-it just might be cancer
DURING the past week, on two occasions in my clinic, I experienced profound sadness. Two patients, whom I have known for many years, sought my opinion on oral lesions they had, which I immediately recognized to be cancer. Now, any dentist, besides being involved with pulpal and periapical disease, is very much involved with the detection of oral cancer. Oral cancer is the sixth most common cancer in the world. Studies show that oral cancer is more common than leukemia, melanoma, and cancers of the brain, liver, kidney, stomach, thyroid, ovary or cervix.
Each year in Guyana, it is estimated that oral cancer strikes 100 people, with a five- year diagnosis that 90 per cent occur in the over-40 age group, and that males are affected more frequently than females. Statistics further show that 95 per cent of all oral cancers are squamous cell carcinoma, which is related to tobacco use.
Part of the reason oral cancer has such a poor prognosis is that in more than half of the cases, the cancer would have metastasized (spread) at the time of diagnosis.  With oral cancer, early detection is the key. For example, one type of oral cancer, when treated while the lesion is still less than half-inch in diameter, has a survival rate about 60 per cent. Conversely, that same type of cancer, if not treated until it is double that size, reduces the patient’s survival rate to just 15 per cent on the average. When diagnosed early, surgery is usually required, followed by radiation and chemotherapy. Many times, the surgery is disfiguring, and the radiation and chemotherapy treatments can cause severe complications.
Major risk factors for oral cancer include the use of tobacco products (smoking and chewing), the use of alcohol, exposure to the sun (lip cancer), poor dietary habits, and exposure to carcinogens in the workplace.
All parts of the oral cavity are affected by oral cancer: The tongue, lips, floor of the mouth, soft palate, tonsils, back of throat and salivary glands. Oral cancer most frequently occurs on the lips (usually the lower lip). This is probably from chronic exposure to the sun, and is especially prevalent in people of light complexion.
The tongue is the second most affected site. These cancers occur most often on the sides and on the back two-thirds of the tongue. The floor of the mouth is the third most affected site. Cancers on the floor of the mouth and the tongue are the most aggressive, and results in the highest death rates, because the cancers here spread most frequently to the lymph nodes and then to other parts of the body. The gums, roof of the mouth, and the insides of the cheeks are less frequently affected, but oral cancers certainly can, and do occur in these areas.
It is estimated that 75 per cent of all oral and pharyngeal cancers are caused by excessive smoking and heavy consumption of alcohol, especially when the habits go together. It is felt by most authorities that alcohol promotes the effects of cancer-producing agents found in tobacco.
Smokeless tobacco (which is not so common in Guyana) is a dangerous substance that has been proven to cause oral cancer. In addition, it has also been proven to be the culprit in numerous heart attacks, high blood pressure, strokes and kidney diseases.
Dental health professionals have the greatest opportunity to identify oral cancer while it is asymptomatic, innocuous, and unsuspected. Patients who smoke and drink alcohol can visit my clinic for a free cancer examination at least every six months. It only takes about two minutes to do an oral cancer exam.
When examining inside the mouth, the dentist usually wraps gauze around the tongue and pulls it forward. He then feels and looks at the tissue under the tongue and inside the cheeks for texture or color changes, bleeding, lesions, masses, ulcerations, and lymphadenopathy (swollen lymph nodes).
When I was in California last October attending the American Dental Association meeting, the FDA announced that it was currently reviewing a new diagnostic system called OraScan that is being developed by Zila Pharmaceuticals. This system incorporates a series of oral rinse solutions to enhance the visualization of abnormal tissue. The disclosing agent leaves areas of unhealthy cells clearly defined in blue, allowing disease to be diagnosed in its early, more treatable stages. A dentist can complete the OraScan diagnostic procedure in less than five minutes as an adjunct to a routine checkup.
However, you the patient can look for these other warning signs:

1. A sore on the lips, gum, or inside the mouth that bleeds easily, and does not heal within two weeks.
2. A lump or thickening in the cheek that can be felt with the tongue.
3. A numbness or loss of feeling in any part of the mouth.
4. Soreness in the mouth, or a feeling that something is caught in the throat with no known cause.
5. A white or red patch on the gums, tongue, or inside the cheeks.
6. Difficulty in chewing or swallowing food

The value of self examination is strictly for screening purposes. When questions arise, your dentist is the best source of information about any suspicious sores in and around the mouth and neck areas.
If your dentist feels you have a suspicious lesion, he will probably do a biopsy. This involves taking a tissue specimen from the affected area and sending it to a pathologist so he can examine it under a microscope to determine the cells present in the area.