Oral Cancer – Signs, Symptoms and New Screening Devices

Did you know that oral cancer is three times more common than cervical cancer? Over 30,000 new cases are diagnosed each year. And did you know that 70% of oral cancers are picked up at a late stage, producing a mortality rate five years after detection of 50%? If picked up early, the survival rate for oral cancer is almost 90%. This is why it is important to do an oral cancer screening both at each new patient exam and during subsequent periodic visits with the hygienist.

Who is at risk for oral cancer?

Those who smoke, use chewing tobacco, regularly consume alcohol, or have a compromised immune system are most at risk for developing oral cancer. Just like with any other cancer, as we age cancer rates increase. Thus, anyone above 40, even if he or she does not smoke or regularly consume alcohol is at increased risk. The human papilloma virus (HPV), which is sexually transmitted, is thought to account for more than 20% of oral cancers. Unfortunately, with oral sex on the rise in younger age groups, we must be vigilant in checking even high school and college students. Another fact to keep in mind – 27% of oral cancer victims do not use tobacco or alcohol and have no other life style risk factors!

This month I would like to discuss some of the early warning signs that you should be aware of, as well as our diagnostic techniques, including some new aids which help us screen for oral cancer.

The following is a list from the American Cancer Society of signs and symptoms of which you should be aware:

– a sore in the mouth that does not heal (most common symptom)
– a lump or thickening in the cheek
– a white or red patch on the gums, tongue, tonsil, or lining of the mouth
– a sore throat or a feeling that something is caught in the throat
– difficulty chewing or swallowing
– difficulty moving the jaw or tongue
– numbness of the tongue or other area of the mouth
– swelling of the jaw that causes dentures to fit poorly or become uncomfortable
– loosening of the teeth or pain around the teeth or jaw
– voice changes
– a lump or mass in the neck
– weight loss

If you have any of these, especially if they are of more than two weeks duration, it is important to see your dentist, or physician.

The main things that dentists look for are enlarged lymph nodes and areas in the mouth that are white or red or a mixture of both. The white areas are called leukoplakias and the red, erythroplakias. Leukoplakias are benign 90% of the time and are unlikely to progress to cancer. However, 10% are precancerous or cancerous. Approximately 90% of erythroplakias are diagnosed as cancer at the time of biopsy or will proceed to become cancerous.

Sometimes these leukoplakias and erythroplakias are just caused by an irritant such as a loose denture, dissimilar metals in the mouth, or a sharp area of a fractured tooth. After correcting for these, if they do not resolve themselves in two weeks, a biopsy should be performed.

Unfortunately, just looking and palpating will often miss cancer in its early stages. This is why I encourage my patients to have an enhanced visual screening test for oral cancer.There are two types on the market, the VELscope® and the Vizilite® Plus, both of which aid in picking up suspicious areas.

VELscope (Visually Enhanced Lesions Scope) is an electrical luminescent device, which emits a blue light that excites oral tissues and causes it to fluoresce. Healthy oral mucosal tissue will appear green, while suspicious areas will not fluoresce and thus appear dark.

The Vizilite uses chemiluminescence. First the patient rinses with a flavored acetic acid solution. This causes abnormal squamous epithelial tissue to appear white when viewed with the special chemiluminescent light source. With this light the leukoplakias are highlighted. Any suspicious areas are then swabbed with additional acetic acid followed by an application of a special blue dye. The area is then swabbed with acetic acid to remove the excess dye. Abnormal areas will retain the blue dye. Similar technology has been used for detecting cervical dysplasias and cancer.

Our office is a certified Vizilite Plus provider. Hopefully more and more dental offices will be offering this valuable service. There is no reason that this should not become as common as the PAP smear.

© 2008, Mark A. Breiner, DDS
The information presented is for educational purposes only. You should consult a qualified dentist or health practitioner for diagnosis and treatment. 

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