions. The risk of its development is increased by poor oral hygiene, deficiency of vitamins A, E, C and beta-carotene, and gastrointestinal diseases.

Precancerous diseases of the lips

Lip cancer does not occur on healthy mucous membranes. Malignant neoplasms develop against the background of obligate or facultative precancerous diseases. Obligate precancerous diseases include:

Abrasive precancerous cheilitis Manganotti;
Warty precancer of the red border;
Limited precancerous hyperkeratosis of the red border.

Facultative precancerous diseases with greater potential for malignancy are:

Erosive and verrucous leukoplakia of the lip;
Papilloma;
Keratoacanthoma;
Cutaneous horn.

Malignant neoplasms of the lip can develop against the background of optional precancerous diseases with less potential malignancy:

Flat leukoplakia of the lip;
Chronic ulcers;
Ulcerative and hyperkeratotic forms of lupus erythematosus and lichen planus;
Chronic cracked lips;
Post-X-ray cheilitis;
Meteorological and actinic cheilitis.

Background conditions that are precursors to lip cancer include scars after burns, trauma, surgery, and benign neoplasms.

Heilith Manganotti

Abrasive precancerous Manganotti cheilitis occurs in older people. Small, round erosions appear on the lips, which do not heal for a long time. They have a smooth surface of yellow-red or bright red color. In some cases, a bloody or serous crust appears on the surfaces of erosions. If you remove it, the opened wound bleeds a little. Touching erosions does not cause pain. Once erosion appears, it does not heal for several weeks or months. After disappearing, soon enough new erosions appear in their place or nearby.

Manganotti cheilitis is diagnosed by external examination and questioning of the patient. This disease has symptoms similar to those of herpes, leukoplakia, lichen planus or lupus erythematosus. For differential diagnosis, oncologists scrape the affected area of the lip and send it for a thorough histological examination. This scraping makes it possible to detect emerging cancer cells in a timely manner and prevent the development of a malignant neoplasm of the lip.

Leukoplakia and lip hyperkeratosis

Leukoplakia of the lip is a lesion of the mucous membranes with keratinization of the epithelial tissues. Unfavorable factors that contribute to the development of leukoplakia may be alcohol abuse, smoking and eating very spicy foods. Leukoplakias of the lower lip most often develop in the mucous membranes at the corners of the mouth.

Hyperkeratosis of the lips appears as a limited area from 0.2 to 1 cm in diameter. Its surface is smooth, covered with thin, tightly packed grayish-white scales. Scraping cannot remove them.

Symptoms of lip cancer

Photo of the initial stage

As a rule, the first symptoms of lip cancer are a thickening or a small ulcer on the mucous membrane. Itching may be bothersome. A little later, the first signs are complemented by pain and discomfort. A soft tissue defect gradually develops in the affected area. Speaking about what stage 1 looks like, it should be noted that at first it is difficult to distinguish such a lesion from ordinary injuries or inflammatory processes.

As lip cancer develops, signs of lip cancer become more pronounced. It becomes difficult for a person to eat. There may be a constant flow of saliva. The pain intensifies, and at the same time the cosmetic defects worsen: the lesion already looks more extensive. Gradually, the process spreads to the oral cavity, cheek, and jaw. In this case, the patient experiences pain, burning, itching, and symptoms of discomfort.

An external examination of the patient reveals the presence of a dense, painless tumor, which is covered with a gray-brown crust. As the pathology develops, the growths gradually become larger and connect. A knot with cracks and ulcers forms, which looks like a wart or part of a cauliflower.

With ulcerative cancer, an ulcer appears with raised, uneven, dense edges. Gradually, endophytically and exophytically growing lip cancer grows into adjacent tissues. The lesion is dense, painful, it is covered with ulcers and growths that alternate with healthy skin.

If the formation grows into the bone, the lower jaw may gradually collapse. If metastasis is lymphogenous, the lymph nodes enlarge and become denser. Later, the lymph nodes merge with the tissues, and infiltrates may appear in their area, sometimes with ulcers.

In order not to miss the development of the pathological process, it is important to pay attention to the appearance of any formations on the lips. In this case, it is necessary to distinguish between the symptoms of ordinary herpes . If a swelling appears on the lip, and it is accompanied by unpleasant feelings when eating, itching and increased salivation, then we are most likely talking about an oncological process.

Benefits of onco

For more than 30 years, onco has been working for the health and comfort of patients with oncology. During this time, we have developed an ideal efficiency formula, which includes:

maximum safety;
exact compliance with domestic and international standards and protocols;
experienced and competent oncologists, diagnosticians, laboratory technicians and consultants;
modern and high-tech medical equipment;
uncompromising comfort and support for patients at every stage of therapy.

The high level of service and quality of services has been repeatedly confirmed by numerous certificates and awards. Most of the doctors working for us have trained in medical institutions in the USA and Europe, learning from the invaluable experience of their foreign colleagues.

In our work, we achieve amazing results not only thanks to modern equipment and a staff of true professionals. Our patients feel safe and comfortable, as all rooms of the oncology center are beautifully designed. The furnishings and interior are imbued with a favorable atmosphere, far from a hospital one. Also available to patients and those accompanying them is a pharmacy, a cozy cafe and a rooftop restaurant with panoramic views.

Two onco buildings have extensive territories; The buildings themselves house many offices, departments and treatment rooms. To prevent you from getting lost, our employee will guide you to the right door. Finding a place for your car will also not be a problem: we have a large parking lot.

Tests and diagnostics

To diagnose the disease, the patient is initially examined. In this case, both a routine examination and stomatoscopy (cheiloscopy) are used. Using this technique, you can determine the characteristics of the ulcer, the condition of the mucous membrane around the lesion and other indicators.

During diagnosis, the following examinations can be used:

A survey of the patient, during which the doctor necessarily finds out information about the patient’s profession, contacts with harmful substances, etc.
Inspection and palpation of the affected area, as well as the submandibular region and neck.
Ultrasound examination of the lip, abdominal organs, lips.
X-ray of the lower jaw.
Orthopantomography.
Cytological examination of smears if ulceration is present.
Biopsy of the affected area.
Puncture of enlarged lymph nodes in the neck.
Laboratory tests - blood and urine tests.
If necessary, such general clinical studies are carried out - ECG, etc.
PET-CT is also sometimes prescribed. This study is carried out to assess how the body responds to the treatment, whether a relapse of the disease is observed, and what stage of the disease the patient has.

Diagnosis of a tumor by a doctor in a hospital

What does lip cancer look like? It could be a small ulcer or a widespread tumor. Doctors at the Oncology Clinic of the Yusupov Hospital make a diagnosis of lip cancer based on the patient’s complaints, the results of an external examination and additional studies. The oncologist carefully examines and palpates the lips, cheeks, gums and regional lymph nodes. When examining the red border of the lips, skin and mucous membrane, use a magnifying glass.

How to identify lip cancer? Further examination is carried out using instrumental and laboratory diagnostic methods:

Ultrasound examination;
X-rays of the lower jaw;
Panoramic tomography;
Cytological examination of material obtained by taking fingerprint smears from the surface of the ulcer or histological examination of tissue obtained during a biopsy.

For lip cancer with lymphatic metastasis, a biopsy of the lymph nodes is performed. To exclude hematogenous metastases, chest X-ray and ultrasound examination of the abdominal organs are used. When the diagnosis of lip cancer is confirmed, an X-ray examination of the chest organs, general clinical and laboratory examination (electrocardiography, blood and urine tests) are performed.

A PET-CT study (positron emission computed tomography) is prescribed for the following purposes:

Determining the stage of lip cancer;
Assessment of response to treatment;
Detection of disease relapse during the observation period.

PET-CT is an innovative method that combines the capabilities of computer technology and radiology. At the Yusupov Hospital, it is used not only to diagnose lip cancer, but also to monitor tumor development and evaluate the outcome of treatment. Thanks to PET-CT, radiologists have the opportunity to very accurately carry out radiation treatment, significantly reduce the irradiation area, and minimize the impact on healthy organs and tissues.

In many cases, the use of PET-CT excludes a number of additional studies in the future. This allows patients of the Yusupov Hospital to save time and money. The issue of the need to use this method is decided individually for a specific patient at a meeting of the expert council with the participation of professors and doctors of the highest category. A comprehensive examination of patients using the latest diagnostic equipment, the use of modern methods of performing laboratory tests using high-quality reagents allows oncologists at the Yusupov Hospital to obtain reliable results and provide adequate therapy for lip cancer at an early stage.

Treatment with folk remedies

As with any other malignant processes, under no circumstances should folk remedies be used to treat this disease. Such actions will lead to loss of precious time. Therefore, if you suspect the development of a tumor, you should immediately consult a doctor.

During treatment, your doctor may recommend rinsing your mouth. For this purpose, decoctions of chamomile, oak bark, sage, and calendula are sometimes used.
Sea buckthorn oil can be used to lubricate the mouth.

However, such measures can only be used after the recommendation of a doctor.

Make an appointment

Do not delay your visit to a specialist - the sooner the disease is detected, the higher the chances of a full recovery. Onco works on weekends and holidays, so you can schedule a consultation at any time. To do this, use the method most convenient for you:

call us at our contact number;
use the online form on the website.

We are located at 2nd Tverskoy-Yamskaya lane, 10, not far from the metro stations “Belorusskaya”, “Novoslobodskaya”, “Mayakovskaya”, “Mendeleevskaya” and “Chekhovskaya”.

Prevention

It is important to follow some prevention rules to reduce the risk of developing the disease.

Primary prevention includes the following measures:

Stop smoking pipes and cigarettes.
Avoid exposure to carcinogens.
Take care of oral hygiene.
Protect your face from exposure to ultraviolet rays.
Do not abuse alcohol.
People prone to lip diseases need to undergo annual preventive examinations.

The rules of secondary prevention are as follows:

Treat all dental diseases, as well as dyskeratosis and cheilitis, .
Those who work in enterprises where carcinogenic exposures are possible should undergo medical examinations more often and, if necessary, treat pre-cancer.

Kinds

According to localization they distinguish:

cancer of the lower lip, accounting for about 95-98% of all cases;
Cancer of the upper lip, which occurs in no more than 2-5% of patients, but has a more aggressive and rapid course, affects mainly women.

According to histological classification, lip cancer is a squamous cell tumor, represented by two types:

keratinizing – the most common, accounting for up to 95% of cases, which is characterized by a slow course with moderate germination into other tissues and slight metastasis;
non-keratinizing - rarer and significantly more malignant, quickly growing into nearby tissues (usually into the anatomical structures of the jaw), forming ulcers and metastasizing relatively early through the lymph and blood flow. Metastases usually affect the lymph nodes under the jaw, in the chin and jugular vein, as well as lung tissue.

In addition, there are four clinical forms of the tumor: ulcerative, ulcerative-infiltrative, papillary and warty. The first two have a more malignant course.

Diet

Diet during radiation therapy

Efficacy: no data
Duration: lifelong / until recovery
Groceries cost: 2300 - 3800 per week

Diet for cancer

Efficacy: no data
Duration: until recovery or lifelong
Groceries cost: 2500 - 4800 per week

During the treatment of the disease, it is necessary to follow the doctor's advice regarding nutrition. It is important to practice gentle nutrition: it is recommended to eat dishes warm, preferring soft and easily digestible foods.

It is important to avoid hot drinks, broths, and soups.
Alcoholic drinks should be excluded.
It is also not recommended to eat spicy, fried, smoked foods.
It is necessary to reduce sweets and dairy products to a minimum.

The diet should consist of boiled vegetables, boiled meat, fermented milk dishes, and cereals. Drinking should be plentiful.

Treatment under a medical policy

You can receive FREE medical care at the Oncology Center under the State Guarantee Program of Compulsory Medical Insurance (Compulsory Medical Insurance) and High-Tech Medical Care.

The service is valid for all Russian citizens.

To find out more details, as well as for what nosologies and services this program works, please call +7, or you can read in more detail here.

The multidisciplinary oncology clinic “Sofia” gives patients the opportunity to undergo a course of therapy within the framework of the compulsory medical insurance policy. This is a special quota program that provides free medical services financed from federal and local budgets. Within its framework the following can be performed:

PET/CT;
radiation therapy;
chemotherapy;
IHC;
surgery.

Medical services under compulsory medical insurance are available to all citizens of Russia. First of all, patients with a diagnosis that poses a serious threat to their life can count on free therapy.

By contacting us for medical assistance under compulsory medical insurance, you can significantly shorten the path to obtaining a quota. Our therapist or oncologist will prepare a statement with a confirmed diagnosis and the results of earlier studies. This document must be submitted to the regional health authority along with:

an application for cancer treatment under the compulsory medical insurance policy;
Russian passport and insurance policy;
SNILS;
consent to the processing of personal data;
pension certificate (for pensioners).