Learn the Signs Oral Cancer!!
Early Detection of oral cancer is Key
In a perfect world we find cancer when it is still carcinoma in situ like below.
The Physical Signs Oral Cancer
- 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.
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 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.
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.
| 5-year survival rates for stages I, II, and III are essentially the same.
Types of throat cancer
|The sides and under the tongue are the most common areas|