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Lip Cancer (Carcinoma of the Lip)

Definition

Carcinoma of the lip is the most common cancer to affect the vermilion zone of the lip. Cancer of the lower lip is a squamous cell carcinoma almost 90% of the times; where as the cancer of the upper lip is more often basal cell carcinoma. Squamous cell carcinoma involves the red colored part of the lip where as the basal cell carcinoma tends to involve the border of the lip at the junction of lip and skin.

Symptoms

Carcinoma of the lip often commences as a small area of thickening, induration, irregularity or ulceration of the surface of the lip. In some cases the cancer starts off as a wart-like growth or fissures on the vermillion border of the lip. The lesions have a crater like appearance and velvety red base.The borders of the lesions are rolled out or indurated in nature. As the lesion progresses the tumor mass becomes a papillary or ulcerative enlargement.

Metastasis

In the cases where early medical intervention is not provided the lesion tends to destroy the local tissue. There is a total destruction of lip and invasion of cheek, the gums and the lower jaw. The ulcerative type of lesions shows an early invasion as compared to the papillary forms. The cancer can metastasize and is usually ipsilateral involvement in metastasis. Carcinoma of the upper lip metastasizes earlier and more frequently as compared to the carcinoma of lower lip. The sub maxillary and sub mental lymph nodes are first to be affected followed by  the cervical lymph nodes.

Causes

Cancer of the lip is the most common type of malignant lesion affecting the oral cavity. Squamous cell carcinoma of the lip shows a peak in appearance in the 6thand 7th decade of life. The disease more commonly occurs in males. Squamous cell carcinoma is more common in people with fair skin.

Risk factors

The disease is also prevalent in persons working in outer climates. The most commonly affected site includes lower lip, as the lower lip undergoes more sun exposure as compared to the upper lip. The other risk factor for squamous cell carcinoma of the lip includes tobacco and tobacco products use for prolonged periods and heavy consumption of alcohol. Infection with HPV (human papilloma virus) is also one of the risk factors associated with cancer of the lip.

Diagnosis

The disease can be diagnosed by the means of clinical examination and biopsy. MRI (magnetic resonance imaging), CT (computed tomography) scan and PET scan can also be used to detect the size, extent and metastasize of the tumor.

Treatment

The early stages of carcinoma of lip can be treated using surgical procedures or radiation therapy. The surgical treatment yields good prognosis if performed before metastasis takes place. The surgery includes removal of all tissues involved in the lesions such as affected nerves or local lymph nodes. The entire lip mucosal field is removed for early lesions followed by reconstruction of the lip. In advanced lesions chemotherapy and other treatment options can be explored along with surgery and radiation therapy.


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