Oral cancer: screenings for improved success | Dr. Fields
Published 2:09 pm Wednesday, April 15, 2015
Most Americans are aware of the benefits of regular screenings for early detection of cancers.
Patients have mammograms to help in diagnosing early breast cancers, a PAP smear for cervical cancer detection, a colonoscopy to check for colon cancer, and a PSA for prostate cancer evaluation. But have you thought about the importance of regular screenings for oral cancer? The Oral Cancer Foundation has named April Oral Cancer Awareness Month.
Oral and upper throat cancers kill nearly one person per hour, every day of the year. The five-year survival rate of a person diagnosed with oral cancer is only 57 percent, making early detection and treatment vital to reducing morbidity and mortality.
Dentists are in a unique position to screen for and detect oral cancers, yet only 60 percent of the U.S. population sees a dentist each year. Regular visits to the dentist, even for people with no teeth remaining, improve the chances a suspicious lesion will be identified early, thereby allowing earlier treatment and improved survival.
A challenge in oral cancer detection is the difficulty in deciding which abnormal appearing tissues in the mouth warrant biopsy. Common conditions such as trauma from biting your cheek, a sore spot from a poorly fitting denture, and canker sores can mimic the appearance of cancerous lesions. Any sore, discoloration, irritation, prominent irregular tissue, hoarseness, difficulty swallowing, or unilateral earache that does not resolve within a two-week period, with or without treatment, requires further examination and possible biopsy.
The appearance, location, relevant risk factors and history of a lesion will be taken into account, but the only way to definitively diagnose a suspicious lesion is through a biopsy. An oral pathologist will then examine the biopsied specimen under a microscope and diagnose the lesion at a cellular level.
Multiple types of oral cancers exist, with the most prevalent being squamous cell carcinoma. This variant accounts for more than 90 percent of malignant oral cancers and is most frequently found along the side of the tongue.
In early stages, a subtle white lesion, red lesion, or red and white mixed lesion that persists for two weeks or more may be present. An ulceration that lasts for two weeks or more may also be of concern, as squamous cell carcinoma is known to present in a number of ways clinically.
In later stages, oral cancers commonly spread to local lymph nodes, into the lymphatic system and may spread throughout the body. Other variants of malignant oral cancers include: verrucous carcinoma, which may appear as a cauliflower like mass; malignant melanoma, which can appear as a dark pigmented lesion; and several types of salivary gland carcinomas.
Risk factors for oral cancer
Age, smoking, use of smokeless tobacco and excessive alcohol use have historically been the primary factors increasing the risk of developing oral cancer. Smoking and alcohol have a synergistic effect, causing those who both smoke and drink to have a 15 times greater risk of developing oral cancer than those who do not.
Although these risk factors continue to have a strong connection to oral cancer, more recently, the human papilloma virus (HPV16), which is sexually transmitted, has been associated with cancers of the throat and back of mouth. This is the same virus, along with HPV18, that causes more than 90% of cervical cancers. The HPV16 virus is rapidly changing the demographics of people diagnosed with oral cancer, as people who have the HPV16 variant of oral cancer may be young, non-drinkers and non-smokers. The fastest growing segment of the oral cancer population is now in non-smokers under the age of 50.
HPV16 is found as the causative factor in an estimated 26-35 percent of head and neck squamous cell carcinomas. Fortunately, infection with HPV16 does not mean that a person will develop oral cancer. The immune system will often clear the infection before a malignancy has the chance to occur. HPV vaccines, such as Gardasil and Cervarix, are intended to prevent cervical and genital cancers.
Based on the known mechanisms of action, HPV vaccines may also reduce the risk of oral cancers, though studies have not yet been performed to determine this. If a diagnosis of HPV16 positive squamous cell carcinoma is made, this variant, as opposed to the HPV16 negative squamous cell carcinoma, tends to have better outcomes. The difficulty lies in detecting the cancer in its early stages, as HPV16 positive squamous cell carcinoma may not have any visual signs, and instead may only be detectable by patient reports of prolonged difficulty with swallowing or hoarseness.
In our office, we screen every patient for oral cancer as a part of the routine dental exam. The visual and tactile examination is combined with a diagnostic aid, called the VELscope. This non-invasive screening device does not replace the conventional examination, but it does aid in finding abnormalities that may not be visible to the naked eye. After evaluation of a suspicious lesion, if biopsy is indicated, a referral will be made to an oral surgeon.
The oral surgeon will discuss biopsy results, prognosis and potential treatment options with the patient. This treatment may range from active observation to surgery, chemotherapy and radiation involving the additional expertise of head and neck medical oncologists.
More information can be found at www.oralcancerfoundation.org and www.headandneck.org.
Jennifer Fields, DDS is a general dentist at Simply Smiles, a dental practice in Auburn. She, Dr. Rich, and their team treat patients of all ages. For more information, visit www.SimplySmilesAuburn.com, call 253-939-6900, or email info@SimplySmilesAuburn.com.
