According to the Oral Cancer Foundation, over 50,000 people will be diagnosed with oral cancer this year, causing over 9,000 deaths. In early stages, oral cancer does not typically present with symptoms (like pain) that are obvious to the patient. Unfortunately for this reason, it is often not diagnosed until it reaches a later stage. Fortunately, oral cancer can be detected early and easily with oral cancer screenings performed by the dentist. These annual screenings are simple and painless. By having these screenings regularly, abnormalities can be detected early, leading to early diagnosis. When oral cancer is diagnosed in early stages, treatment is generally very successful.
Oral cancer can involve the lips, tongue, floor of mouth, gums, cheeks, salivary glands, jaws, hard and soft palate, sinus, and throat. It is most commonly found on the tongue and floor of the mouth. Although there are different types or oral cancer, around 90% are squamous cell carcinomas.
Causes of Oral Cancer
Tobacco use in all forms (including smoking) and alcohol use is responsible for 75% of all oral cancers. Tobacco use is the top risk factor of oral cancer in people over the age of 50. Over 75% of people over 50 with oral cancer had a history of tobacco use. Another lifestyle factor that's a common cause of oral cancer is excessive alcohol consumption. In fact, the combination of tobacco use and excessive alcohol use significantly increases one's risk. People who use both tobacco and alcohol are 15 times more likely to develop oral cancer than those who do not. Exposure to ultraviolet (UV) radiation also puts people at risk of oral cancer, specifically cancer of the lip.
Fortunately, the increase in use of sun protection has shown a decrease in lip cancer. Also, the decrease of tobacco use has resulted in a decline in oral cancers caused by tobacco. However, while the majority of patients with oral cancer are over the age of 40, there has been a shift in the demographics most frequently affected. Research shows the fastest growing demographic is non-smokers under the age of 50. Human papillomavirus version 16 (HPV16), a sexually transmitted virus which can cause cervical cancer, is now known to also cause oropharyngeal cancer (cancer of the back of the tongue, soft palate, walls of the throat, and tonsils). The increase in prevalence of HPV16 seems to be largely responsible for the increasing frequency of oral cancer of this age group. In fact, it is believed that HPV16 is replacing tobacco as the primary cause of oropharyngeal cancer in people under 50. Furthermore, the popularity of smokeless tobacco (vape pens, e-cigarettes), which is no less likely to cause oral cancer than traditional tobacco, may also be contributing to increasing rates in young people.
Oral Cancer Screenings, Diagnosis, & Treatment
Your dentist will perform an annual oral cancer screening during your dental exam. Screenings are painless and take less than 5 minutes. The dentist will visually examine and palpate (feel) the areas of the head and neck for suspicious findings. Specifically, they will look for abnormalities such as asymmetry, discolorations, masses, lesions, red patches/sores, leukoplakias (white lesions), and lymph node enlargements.
If an abnormality is noted, it will be documented and appropriate action will be taken. Some abnormalities may resemble findings that are not harmful, like a traumatic ulcer due to a burn from hot food, a canker sore, or a cold sore caused by the common herpes simplex virus 1 (HSV-1). In these cases, the area may be monitored for no longer than 2 weeks and home care instructions may be given. If however, it does not resolve within that time, a referral to a specialist for evaluation and biopsy will be made. On the other hand, if the suspicious area does not resemble a benign alternative, a referral will be made immediately.
If a referral is made, the patient is urged to be seen by the specialist as soon as possible. Many times the specialist may find the suspicion is non-cancerous. However, it is very important to follow through with testing in case oral cancer is present. The sooner a diagnosis is made, the sooner treatment can begin and the higher the chances of success.
After the type of oral cancer and stage are identified, treatment can begin. The exact treatment depends on each individual case but typically involves a multidisciplinary approach (surgery, radiation therapy, chemotherapy, etc.).
*Please note the people depicted in the photographs are models and not real patients.*