According to www.mouthhealthy.org, the ADA’s patient information website, 51,540 people will be diagnosed with oral cancer and cancers of the throat, tonsils and back of the tongue in 2018. Cancerous lesions of the oral cavity detected in their early stages are curable; however, the five year survival rate of patients with cancerous lesions in the oral cavity greater than two centimeters is less than 35%. This is a scary and staggering statistic. Early detection of suspicious lesions and referral for biopsy are services that can be provided by dentists to decrease the risk of oral cancer advancing to proportions that decrease long term survival of our patients.
The ADA has also identified multiple risk factors for oral cancer. Men are twice as likely to develop oral cancer due to their increased alcohol and tobacco use; young men are also more likely to develop HPV (Human Papilloma Virus)-related oropharyngeal cancers, and, according to the CDC (Center for Disease Control), HPV-related oropharyngeal cancers can be a sexually transmitted disease. These HPV related cancers are undetectable until discovered by metastasis to regional lymph nodes. Most people diagnosed with oral cancer are 55 years or older. Tobacco and alcohol, especially when used excessively together, increase the chance of developing oral cancer (Blot, et al, 1988 and Hashibe, et al, 2009). People who work and play outside who are exposed to sunlight are at risk for lower lip cancer. Poor nutrition and poor oral hygiene also increase one’s risk for developing oral cancer.
The role of the dentist is early detection and diagnosis. All dentists should perform an intraoral soft tissue examination and also perform a head and neck examination for lymphadenopathy. Treatment or removal of the suspected cause of the lesion is recommended with observation for 7-14 days only. If the lesion does not improve, the dentist should refer the patient to a dental specialist for biopsy.
Atypical, premalignant or malignant squamous epithelium appears white, red, red and white combined or ulcerated. Leukoplakia is a clinical term for white plaques on the oral mucosa. Whitish rough epithelium increasing in keratinization by itself, or in combination with the increase in squamous epithelial cells, is called hyperkeratosis. Erythroplakia is a red patch with no identifiable cause. Precancerous erythroplakia is most prevalent on the oral floor, soft palate, buccal mucosa and ventral tongue. It may exist alone or accompanied by leukoplakic zones. Ulcerations of the lips and oral mucosa can be cancerous.
The clinical nature of oral cancer in its early stages is as follows. It is insidious without pain. It presents as small ulcers, white rough areas (Leukoplakia) or red areas (Erythroplakia). In its late stages, oral cancer presents itself in the following ways. The patient can experience dysphagia. Spread to regional lymph nodes is possible and cervical nodal spread is most likely for oral cancer in its later stages.
Basal cell carcinoma is focal and only locally aggressive, but squamous cell carcinoma is capable of metastasis. Remember, if the lesion is not responding to removal of the cause, or not responding to treatment within one to two weeks, refer the patient for biopsy!
Ned L. Nix, DDS, MA