Learn the Signs Oral Cancer!!

According to SEER, it is estimated that 40,250 Americans will be diagnosed with oral and pharyngeal (throat) cancer in 2012. Oral cancer will kill one person every hour in America or 7,850 Americans this year. Oral cancer kills more people than endometrial, renal, melanoma, and thyroid cancers do; all of which are considered “common cancers”.1 Where oral cancer is located and at what stage it is at when diagnosed have a huge impact on the survival rate, eg compare lip to tonsil at bottom of post.

Oral cancer lesion on the side of the tongue — Invasive and Keratinizing Squamous Cell Carcinoma on side of the tongue

Early Detection of oral cancer is Key

When found early, most types of oral cancers have a 70 to 90 percent 5 year survival rate. Unfortunately, most oral cancers are discovered at later stages, resulting in survival rates of 45-57%.

You may not realize that oral cancer screenings are a routine part of a more extensive exam you receive during your regular dental appointment @ Bauer Dentistry and Orthodontics. When we ask you to stick out your tongue and when we are feeling around your neck we are searching for signs oral cancer. We also utilize modern technology to aid in our detection efforts. Our office using autofluorescence technology with the VELscope.

Invasive and Keratinizing Squamous Cell Carcinoma on the tongue — SCC

In a perfect world we find cancer when it is still carcinoma in situ like below.

The Physical Signs Oral Cancer

Signs oral cancer include:

Sores in the mouth or on the lip that bleed easily or do not heal
White, red, or speckled (white and red) patches in the mouth
A thick or hard spot or lump
A roughened or crusted area
Hoarseness, change in voice, sore or painful throat that does not get better
Feel like something is stuck in throat, difficulty or pain when swallowing, or can’t speak properly
Pain when chewing.
Numbness, pain or tenderness anywhere in the face, mouth, ears, or neck
A change in the way your teeth fit together when you bite down or the way your denture fits
Pain in the tongue
Asymmetrical tonsils is a characteristic finding for tonsillar cancer
Swollen and or tender lymph nodes (marked in green). Lieberman has a nice article on the lymphadenopathy from Gen Dent 2013.

Where are the lymph nodes?

A swollen lymph node indicates that there is something wrong in that area. Often a swollen lymph node occurs from an infection and will go away on it’s own pretty quickly. However, a lymph node that stays swollen may indicate cancer in the area.

Image of a swollen lymph node under the mandible. — A swollen tonsillar lymph node.

Risk Factors for Oral Cancer

Smoking and tobacco use are long-term historic causes of all types of oral cancer.
The HPV-16 virus, a sexually-transmitted disease, is resulting in the fastest growing segment of oral cancer patients being young, healthy, nonsmoking individuals. HPV is strongly linked to oropharyngeal and tonsil cancers, which have the worst survival rates of all oral cancers, and other posterior areas to some extent. Currently HPV is not strongly linked to the other oral cancers, although you will erroneously see this reported often. The HPV+ cancers have a better survival rate.
Actinic Radiation, or sun exposure, is primarily a risk factor for lip cancer
Mouthwashes studies are inconclusive. However, it would be wise to avoid there use due to the high alcohol content and the frequent and regular use, ie don’t use it multiple times throughout the day.

Advanced technology to search for oral cancer

Tissue Reflectance

Tissue reflectance utilizes a 440nm blue light that causes abnormal tissue to appear white following a rinse with acetic acid. No one likes to rinse with acetic acid so this is pretty impractical. Microlux/DL, Orascoptic DK and ViziLite Plus are all devices utilizing this technology to search for signs of oral cancer.

Autofluorescence

Unhealthy tissue appears dark as the basement membrane of the mucous does not autofluorescence. Healthy tissue does auotfluoresecene and appears green when viewed through the device. The only products on the market are VELscope and Identafi 3000. We use the VELscope because it is a simple and quick screening tool.

These devices and techniques are not completely reliable but they allow an easy way for clinicians to discuss the signs or oral cancer. The “ice-breaker” effect of these devices is IMHO the most important aspect of them.

Survival rate of Oral Cancer

From 2005-2009, the median age at diagnosis for cancer of the oral cavity and pharynx was 62 years of age and the median age of death was 67. In 2000-2003 it was the same. The average age is also right around 60, although I can not find where that stat originates.

The following 5 year survival statistics come from the National Cancer Institute’s SEER program. This data is from 1988 to 2001.

The 5 year survival rate does not reflect whether or not the cancer itself killed you; it more broadly states whether or not you are alive=survive in 5 years. Obviously as you get older the likelihood of being alive in 5 years continues to drop with or without cancer; so any cancer diagnosis later in life will automatically have a lower 5 year survival rate. Plus even if the cancer itself does not kill you, those diagnosed with cancer die from many other things at higher rates. For example while about 93% of 62 year olds will survive to 67(source), only about 80% will survive those 5 years even when you do not include those directly killed by cancer.