Apart from a dental revision and a revision of surrounding tissues, all the patients that come to visit us for the first time, undergo a rutinary non-invasive test for an early detection of oral cancer.
In the United States a patient with oral cancer dies every hour. The oral cancer is the sixth most common cancer in the United States. At present, 30.000 patients are diagnosed with oral cancer annually. The survival rate of oral cancer after five years is only 50%, which means more than 8.000 deaths every year.
Among the most common risk factors of oral cancer we have the use of tobacco and alcohol consumption, a compromised immune system, personal or familiar antecedents of cancer, and the presence of the HPV virus. In the last ten years, the 25% of all the new cases diagnosed have been patients under forty with none of the risk factors mentioned above. Oral cancer is one of the few cancers in which the survival rate has not improved in the last 50 years.The main reason for this is that during this time the way in which the illness was diagnosed had not changed (a visual manual and clinical examination of the oral cavity, head and neck), We did not count with appropriate equipment to support us.
The oral kind of carcinoma flaky cells represents more than the 90% of all oral cancers, and due to its manifestations it has been difficult to distinguish it from other relatively benign lesions of the oral cavity. Carcinoma flaky cells and other potentially malign lesions at an early stage may appear as white stains (leukoplakia), and as an area of pseudo red lesions (erythroleukoplakia). The mucus does not change in appearance in general conditions under a white light examination. These cellular changes are very difficult to detect by human eye (even with magnifying glasses) under standard illumination conditions.
Very frequently, when the lesion is made visible, it is already in the invasive stages. High mortality rate is directly related to the lack of early detection. When the diagnosis and treatment are made before a carcinoma reaches the second stage, the survival rate is of 90%.
The decrease in the mortality rate of cancers like colon cancer, prostate cancer and cervical cancer is due to early detection.
Understanding the causative factors of cancer will contribute to its prevention.
1- Age: Age is frequently name as a risk factor for oral cancer, as historically it occurs in those over the age of 40. The age of diagnosed patients may indicate a time component in the biochemical or biophysical processes of aging cells that allows malignant transformation, or perhaps, immune system competence diminishes with age.
However, it is likely that the accumulative damage from other factors, such as tobacco use, alcohol consumption, are the real culprits.
2- Irritative chemical factors: it may take several decades of smoking for instance, to precipitate the development of a cancer. Having said that, tobacco use in all its forms is number one on the list of risk factors in individuals over 50. Historically at least 75% percent of those diagnosed are tobacco users. This percentage is now changing, and has yet to be definitively determined as new data related to viral causes are changing the demographics rapidly. When you combine tobacco with heavy use of alcohol, your risk is significantly increased, as the two act synergistically. Those who both smoke and drink, have a 15 times greater risk of developing oral cancer than others.
3- Atmospheric factors: certain stressful lifestyles nowadays can also be considered risk factors, besides these, there are physical factors such as exposure to ultraviolet radiation. This is a causative agent in cancers of the lip, as well as other skin cancers. Cancer of the lip is one oral cancer whose numbers have declined in the last few decades. This is likely due to the increased awareness of the damaging effects of prolonged exposure to sunlight, and the use of sunscreens for protection.
4- Biological factors: Biological factors include viruses and fungi, which have been found in association with oral cancers. The human papilloma virus, particularly HPV16, has been definitively implicated in oral cancers, particularly those that occur in the back of the mouth. (Oropharynx, base of tongue, tonsillar pillars and crypt, as well as the tonsils themselves.) HPV is a common, sexually transmitted virus, which infects about 40 million Americans today. There are over 120 strains of HPV, most thought to be harmless. But 1% of those infected, have the HPV16 strain which is a primary causative agent in cervical cancer, cancers of the anus and penis, and now is a known cause of oral cancer as well. It is likely that the changes in sexual behaviours of young adults over the last few decades, and which are continuing today, are increasing the spread of HPV, and the oncogenic versions of it. There are other minor risk factors which have been associated with oral cancers, but have not yet been definitively shown to participate in their development. These include lichen planus, an inflammatory disease of the oral soft tissues.
5- Food factors: There are studies which indicate a diet low in fruits and vegetables could be a risk factor, and that conversely, one high in these foods may have a protective value against many types of cancer.
One of the real dangers of this cancer, is that in its early stages, it can go unnoticed. It can be painless, and little in the way of physical changes may be obvious. The good news is however, that your dentist or doctor can, in most cases, see or feel the precursor tissue changes, or the actual cancer while it is still very small, or in its earliest stages. It may appear as a white or red patch of tissue in the mouth, or a small indurated ulcer which looks like a common canker sore. Because there are so many benign tissue changes that occur normally in your mouth, and some things as simple as a bite on the inside of your cheek may mimic the look of a dangerous tissue change, it is important to have any sore or discoloured area of your mouth, which does not heal within 14 days, looked at by a professional. Other symptoms include; a lump or mass which can be felt inside the mouth or neck, pain or difficulty in swallowing, speaking, or chewing, any wart like masses, hoarseness which lasts for a long time, or any numbness in the oral/facial region. Unilateral persistent ear ache can also be a warning sign.
Other than the lips which are not a major site for occurrence any longer, common areas for oral cancer to develop in the anterior (front) of the mouth are on the tongue and the floor of the mouth. Individuals that use chewing tobacco are likely to have them develop in the sulcus between the lip or cheek and the soft tissue (gingival) covering the lower jaw (mandible). In the US, cancers of the hard palate are uncommon, though not unknown. The base of the tongue at the back of the mouth, the oropharynx (the back of the throat) and on the pillars of the tonsils, and the tonsillar crypt and the tonsil itself, are other sites where it is now more commonly found, particularly in young non smoking individuals. If your dentist or doctor decides that an area is suspicious, the only way to know for sure if it is something dangerous is to do a biopsy of the area. This is not painful, is inexpensive, and takes little time. It is important to have a firm diagnosis as early as possible. It is possible that your general dentist or medical doctor may refer you to a specialist to have the biopsy performed. This is not cause for alarm, but a normal part of referring that happens between doctors of different specialties.
Historically, it has been difficult to determine which abnormal tissues in the mouth are worthy of concern. The fact is, the average person routinely has conditions existing in their mouths that mimic the appearance of pre-cancerous changes, and very early cancers of the soft tissues. One study determined that the average dentist sees 3-5 patients a day who exhibit soft tissue abnormalities, most of which are benign in nature. Even the simplest things, such as apthous ulcers, herpes simplex, herpes labialis, the wound left by accidentally biting the inside of your cheek, or sore spots from a poorly fitting prosthetic appliance or denture, all at first examination, share similarities with dangerous lesions. Some of these conditions cause physical discomfort, others are painless. The question is which ones deserve action, and which ones bear watching and waiting?
There has been a tendency to watch these areas over an extended period to determine if they are dangerous or not. Unfortunately, this philosophy leads to a situation in which a dangerous lesion may continue to prosper and grow into a later stage, hard to cure cancer. Any sore, discoloration, induration, prominent tissue, irritation, hoarseness, which does not resolve within a two week period on its own, with or without treatment should be considered suspect and worthy of further examination or referral. Besides a routine visit to the dental office for regular examinations, it is the patient’s responsibility to be aware of changes in their oral environment. When these changes occur, they need to be brought to the attention of a qualified dental professional for examination. The dental professional needs to be current in the knowledge base necessary to make a proper diagnosis, and be competent in the proper screening procedures to identify oral cancer.