April 18, 2019

April is here, bringing warm wet weather, Easter egg hunts, and dreams of May flowers.  But April is an important month in other ways, as it is oral cancer awareness month.  That means that now is a great time to learn a little more about the signs, symptoms and causes of this disease.  Maybe not something we all want to talk or think about, but very important. According to the American Academy of Oral and Maxillofacial Surgeons, oral and pharyngeal cancer kills nearly one person every hour of every day of the year. 

Oral and pharyngeal cancer is located in the oral cavity, nose, pharynx, voice box trachea and esophagus.  The mortality rate is higher than other cancers because typically it is not detected early.  The prognosis for patients who have oral cancers is much higher the earlier it is detected.   Oral cancer can be broken into two categories, non-HPV related oral cancers and HPV related oral cancers.

The most common cause of non-HPV related oral cancers are excessive alcohol and tobacco use.  In particular, the combination of smoking and heavy alcohol use increases the risk of oral cancer by 15 times, according to the NIH.  Men are at higher risk than women, as well as those age 55 or older.   Exposure to sunlight can increase the risk of oral cancers of the lip (so don’t forget your sunblock!)

Signs and symptoms of oral cancer caused by tobacco usage and/or excessive alcohol usage may include one or more of the following and are persistent in nature (meaning they do not resolve on their own and linger beyond two weeks:

  • Any sore or ulceration that does not heal within 14 days.
  • A red, white, or black discoloration of the soft tissues of the mouth.
  • Any abnormality that bleeds easily when touched.
  • A lump or hard spot in the tissue, often on the lateral border of the tongue or underneath the tongue.
  • Tissue raised above the area that surrounds it; a growth.
  • A sore under a denture, which even after adjustment of the denture that does not heal.
  • A lump or thickening that develops in the mouth.
  • A painless, firm, fixated lump felt on the outside of the neck that has been there for at least two weeks.

HPV related oral cancers differ slightly form non-HPV cancers.  HPV is the human papilloma virus.  According to the CDC, up to 8-0% of Americans with have an HPV infection during their lifetime, but the great majority (99%) will not develop cancer as their immune system will clear the virus.  Men are affected more than women (approximately 4:1), particularly white, non-smoking men between the ages of 35-55.  The HPV vaccine protects against cancers caused by the virus.  Your child can and should be vaccinated as early as 11 or 12.  The vaccine is recommended for young women through age 26 and young men through age 21.

Signs and symptoms of HPV related oral cancer may include:

  • Hoarseness or sore throat that does not resolve.
  • A painless, firm, fixated lump felt on the outside of the neck, which has been there for at least two weeks.
  • Constant coughing that does not resolve.
  • Difficulty swallowing; a sensation that food is getting caught in your throat.
  • An earache on one side (unilateral) that persists for more than a few days.

In addition to preventing, identifying and treating diseases of the dentition and periodontium, one of the most important jobs your dental team does is screen for oral cancer.  This includes both an extra oral assessment of the head and neck region as well as a thorough assessment of the oral cavity including the lips, tongue, tongue, cheeks, tonsils and throat.  If you have noticed a lesion that you are concerned about, make sure to let your dental team know.  

There is always more to learn about Oral Cancer.  Check it all out at the Oral Cancer Foundation’s web site.

By Dr. Warder, Dental Director