Cancer of the lip is a malignant tumor of the stratified squamous epithelium of the red border of the lower or upper lip. Among all tumors of the head and neck, this cancer is 8.4%. This disease is more typical for men – they get sick three times more often than women, mostly over the age of 60 years. The incidence rate for men is 1.65 cases per 100,000 population, and 0.27 for women. Lip cancer is more common in fair skinned patients.
Causes of lip cancer
Precancerous diseases with a high frequency of malignancy include limited hyperkeratosis, warty precancer and Manganotti cheilitis, more rarely, verrucous leukoplakia, keratoacanthoma, skin horn, papilloma with malignancy, erosive-ulcerative and hyperkeratotic forms of lupus erythematosus and lichen planus, post-radiation cheilitis lead to the development of cancer. . Background processes for the development of malignant neoplasms are chronic ulcers, lip cracks, and flat leukoplakia.
In addition to smoking, risk factors are chewing various mixtures, the influence of adverse meteorological factors – prolonged exposure to the sun, sudden temperature fluctuations, exposure to carcinogens, viral infections (herpes simplex), vitamin deficiency (A, E, C), wearing improperly made dentures, habits leading to chronic mechanical injury to the lower lip – biting, chewing lips, thermal exposure.
Classification of the disease
Malignant neoplasms of the lip are classified depending on which lip is affected – upper or lower, and whether the surface of the lip is internal or external.
Clinically, three forms of cancer are distinguished – papillary, warty, ulcerative and ulcerative-infiltrative.
Like other epithelial malignant tumors, lip cancer is classified according to the TNM system, where T (tumor) reflects the size and spread of the primary tumor, N (noduli) – damage to regional lymph nodes (LN), M (metastasis) – the presence of distant metastases or their absence.
The classification of lip cancer according to the TNM system suggests:
Primary tumor (T):
- TX – insufficient data to evaluate the primary tumor,
- Tis – carcinoma in situ, a tumor in the initial stages of development,
- T1 – tumor up to 2 cm in greatest dimension,
- T2 – tumor less than 2 cm, depth of invasion (germination) of the tumor from 5 to 10 mm or tumor less than 4 cm and depth of invasion less than 10 mm,
- T3 – tumor more than 4 cm or depth of invasion from 10 to 20 mm,
- T4a is a moderately locally advanced cancer. Tumor invades only adjacent tissues (eg, cortical bone, maxillary sinus, or facial skin) or large tumor with bilateral tongue involvement and/or invasion depth greater than 20 mm
- T4b, locally advanced cancer. The tumor invades the masticatory apparatus, the pterygoid processes of the sphenoid bone or the base of the skull, and/or involves the carotid artery.
Regional lymph nodes (N) according to clinical and instrumental studies:
- NX – insufficient data to assess the state of regional LUs,
- N0 – no signs of metastatic lesion of regional lymph nodes,
- N1 – metastases in one lymph node on the side of the lesion less than 3 cm in the greatest dimension, extra extranodal (outside the lymph node) spread (ENE) of the tumor is absent,
- N2 – metastases in one lymph node on the side of the lesion, from 3 to 6 cm in the largest dimension and there is no tumor spread beyond the lymph node, or metastases in several lymph nodes of the neck on the side of the lesion, up to 6 cm in the largest dimension and there is no tumor spread beyond the lymph node; or on both sides or on the opposite side up to 6 cm in the greatest dimension and ENE is absent,
- N2a – metastases in one LN on the side of the lesion > 3 cm, but not more than 6 cm in the greatest dimension,
- N2b – metastases in several lymph nodes on the side of the lesion up to 6 cm in the greatest dimension,
- N2c – metastases in the lymph nodes on both sides or on the opposite side up to 6 cm in the largest dimension and there is no spread of the tumor outside the lymph node,
- N3 – LN metastases >6 cm in greatest dimension and no ENE or metastases of any size and ENE+,
- N3a – LN metastases >6 cm in greatest dimension and no ENE,
- N3b – metastases of any size and ENE +.
Distant metastases (M):
- M0 – no distant metastases,
- M1 – the presence of distant metastases.
Symptoms of lip cancer
The pathological process develops in the epithelium of the red border of the lips, and the skin and oral mucosa are involved in the process for the second time.
In 90% of cases, the lower lip is affected, but in turn, cancer of the upper lip is more aggressive.
Usually, a scale appears first, under which a seal is determined. Possible manifestation of the tumor in the form of erosion, ulcers, dense node. First, the tumor spreads to the sides, then vertically. The tumor can wear an endophytic form, that is, grow mainly in the thickness of the tissue without clear boundaries, or grow above the surface of the lips, having the appearance of papilloma, multiple small outgrowths, cauliflower – this is an exophytic form of cancer. The development of the tumor is accompanied by itching, severe burning, throbbing or shooting pain, a feeling of fullness or stiffness.
The tumor gradually spreads to the surrounding tissues, decay processes occur, an infection can join, leading to gross cosmetic defects. By spreading to nearby structures, lip cancer can make eating difficult. Through the body, cancer cells are carried with lymph flow to the submandibular, mental, facial, parotid and deep cervical lymph nodes. Distant metastases from lip cancer are rare and most often develop in the lungs, but can affect the liver and spine.
Diagnosis of lip cancer
To make a diagnosis, a thorough examination with palpation of the lesion and regional lymph nodes is carried out.
