Intra-oral cancer

PART of the reason oral cancer has such a poor prognosis is that more than half of the cancers have metastasised (spread) at the time of diagnosis. Detecting oral cancer early is the key. As an example, one type of oral cancer, when treated while the cancer is still less than half an inch in diameter, has a survival rate of about 60 percent. The same cancer, if not treated until it is double that size, reduces the patient’s survival rate to only 15 percent on the average. When diagnosed, surgery is usually required with follow-up radiation and chemotherapy treatments. Many times the surgery is disfiguring, and the radiation and chemotherapy therapy can cause severe complications.

The 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 oral cancers are more common than leukaemia, 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, and 90 percent occurs in the over-40 age group, and males are affected more frequently than females. Statistics further show 95 percent of all oral cancer is squamous cell carcinoma, which is related to tobacco use.
Major risk factors for oral cancer include the use of tobacco products (smoking and chewing), the use of alcohol, and exposure to the sun (lip cancer), dietary factors, and exposure to carcinogens in the workplace. All parts of the oral cavity are affected by oral cancer: tongue, lips, the floor of the mouth, soft palate, tonsils, back of the throat and salivary glands. Oral cancers most frequently occur on the lips (usually the lower lip). This is probably from chronic exposure to the sun and is especially prevalent with people with a 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 result 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 gingiva (gums), roof of the mouth, and the inside of the cheeks are less frequently affected. But oral cancers certainly can and do occur there.

It is estimated that 75 percent 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 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 colour changes, bleeding, lesions, masses, ulcerations, 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 visualisation of abnormal tissue. The disclosing agent leaves areas of unhealthy cells clearly defined in blue, allowing the 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. 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.

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