The topic for this month was supposed to be “Medical history in the dental office”, however I decided to change it and address the American Dental Association’s topic of the month: Oral Cancer
Oral cancer is cancer which develops in the mouth. It usually involves most commonly the tongue and the floor of the mouth, under the tongue. It can also involve the mucosa lining of the cheeks, the gingival (gum) tissue, and finally the roof of the mouth and to a lesser degree the lips.
The majorities of cancer detected in the mouth are of the squamous cell types, squamous cell carcinoma; they develop and spread rapidly. A squamous cell is a type of epithelial cells (skin cells) which develops quickly and can be found in different part of the body. Historically smoking cigarette and the use of other tobacco products, such as smokeless tobacco were linked to the majority of the cases of oral cancer. Heavy alcohol use has also been associated with increases in risk for oral cancer. Other factor that may increase the risk for oral cancer include chronic irritation such as those from rough teeth, dentures, or fillings, medications that decrease the immune system, illnesses that decrease the immune system (such as HIV or AIDS) and poor dental and oral hygiene.
More recently there has been an increase in oral cancer associated with Human Papilloma Virus (HPV) infection, especially in young men. Several studies have shown associations between the HP virus and cancer of the oral cavity and the pharynx (throat). HPV is the usual causal agent of cervical cancer. A direct causality is still being investigated.
Some of these lesions start as a whitish area in the mucosa or an ulcer that does not heal over a long period of time. Men get oral cancer twice as often as women do, particularly men older than 40; however among non smokers over the age of 50 years, the risk seems to be significantly higher for women than men. The early symptoms are usually mild or nonexistent, soreness in the mouth or an ulcer that does not heal in any area in the mouth. Some of the usual presentation is a deep, hard-edged crack in the gum, cheek tissue, and floor of the mouth or the tongue. These lesions are usually pale colored, but may be dark or discolored. Usually painless at first, the affected individual may develop a burning sensation or pain when the tumor is advanced.
Other symptoms that may develop as the oral cancer progresses include problem chewing foods, soreness, pain and difficulty with swallowing and/or speech difficulty, especially if the tongue is affected. Swollen lymph nodes in the neck or weight loss are sometimes the first signs that bring a patient to a physician or a dentist.
There are a variety of tests available to the dentist to help in the early detection of oral cancer. A lesion on the lip, tongue, or other area of the mouth that persists for more than one (1) month should be examined by a dentist or a physician. An ulcer that does not heal should raise suspicion and need to be investigated. When a lesion is deem suspicious, a biopsy may be ordered by a physician or a dentist to confirm its nature. Occasionally, X-rays and CT scans may be done to determine if the cancer has spread in the bone.
When detected early, surgery is usually recommended to remove the tumor if it is small enough. For larger tumors, surgery may be used together with radiation therapy and chemotherapy. Surgery is not commonly done if the cancer has spread to lymph nodes in the neck.
In the US alone, approximately 35,000 individuals are diagnosed with oral cancer every year, and 8.000 die of the disease. About 1 in 4 persons with oral cancer die because of delayed diagnosis and treatment. Worldwide the problem is much greater problem. Approximately half of people with oral cancer will live more than 5 years after they are diagnosed and treated. If the cancer is found early, before it has spread to other tissues, the cure rate is nearly 90%. However, late diagnostic negatively affect the chances of survival.
There are many complications associated with oral cancer and its treatment modalities. Delayed detection and late treatment may lead to the spreading of the cancer to surrounding areas, such as the jaw bone or more distant areas such as the colon or bladder. Other complications result from the treatment methods available. Complications of radiation therapy include dry mouth which increases caries risks and difficulty swallowing among other problems. Complications of surgery include disfigurement of the face, head, and neck.
The best way to prevent oral cancer is to avoid tobacco and heavy alcohol use. Regular dental checkups, including examination of the entire mouth is essential in the early detection of pre-cancerous and cancerous lesions. Dental problems that cause irritations should be corrected as soon as possible and patient should practice good oral hygiene.
The American Dental Association has been raising awareness about oral cancer since the late 1990 and encouraging dentists to include at the least a visual inspection of their patient soft tissue every 6 months at the dental exam. Many lesions have been discovered during a “routine” examination or a cleaning.
See your health care provider if you have a sore in your mouth or lip or a lump in the neck that does not go away within 1 month. Early diagnosis and treatment of oral cancer greatly increases the chances of survival.