“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
- 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!
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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