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Are you at risk for Oral Cancer?

“I’m sorry to tell you that you have oral cancer”.

It’s something that no one wants to hear in their lifetime – whether it affects you or a loved one. Unfortunately, over 2000 new cases of oral cancer (including lip cancers) are diagnosed per year in Australia, and this number is expected to continue rising 1. In fact, oral cancer is 2.5 times more common than cervical cancer 2.

“BUT…I’m young! I don’t smoke and I don’t drink alcohol!” 

We all think that it will never happen to us. Traditionally it was older men (> 60 years) who smoked and drank heavily who were most often affected by oral cancer3. Smoking and drinking remain significant risk factors4, and stopping these habits decreases the chance of developing an oral cancer5. However, the incidence of oral cancer amongst younger age groups (< 45 years), women and people who do not smoke or drink alcohol is increasing4. Current research indicates that the sexually transmissible human papillomavirus (HPV) has a causative role, similar to cervical cancer, particularly in cancers affecting the base of the tongue, tonsils and throat6. Also, due to sun and UV radiation exposure, Australia has one of the highest incidences of lip cancer in the world7.

“But, it’s treatable isn’t it? I’m going to beat it, aren’t I?”

Disappointingly, most oral cancers are discovered at a late stage, often requiring extensive treatment, which may involve combinations of surgery, radiation therapy and chemotherapy. The average 5-year survival rate for oral cancer worldwide is only around 50 – 60%8. Early stage cancers have a more favorable survival of 66 – 85%, but late stage cancers have only a 9 – 41% 5-year survival rate9.

“What should I look out for?”

Oral cancer does not have a specific presentation, and is often symptomless.

Some of the reported signs and symptoms of oral cancer include:

  • a mouth ulcer /sore / wound that does not heal within three weeks
  • an unexplained new lump, thickened area or hard spot in your mouth which lasts for more than three weeks
  • a white or red (or mixed) patch anywhere in the mouth
  • rough, crusted lesion on the lips
  • difficulty swallowing, chewing or moving the jaw or tongue
  • a feeling that something is caught in your throat
  • chronic sore throat or hoarseness
  • neck swelling
  • numbness
  • pain / tenderness tends to be a late sign of oral cancer

 ‘Who should I get to check my mouth for cancer?’

The best person to examine the oral cavity is your dentist10,11, and screening for oral cancer is part of a regular dental examination. Dentists are not just interested in your teeth, but also the general appearance and health of your oral tissues – the gingivae (gums), inside the cheeks, the tongue (including the sides and underneath), as well as the roof and floor of mouth. They also check for any changes or abnormalities in the face or neck. Dentists have been trained to recognise the signs of oral cancer and are better at identifying smaller cancers than doctors10,12. Many doctors are not confident in identifying pathology in the oral cavity13. Regular screening by a dentist at least every 12 months can pick up early signs of oral cancer, which increases the chance of survival.

‘The dentist found something suspicious! What now?’

If a suspicious area is detected, your dentist will usually try to correct any factors that may be contributing (such as a sharp tooth or ill-fitting denture), and will re-examine you in 1 – 2 weeks to see if the lesion has healed. They may take a clinical photograph to compare the changes in the lesion. Most of the time, these lesions heal. However, if the abnormal area persists, referral to an Oral Medicine Specialist is necessary. The Oral Medicine Specialist will undertake further evaluation and investigations, such as a biopsy, to confirm or rule out the presence of cancerous cells. If an oral cancer is confirmed, patients are managed by a team of specialist doctors who are experienced in treating oral cancers.

So, what are you waiting for? Book in to see your dentist for an oral cancer check now!

 


Dr Jacinta Vu
Author – Dr Jacinta Vu

Oral Medicine Specialist @ Perth Oral Medicine & Dental Sleep Centre
BDSc (Hons) (UWA), DClinDent (Oral Med/Oral Path) (USyd), MRACDS (Oral Med), FRACDS

Dr Jacinta Vu graduated from the University of Western Australia with a Bachelor of Dental Science (Honours) in 2001. She practiced general dentistry in public as well as private practice, in both rural and metropolitan locations.

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References

1. Australian Institute of Health and Welfare 2014. Head and neck cancers in Australia. [Internet].  [cited 2016 17 May]. Cancer series no. 83. Cat. no. CAN 80. :[Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547289.

2. Australian Institue of Health and Welfare. 2014. Cancer in Australia: an overview 2014 [Internet].  [cited 2016 17 May]. Cancer series No 90. Cat. no. CAN 88.:[Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129550202.

3. Conway DI, Petticrew M, Marlborough H, et al. Socioeconomic inequalities and oral cancer risk: A systematic review and meta‐analysis of case‐control studies. International Journal of Cancer 2008;122(12):2811-19.

4. Hashibe M, Brennan P, Chuang S-c, et al. Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiology Biomarkers & Prevention 2009;18(2):541-50.

5. Marron M, Boffetta P, Zhang Z-F, et al. Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk. International Journal of Epidemiology 2010;39(1):182-96.

6. Heck JE, Berthiller J, Vaccarella S, et al. Sexual behaviours and the risk of head and neck cancers: a pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. International journal of epidemiology 2010;39(1):166-81.

7. Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncology 2009;45(4–5):309-16.

8. Warnakulasuriya S. Living with oral cancer: Epidemiology with particular reference to prevalence and life-style changes that influence survival. Oral Oncology 2010;46(6):407-10.

9. Sciubba JJ. Oral Cancer: The Importance of Early Diagnosis and Treatment. American Journal of Clinical Dermatology 2001;2(4):239-51.

10. Allen K, Farah CS. Patient perspectives of diagnostic delay for suspicious oral mucosal lesions. Australian Dental Journal 2015;60(3):397-403.

11. Patton LL, Ashe TE, Elter JR, et al. Adequacy of training in oral cancer prevention and screening as self-assessed by physicians, nurse practitioners, and dental health professionals. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 2006;102(6):758-64.

12. Dimitroulis G, Reade P, Wiesenfeld D. Referral patterns of patients with oral squamous cell carcinoma, Australia. European Journal of Cancer Part B: Oral Oncology 1992;28(1):23-27.

13. Webster J, Batstone M, Farah C. Failure to achieve early diagnosis in oral cancer–who is to blame? International Journal of Oral and Maxillofacial Surgery 2015;44:e164.

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