April is annually designated as oral cancer awareness month. There are several types of oral cancers, by far the predominant type of oral cancer is squamous cell carcinoma, representing >90%. Oral cancer represents approximately 3% of all cancers and is the 8th most common cancer affecting men in the United States. Oral cancer may arise in any site within the mouth including the lips, cheeks, gums, palate, or tongue.
No single causative agent can be attributed to the development of oral cancer. Several carcinogens have been identified, most notably, tobacco and alcohol appear to have the greatest impact on development of oral cancer. Risk of oral cancer is estimated to be 5 to 12 times higher in smokers versus nonsmokers. Alcohol in itself is not recognized as an initiator of oral cancer, however it is recognized as a promoter when coupled with another known carcinogen, especially smoking. Recently, research has focused on a possible viral cause, the human papilloma virus (HPV). HPV is best known as a cause of cervical cancer. Research has shown that presence of some specific strains of HPV in the oral cavity was associated with a nearly 4 times greater chance of cancer development versus non-infected individuals. Ultraviolet (UV) radiation is also associated with increased risk of cancer development, particularly in the lower lip. Region and culture-specific risk factors are also present, such as the use of betel quid in southeast Asia.
Oral cancer has a multitude of different possible presentations, these include a lump, ulcer, a red, white, or mixed red and white area. The lesion may have some associated discomfort, though often the area is painless. Advanced signs and symptoms may include difficulty with moving the tongue, difficulty or painful swallowing, numbness or altered sensation. Diagnosis is made based upon a combination of clincial evaluation by a health care professional, histologic analysis following tissue biopsy, and radiologic studies. Ultimately, definitive diagnosis is only established by tissue biopsy.
Treatment possibilities for oral cancer include surgical removal, radiation therapy, and chemotherapy. Surgical excision is typically the first line of treatment, unless the tumor is too advanced or in a location that surgery is not possible. The extent of cancer spread, location, and nature will dictate the best mode of therapy, be it surgery, radiation, or chemotherapy or a combination.
Five year survival for people diagnosed with oral cancer is approximately 60%. Survival rates have been found to be lower for African-American males and females. The earlier diagnosis of oral cancer confers an improved survival rate. Overall, cancer survival rates have steadily improved since 1975.
Oral and maxillofacial surgeons recommend that everyone perform an oral cancer self-exam each month. It is also recommended that each person undergo an annual exam by his/her dentist or oral surgeon. Higher risk individuals should be examined on a more frequent basis. For more information refer to the American Association of Oral and Maxillofacial Surgeons (AAOMS) website at www.aaoms.org, or speak with your dental health care professional.