Let's Talk About Oral Cancer

I hear about many different types of cancer on a regular basis, but I never really heard much about oral cancer until some new pamphlets arrived at my dentist's office.  This pamphlet details a new (okay, not NEW, but newer to me) way to detect forms of oral cancer early.  And, as we know, early detection is one of the keys to successfully fighting cancer.

Per the American Cancer Society's page "Learn About Cancer" - "Oral cancer starts in the mouth, also called the oral cavity. The oral cavity includes the lips, the inside lining of the lips and cheeks, the teeth, the gums, the front two-thirds of the tongue, the floor of the mouth below the tongue, and the bony roof of the mouth."  That may seem like a small area, but anyone who's had a cavity, absessed tooth, wisdom tooth, root canal, crown, etc. knows that there are many things that can happen in your mouth.

Let's run the numbers:  ACS estimates that 35,000 people will be diagnosed this year with an oral cavity or oropharyngeal cancer, and 6,800 will die from these cancers.  They are about 2x more common in men than women, but they are equally common across races.  Now, here's the kicker - there has been an uptick in these cancers with relation to the human papilloma virus (HPV) in white men under 50.  HPV is the virus that can cause cervical cancer in women.  And, patients newly diagnosed with these cancers can end up with secondary diagnoses of cancer in the larynx, esophagus, or lung.  Some may even develop cancer again after being cured, which means patients need to be monitored for the rest of their lives.

Risk factors:  I'm sure no one is shocked that tobacco use would be on this list, but we should also note that pipe smoking is linked with cancer on the lips, and snuff or chewing tobacco are linked with cancer of the cheek, gums, and inner surface of the lips.  There are no safe tobacco product.  Other risk factors include:

1. Drinking alcohol, particularly heavy drinkers.  Heavy drinking and smoking increase your chance of oral cancers 100 times.
2. Betel quid and gutka - this is more common in Southeast Asia and South Asia, but it is similar to chewing tobacco.
3. HPV infection - this group tends to be younger, and they also tend not to smoke or drink heavily.
4. Gender - as specified above, these cancers are more common in men than women.
5. Age - the average age of diagnoses is 62, currently.
6. Ultraviolet light - much like your skin, you should also protect your lips when outside.
7. Poor nutrition - yet one more reason to eat your veggies and fruit!
8. Weakend immune system
9. Graft-versus-host diseas - this sometimes occurs after stem cell transplants.
10. Genetic syndroms - including fanconi anemia and dyskeratos congenita.
11. Lichen planus - an itchy rash that mainly occurs in middle-aged people.  It can also affect the lining of the mouth and throat.
12. Mouthwash and denture irritation - these are mostly uncertain and unproven, but it may be a good idea to make sure your dentures fit properly and your mouthwash is a low alcohol version (i.e. Act).

This brings me to the pamphlet at my dentist's office: 

Full Brochure

There are many ways to diagnose these cancers early, and regular dental checkups (obviously including the ENTIRE mouth) are very important.  Dentist use the following techniques to look for abnormal areas and determine if they could be cancerous:

1. Toluidine blue - this is a dye that will stain an abnormal area blue.
2. Laser light - the light reflects off areas in the mouth, and abnormal areas look different than normal areas.
3. Acetic acid - this is the acid in vinegar, and a special light is used on the area after the mouth has been rinced with the acid.
4. Brush biopsy - if an abnormal area is detected, the lesion can be scraped with a stiff brush so cells can be examined microscopically. (Source)

My dentist found a thickened area in the side of my mouth a few years ago.  After a referral and an appointment with a specialist, it was determined that nothing was wrong (save some scar tissue from biting the inside of my mouth).  As nervous as I was, I'm glad for that referral. 

I know many people have a fear of the dentist, and I can totally understand why.  I would suggest finding a dentist with whom you are comfortable, though, since early detection is key!

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