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Cancer (Oncology)

Oral Cancer

Oral cancer starts in the mouth, lips, the inside lining of the cheeks, the teeth, the gums, the front portion of the tongue, the area below the tongue, and the roof of the mouth. The throat area just behind the mouth is considered part of the oropharynx. Cancer that begins there is considered oropharyngeal cancer. Ninety percent of oral and oropharyngeal cancers are squamous cell carcinomas (meaning they begin in the flat cells that form the lining of the mouth and throat).

Oral cancers are more than twice as common in men than in women. The average age most people are diagnosed with these cancers is about 62. The rate of new cases has been dropping for the past few decades. However, the rate of oropharyngeal cancer related to human papilloma virus (HPV) has recently begun to rise, particularly in Caucasian men under 50.

Risk Factors

Tobacco and alcohol use are among the strongest risk factors for oral cancer. Smoking particularly affects the mouth, lips, inner cheeks and throat. The majority of oral cancer patients are heavy drinkers; the risk increases for people who use both tobacco and alcohol.

People infected with certain types of HPV are at a higher risk for oropharyngeal cancer. Those people tend to be younger, are less likely to be smokers and drinkers, and generally have a better outlook than patients whose oral cancer is not connected to HPV.

Other risk factors include prolonged exposure to UV light, a diet low in fruits and vegetables, a weakened immune system, having graft-versus-host disease (associated with stem cell transplants), and suffering from certain geneticsyndromes, including fanconi anemia and dyskeratosis congenita.

Screening and Prevention

There is no clear cause for many oral cancers and they cannot all be prevented. But avoiding excessive alcohol or tobacco use can greatly reduce the risk. Protecting your skin from the sun's UV rays also decreases the risk of lip cancers. Wearing properly fitted dentures can avoid oral irritation that may lead to an increased risk for cancer. Eating a healthy diet may also help. Transmission of the human papilloma virus (HPV) can occur through sexual contact and scientific evidence shows that multiple partners and high risk behaviors may increase the chance of transmission and possibly development of the HPV related form of this cancer.

It is also important to treat pre-cancerous growths. Patches of white or gray (leukoplakia) or red areas that bleed easily (erythroplakia) sometime become cancerous and should be removed.

Symptoms

The most common symptom of oral cancer is a sore in the mouth that does not heal. Other noticeable symptoms include pain, thickening in the cheek, trouble chewing or swallowing, numbness or swelling of the tongue or another area in the mouth, loosening of the teeth, voice changes, weight loss, or constant bad breath.

Symptoms may not appear until the cancer has reached an advanced stage, or they may resemble symptoms of a different condition. Regular dental checkups are important in finding oral and oropharyngeal cancers early.

Treatment

Surgery (sometimes followed by reconstructive surgery) to remove a tumor is normally the primary treatment for cancers of the oral cavity. It may be followed by radiation or combined chemotherapy and radiation. Oropharyngeal cancers are usually treated with a combination of chemotherapy and radiation. Patients with oral and oropharyngeal cancer sometimes develop other cancers in nearby areas, so it is important that they receive medical follow-up for the rest of their lives.

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