Oral Cancer

How common is oral cancer?

Oral and pharyngeal (throat) cancers make up approximately 2% of all the cancers diagnosed in the United States. As of 2014, that was about 50,000 new cases each year. The most common type of oral cancer is known as squamous cell carcinoma with about 90% of the total cases.

What are the risk factors for oral cancer?

• Smoking tobacco
• Smokeless tobacco – Using smokeless can be better for preventing lung cancer but increases rates of oral cancer. Oral cancer usually appears where the tobacco is held in the mouth.
• Alcohol use – Increasing alcohol use is linked to higher rates of oral cancer
• Human Papilloma virus number 16 (HPV16) – This is a very common sexually transmitted disease. It causes anal, penile, cervical, and oral cancer. A vaccine is available for HPV now.
• A diet high in processed foods and low in fruits and vegetables is thought to be related.
• More commonly found in men, especially minorities

What is the long term prognosis?

The five year survival rate for oral cancer is 57% and hasn’t changed much over the years. The biggest challenge with oral cancer is that it is often discovered at a much later stage than other cancers, oftentimes after it has already spread to your lymph nodes or elsewhere in your body. The success rates of treatment are much lower for late stage cancers than early stage.

How is oral cancer detected?

Early stage oral cancer is most easily detected by your dentist at your routine visits. The most common locations for oral cancer are on the floor of your mouth, on the sides of your tongue, and between the cheek and gum tissue where smokeless tobacco is held. It usually starts as a non painful, red or white ulcerated area that looks similar to a canker sore or other type of injury to mouth. The biggest distinction is that areas of oral cancer will not go away whereas the other cases will almost always resolve within two weeks. If you have an area in your mouth that looks like this and doesn’t go away within two weeks, make sure to get it checked out.

Due to the rising incidence of HPV16, the back of your tongue, the back of the throat, and on your tonsils have become more common and are usually more difficult to detect as they don’t tend to develop the same kind of tissue changes.

Later stage oral cancers are often found once they have spread to the lymph nodes of the neck and start to cause more symptoms such as the feeling of a mass in your mouth, throat, or neck, pain, or numbness.

When a concerning area presents, your dentist or physician will usually refer you to a surgeon to have a biopsy of the area done. This is the only sure way to tell what is happening. It is better to be safe than sorry. I have had several patients within the last couple of years who I had to send out for a biopsy for oral cancer that came back positive. They had treatment done and are still alive today thankfully.

What kind of treatments are used for oral cancer?

The most common treatments for oral cancer are a combination of radiation, surgery, and chemotherapy drugs.

What are the side effects of treatment for oral cancer?

The side effects of treatment for oral cancer can be very challenging to manage both before, during, and after treatment. You should have a dental evaluation prior to treatment to fix any dental problems and remove any teeth that are in bad shape. Having teeth removed after radiation can cause a condition known as osteoradionecrosis of the jaw which causes significant pain and damage to your jawbone.

During treatment you’ll likely develop mucositis, which is inflammation of the tissue inside of your mouth. The outer layer of tissue will slough off and you develop painful mouth sores. Most treatments for this only seek to treat the symptoms. Common options include pain medication and magic mouthwash mouthrinse.

Treatment often includes some amount of surgery ranging from removal of a small amount of tissue to removal of your entire jawbone. After healing they can do some amount of reconstruction but it can be extremely difficult and usually requires a team of specialists to complete.

After treatment the mucositis usually resolves but you are often left with an extremely dry mouth. Radiation to the head and neck area destroys all the cells that produce saliva. Dry mouth can be uncomfortable as well as significantly increasing your risk of developing cavities. This is best managed by drinking water throughout the day, dry mouth mouthrinses, brushing with a prescription strength fluoride toothpaste, using a fluoride containing mouthrinse, and watching your diet closely.