Talking with Patients

Oral CancerRicardo Padilla, DDS*André V. Ritter, DDS, MS

WHAT IS IT?

Oral cancer is a cancer thataffects any part of the mouth,such as the jaw bone, oralmuscles, the gums, lips, tongue,and/or the cheek. According tothe American Cancer Society, over34,000 Americans are diagnosedwith oral cancer every year, withmore than 5,000 deaths expectedbecause of this aggressive diseasein 2008. Only half of the patientsdiagnosed with oral cancer survivelonger than 5 years.1,2

The most common type of oralcancer is called squamous cellcarcinoma and affects the sidesand undersurface of the tongueas well as the floor of the mouth.Oral cancer also includes metasta-sis from other organs, cancerof the salivary glands,and lymphomas.1

The majority of the cases of oralcancer are associated with indi-viduals who smoke, use smokelesstobacco (chewing or snuff),consume excessive alcohol, or areinfected with certain types ofhuman papillomavirus (HPV).However, oral cancer can developin people with no knownrisk factor(s).

HOW IS ORAL CANCERDIAGNOSED?

The early signs of oral cancer arenonspecific and can include awhite, red, or red/white patch; anulcer that does not heal; oralbleeding; a lump or mass that doesnot go away; pain that does notsubside; altered or lack of sensa-tion of an area of the mouth; anddifficulty while eating, talking,swallowing, or moving the tongue.While these symptoms can also beassociated with noncancerouschanges,2 if they last for more than2 weeks, the patient should havethe area checked.

Trained health care professionalsincluding dentists, dental hygien-ists, dental assistants, and othermedical personnel can performperiodic oral examinations to lookfor early signs that may suggestcancerous growths in the mouth. Ifa suspicious area is discovered, itshould undergo additional evalua-tion by an oral pathologist, an oralsurgeon, or an ENT (Ear, Nose,and Throat) doctor.

The most reliable diagnostic testfor oral cancer is a tissue biopsyand subsequent examination of thesample under the microscope by a

pathologist who is familiar withoral cancer. Emerging technologies,such as stains, lights, and brushbiopsies are promising but, at theircurrent stage of development, areconsidered only screening tools atbest, not definitive diagnostic tests.

An example of an early cancerouslesion is shown in Figure 1. Thepatient was unaware of the irregu-lar lesion at the lateral/ventraltongue, which was identified by adentist upon periodic examination.A biopsy confirmed it to be a pre-cancerous condition known as epi-thelial dysplasia. The lesion wasremoved surgically, and the patienthealed uneventfully and is free ofrecurrence 5 years after treatment.If this lesion had not been diag-nosed and removed, it most likelywould have progressed intooral cancer.

HOW IS ORAL CANCER TREATED?

The treatment of oral cancer isdependent on the size, extent, andlocation of the tumor. This isknown as disease stage and variesaccording to the specific locationof the lesion, the presence ofregional spread, and evidence ofmetastasis. The typical treatmentrelies on surgery, radiation therapy,

*Clinical Assistant Professor, Graduate Program Director, Department of Diagnostic Sciences &General Dentistry, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA

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chemotherapy, or a combination ofthese. New approaches to cancertreatment are being researched andinclude immune system alteration,hormone-receptor modification,blood vessel disruption, and gene-based therapy. The best treatmentfor each patient is usually deter-mined by a multispecialty advisorygroup of health care professionals.

The prognosis of oral cancer isgenerally dependent on the extentof the disease at the time it is dis-covered and treated. The moreadvanced the cancer, the worst is

the prognosis and the higher thelikelihood of it having spread toother distant body sites (metasta-sis). Therefore, screening forearly detection and diagnosis isextremely important, as with allother types of cancer.

HOW IS ORAL CANCERPREVENTED?

Oral cancer can be prevented byavoiding all tobacco andalcohol products, eating a balanceddiet rich in fruits and vegetables,using sunblock lip balm, using

vitamin A derivatives, and possiblyby getting vaccinated againstcertain strands of HPV. Despitethese measures, some individualsstill develop oral cancer, whichis potentially explained becauseof genetic abnormalities orunknown risk factors.Therefore, it is important toundergo periodic andcomprehensive oral examinationsby a trained oral healthprofessional in order to detectany potentially cancerouschange in the mouth, andinstitute prompt andappropriate management.

DISCLOSURE

The authors do not have anyfinancial interest in the manu-facturers whose materials arediscussed in this article.

R E F E R E N C E S

1. U.S. Department of Health and HumanServices—National Cancer Institute. WhatYou Need to Know about Oral Cancer.Available at: http://www.cancer.gov/pdf/WYNTK/WYNTK_oral.pdf (accessedMarch 11, 2008).

2. American Cancer Society. Oral Cancer.Available at: http://www.cancer.org/docroot/PRO/content/PRO_1_1x_Oral_Cancer.pdf.asp?sitearea=PRO (accessedMarch 11, 2008).

Figure 1. Irregular leukoplakia of the lateral/ventraltongue, identified by a dentist during routine oralexamination. Biopsy revealed a precancerous conditionknown as epithelial dysplasia. The lesion was removedsurgically, and the patient healed uneventfully and is freeof recurrence 5 years after treatment.

TA L K I N G W I T H PAT I E N T S

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