Is Early Oral Cancer Detection Possible?

Over 50,000 Americans will be diagnosed with oropharyngeal or oral cancer this year alone. It will cause almost 10,000 deaths, killing roughly 1 person per hour, 24 hours per day for the entire year. Of those 50,000 or so newly diagnosed oral cancer cases, about 57% will be alive in 5 years. The death rate of oral cancer is higher than that of cancers which we routinely hear about such as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, testicular cancer, and many others.

Worldwide the problem is far greater, with over 450,000 new cases being found each year. The death rate for oral cancer is particularly high not because it is hard to discover or diagnose, but due to this type of cancer being routinely discovered in its later stages. 

In many cases oral cancer is only discovered when the cancer has metastasized to another location, most likely the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intra oral area. Besides the metastasis the primary tumor has had time to invade deep into local structures.

Oral cancer can develop silently because it generally does not produce pain or symptoms initially. For patients who survive the first bout with oral cancer, they have a 20x higher risk of developing a 2nd oral cancer. This increased risk usually runs 5-10 years after initial treatment. 90% of all oral cancers are squamous cell carcinomas. In the past, the majority of oral cancer was found in older males who drank and smoked heavily.

Now, due to HPV (human papilloma virus), cancer affect anyone , male or female, even  healthy, non-smoking, non- drinking young adults. The treatment of oral cancer very often produces major changes in speech, chewing, swallowing and oral health, which in addition to the disease, affects the social life and self confidence of the person afflicted with oral cancer.

Can Oral Cancer Be Detected Early?

While difficult it can be possible. Detection relies upon a good dentist who has tools that can help the diagnosis. One such tool is called the Velscope enhanced oral assessement tool. The VELscope light technology uses fluorescence of the tissues to allows detection of changes of the oral tissues in a non-evasive manner. This gives your dentist an extra view into your tissues beyond a thorough head and neck examination. These examination should be performed routinely at your dental visits.

The VELscope technology does not have the ability to diagnose oral cancer by itself, but is used for additional information along with a thorough head and neck examination by your dentist. The VELscope will not determine whether or not the change in oral tissues is cancerous. It simply cannot replace a surgical biopsy. It simply aids in finding abnormalities not visible to the naked eye that may require further examination.

“I personally never charge anything extra for use of the VELscope system. It is too important a tool to not use it on every patient that undergoes treatment in my office. When it comes to possibly saving lives I feel we should provide the highest level of care along with the latest technology to do the job. VELscope is that tool.“ Marielaina Perrone DDS

Is the Velscope the perfect tool?, no…..but it is better to refer someone to the oral surgeon for a oral biopsy then to have completely missed the early warning signs. The VELscope is a tool that gives us added information above a normal examination and should be the standard of care in every dental office. The other important preventive is to be vaccinated against HPV at a young age so that you don’t get infected.

Different Types Of Oral Cancer

-Squamous cell carcinoma: Over 90% of oral cancers are of the squamous cell carcinoma variety. Normally, the throat and mouth are lined with squamous cells, which are flat and arranged in a scale-like way. Squamous cell carcinoma means that some squamous cells have become abnormal and changed from their normal state.

-Verrucous carcinoma: Around 5% of all oral cavity tumors are verrucous carcinoma. This is a type of very slow growing cancer made up of squamous cells. This type of oral cancer rarely spreads to other parts of the body, but can invade the tissue surrounding the site where it began.

-Minor salivary gland carcinomas: This category includes several types of oral cancers that can develop in the minor salivary glands. These glands are found throughout the lining of the mouth and throat. This type of carcinoma includes adenoid cystic carcinoma, mucoepidermoid carcinoma, and polymorphous low-grade adenocarcinoma.

-Lymphomas: These are oral cancers that develop in lymph tissue (part of the immune system) are known as lymphomas. The tonsils and base of the tongue both contain lymphoid tissue.

-Benign oral cavity and oropharyngeal tumors: Several types of non-cancerous tumors and tumor-like conditions can arise in the oral cavity and throat. Sometimes, these non cancerous conditions may develop into oral cancer. For this reason, benign tumors, which usually do not recur, are often removed surgically.

-Leukoplakia and erythroplakia: With leukoplakia, a white area can be seen, and with erythroplakia, there is a red area, flat or slightly raised, that often bleeds when scraped. Both conditions may be precancerous; that is, they can develop into different types of cancer. When these conditions occur, a biopsy or other test is done to determine whether the cells are cancerous. About 25% of cases of leukoplakia are either cancerous when first discovered or become precancerous. Erythroplakia is usually more serious, with about 70% of cases cancerous either at the time of diagnosis or later.

Known Links To Oral Cancer

Medicine is not entirely sure exactly what causes oral cancer, but they have found links that put some people more at risk.

-HPV (human papilloma virus): Contact with HPV 16 (a sexually transmitted disease) has been found to be linked to certain oral cancers.

-Age: Oral cancer risk increases with age; It is predominantly seen in people 40 and over.

-Tobacco: The majority of cancer cases are associated with some form of tobacco use, specifically cigarette smoking.

-Alcohol: Heavy alcohol consumption increases the risk of oral cancer and those risks are even greater with combined use of alcohol and cigarettes.

-Diet: A diet that lacks proper nutrition such as vegetables and fruits can increase the risk of oral cancer (as well as other types of cancer).

-Exposure To Sun: Cancers of the lip can been caused by exposure to the sun.

Oral Cancer Symptoms

-A persistent sore throat that does not get better over time.

-Loose teeth.

-Increased difficulty swallowing.

-Increased difficulty chewing.

-Lump in lining of mouth.

-White or reddish patch inside mouth or on the lips.

-Pain in the Jaws.

-Tongue pain or numbness.

-A feeling that something is caught in your throat (even though nothing is there).

Oral Cancer Treatment

If during your routine dental examination, your dentist finds anything out of the ordinary or suspicious they will recommend that you have a biopsy performed of that area. The biopsy of the lesion will be used to confirm the diagnosis of cancer. If it is confirmed that you do indeed have oral cancer you will probably be referred to an oral surgeon for removal of the tumors. Radiation or chemotherapy may be also used in the course of your oral cancer treatment.

Oral Cancer Conclusion

As dentists we play an important role in patients’ oral and overall health. Detecting possible hidden lesions before they have the chance to progress will most definitely save lives. It is a proven fact that the detection of oral cancer in its early stages makes up an important facet of oral cancer prevention and is the key to survival.