Oral Cancer Facts
Rates of occurrence in the United States
More than 35,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 35,000 newly diagnosed individuals, only slightly more than half will be alive in 5 years. This is a number which has not significantly improved in decades. The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer, Hodgkin's lymphoma, laryngeal cancer, cancer of the testes, and endocrine system cancers such as thyroid, or skin cancer (malignant melanoma). The death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development. Often it is only discovered when the cancer has metastasized to another location, most likely the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intra oral area. Oral cancer is particularly dangerous because in its early stages it may not be noticed by the patient, as it can frequently prosper without producing pain or symptoms they might readily recognize, and because it has a high risk of producing second, primary tumors. This means that patients who survive a first encounter with the disease, have up to a 20 times higher risk of developing a second cancer.
Age, gender, race, and ethnicity
While historically the majority of people are over the age of 40 at the time of discovery, it is now occurring more frequently in those under this age. Exact causes for those affected at a younger age are now becoming clearer in peer reviewed research, revealing a viral etiology (cause). There are also links to young men and women who use conventional "smokeless" chewing or spit tobacco. It is also now confirmed that in a younger age group, including those who have never used any tobacco products, have a cause which is HPV viral based. The human papilloma virus, particularly version 16, has now been shown to be sexually transmitted between partners, and is conclusively implicated in the increasing incidence of young non-smoking oral cancer patients. From a gender perspective, for decades this has been a cancer which affected 6 men for every woman. That ratio has now become 2 men to each woman.
Risk Factors
Age is frequently named as a risk factor for oral cancer, as historically it occurs in those over the age of 40. The age of diagnosed patients may indicate a time component in the biochemical or biophysical processes of aging cells that allows malignant transformation, or perhaps, immune system competence diminishes with age. Very recent data (late 2007-2008) lead us to believe that the fastest growing segment of the oral cancer population are non smokers under the age of fifty, which would indicate a paradigm shift in the cause of the disease, and in the locations where it most frequently occurs in the oral environment. However, it is likely that the accumulative damage from other factors, such as tobacco use, alcohol consumption, and persistent viral infections such as HPV, are the real culprits. The human papilloma virus, particularly HPV16, has been definitively implicated in oral cancers, particularly those that occur in the back of the mouth. (Oropharynx, base of tongue, tonsillar pillars and crypt, as well as the tonsils themselves.) HPV is a common, sexually transmitted virus, which infects about 40 million Americans today.
Possible signs and symptoms
One of the real dangers of this cancer, is that in its early stages, it can go unnoticed. It can be painless, and little in the way of physical changes may be obvious. The good news is however, that your dentist or doctor can, in most cases, see or feel the precursor tissue changes, or the actual cancer while it is still very small, or in its earliest stages. More about the stages of cancer It may appear as a white or red patch of tissue in the mouth, or a small indurated ulcer which looks like a common canker sore. Because there are so many benign tissue changes that occur normally in your mouth, and some things as simple as a bite on the inside of your cheek may mimic the look of a dangerous tissue change, it is important to have any sore or discolored area of your mouth, which does not heal within 14 days, looked at by a professional. Other symptoms include; a lump or mass which can be felt inside the mouth or neck, pain or difficulty in swallowing, speaking, or chewing, any wart like masses, hoarseness which lasts for a long time, or any numbness in the oral/facial region. Unilateral persistent ear ache can also be a warning sign. Other than the lips which are not a major site for occurrence any longer, common areas for oral cancer to develop in the anterior (front) of the mouth are on the tongue and the floor of the mouth. Individuals that use chewing tobacco, are likely to have them develop in the sulcus between the lip or cheek and the soft tissue (gingiva) covering the lower jaw (mandible) where the plug of tobacco is held repeatedly. There are also a small number of cancers that are unique to the salivary glands, as well as the very dangerous melanoma.
Dental issues
The dental community is the first line of defense in early detection of the disease. Published studies show that currently less than 15% of those who visit a dentist regularly, report having had an oral cancer screening. This is unfortunate, when you consider that historically, the greatest strides in combating most cancers have come from increased awareness and aggressive campaigns directed at early detection. It is now commonplace to annually get a PAP smear for cervical cancer, a mammogram to check for breast cancer, or PSA and digital rectal exams for prostate cancer. These screening efforts have been possible as a result of the increased public awareness of the value of catching cancers in their earliest forms, combined with effective technologies for conducting the examinations. Oral cancer is no different. Actually, it is potentially easier to obtain public compliance for oral cancer screenings, since unlike many other cancer screening procedures, there is no invasive technique necessary to look for it, no discomfort or pain involved, and it is very inexpensive to have your mouth examined for the early signs of disease. Education of the public regarding the risk factors which lead to oral cancer, and the development of public awareness, are primary responsibilities of the dental community. Realize that a visit to the dentist is no longer about a filling, a crown, or a postponable cleaning, but is actually a matter of life and death. Dental examinations, when properly done and which include a screening for oral cancer, will save lives.
Discovery and diagnosis
Any sore, discoloration, induration, prominent tissue, irritation, hoarseness, which does not resolve within a two week period on its own, with or without treatment, should be considered suspect and worthy of further examination or referral. Besides a routine visit to the dental office for regular examinations, it is the patient's responsibility to be aware of changes in their oral environment. When these changes occur, they need to be brought to the attention of a qualified dental professional for examination. The dental professional needs to be current in the knowledge base necessary to make a proper diagnosis, and be competent in the proper screening procedures to identify oral cancer. There are two separate issues, discovery and diagnosis. Discovery is the result of a thorough visual and manual examination. Once suspect tissues have been detected, the only way a definitive diagnosis of oral cancer may be made is through biopsy. Given the large number of tissue abnormalities a dentist sees every day, it is not logical, nor practical, that each one of these be biopsied. The first question which may help in the determination of which abnormality bears closer examination, is how long has the suspect condition been present? Any condition that has existed for 14 days or more without resolution should be considered suspect and worthy of further diagnostic procedures or referral. Certainly, it is common knowledge that two of the most prevalent lesions that mimic oral cancer, are the herpes simplex ulceration, and aphthous ulcerations, each resolving of their own accord in approximately 10-14 days. These all too frequently turn out to be squamous cell carcinomas, which have been under observation.... for several months. Creating awareness, discovery, diagnosis, and referral. When it comes to oral cancer and saving lives, these are the primary responsibilities of the dental community. The most important step in reducing the death rate from oral cancer is early discovery. No group has a better opportunity to have an impact than members of the dental community.
