Understanding your risk factors and being able to identify signs and symptoms of oral cancer are good first steps in the prevention of the disease. If you are concerned or feel you may be at risk for developing oral cancer, talk to your dentist. Dr. Ghamian and Dr. Khoury perform an oral cancer screening on each and every adult patient at their first dental visit, and at every recall exam.
Oral cancer refers to all cancers of the oral cavity, which includes:
• lips
• tongue
• teeth
• gums (gingiva)
• lining inside the lips and cheeks (labial mucosa and buccal mucosa)
• floor of the mouth
• roof of the mouth (palate)
• the area behind the wisdom teeth.
However, most oral cancers are located on the sides of the tongue, floor of the mouth and lips.
INCIDENCE & SURVIVAL RATES
Oral cancer represents approximately 2.3 percent of all cancers in Canada. In 2002, these cancers accounted for more than 3,000 new cases and 1,000 deaths.* The five-year survival rate for oral cancer is low, just below 50 percent. However, early detection can raise the survival rate to 80 percent.
* National Cancer Institute of Canada: Canadian Cancer Statistics 2002 and 2003
KEY RISK FACTORS
• Smoking – particularly if combined with heavy alcohol consumption, and vice versa (about 90 percent of people with oral cancer use tobacco)
• Excessive sun exposure to the lips, often through working in outdoor jobs like construction
• Age – oral cancer is more common in people over 50
• Gender – more men than women develop oral cancer
SYMPTOMS
• A sore on the lip or in the mouth that does not heal within two weeks
• A lump on the lip or in the mouth or throat
• A white or red patch on the gums, tongue or lining of the mouth
• Unusual bleeding, pain or numbness in the mouth
• A sore throat that does not go away, or a feeling that something is caught in the throat
• Difficulty or pain with chewing or swallowing
• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable
• A change in the voice and/or pain in the ear.
DIAGNOSIS
A complete medical history is required before conducting an oral cancer assessment. Any lesion, or damaged area that your dentist determines is unlikely to be cancerous should be observed for seven to 14 days to ensure that the healing process is ongoing.
If the lesion persists, it may be treated non-surgically with:
• Antibiotics
• Cleaning or rinsing with a medicated solution (lavage)
• Lining or repair of sharp or failing restoratives or prosthetics (a sharp edge could cause a cut or lesion inside your mouth — one way which oral cancer can start), and
• Elimination of external factors such as smoking and tobacco chewing.
TESTING
When there is a high suspicion of cancer, an immediate biopsy will be needed to determine if the lesion is cancerous. In these cases, waiting for seven to 14 days is not advised. Depending on the degree of difficulty, your dentist may decide to remove the tissue in office or refer you to a specialist. Lab tests may also be done before or with the biopsy to help determine a diagnosis. These could include:
• Blood tests
• Culture and sensitivity
• Glucose tolerance tests for diabetes
• Skin tests for allergies
• Radiographic surveys
• Dietary tests
TREATMENT
Treatment plans are developed to fit the specific needs of the patient and must consider the patient's age and general health as well as the location, size, type and extent of the tumour and stage of the disease. In most cases, treatment involves surgery, chemotherapy, radiation therapy or, in many cases, a combination of the two. Some patients receive chemotherapy treatment with anticancer drugs.
FOLLOW-UP & REHABILITATION
Rehabilitation often involves the entire health care team. It can include dietary counselling, surgery, a dental prosthesis, speech therapy, and other services.
Sometimes a patient needs reconstructive and plastic surgery to rebuild the bones or tissues of the mouth or an artificial dental or facial part. Regular follow-up exams by your dentist and doctor are very important for anyone who has been treated for oral cancer. Patients suffering from dry mouth due to radiation therapy should have dental exams three times a year. Patients who continue to drink or smoke are strongly advised to quit.
