Risk Factors for Oral Cancer

Working as a technician in New England Medical Center nearly twenty years ago, I was assigned to draw blood samples from inpatients before breakfast. Most of the rooms were open when I arrived, but one patient’s door was shut. Signs on the door directed all visitors and employees to stop at the nurses’ desk for instructions. I was informed that the patient had undergone very disfiguring surgery to treat basal cell carcinoma, a type of oral cancer. No one was allowed into her room without being advised that she was missing a large portion of her face.

I was glad to have been prepared for what I was about to see. The patient was a slim woman who was not quite middle-aged. She often wore a kerchief over her face, but she had not put it on that early. Oral cancer had robbed her of most of her face. Her nose, left eye, left cheek and at least half of her tongue were missing. She could not speak so I could understand her. Later, silicon prosthetics would be fabricated to replace the missing anatomy; until then she was forced to live in the solitary of a private hospital room for several months.

Oral cancer is a serious problem affecting the soft tissue and bone of the face and mouth. It can be disfiguring and deadly. According to the American Cancer Society, nearly 30,000 new cases of oral cancer will be diagnosed in the United States this year. Over 7,000 oral cancer related deaths are expected. The incidence of oral cancer and death rate has been declining since the late 1970’s. This is probably due to a decrease in smoking and alcohol consumption, both of which are risk factors for the disease.

The likelihood of getting oral cancer and suffering its negative effects can be lessened. First, decrease your risk factors. If you use tobacco products such as cigars, cigarettes, snuff, or chewing tobacco, stop. Drink alcohol in moderation. Use sun blocking lip balm or lipstick.

Early detection is important. You can screen yourself by checking for sores that take longer than 2 weeks to heal, white or red patches that do not go away or wipe away, and lumps or thickenings in the inner surface of the mouth or on the tongue. Report difficulty swallowing, chewing, breathing or moving the tongue or jaw to your Dentist or physician. Visit your dentist regularly. A visual oral cancer screening is a routine part of every dental exam. Ask your dentist to show you how it is done.

When a suspected lesion is found a sample or the entire lesion is removed. This is called a biopsy. The biopsy sample is sent to a pathology lab. Technicians and pathologists examine the tissue sample microscopically.

There is even a new biopsy technique called OralCDx. The following description is from the OralScan Laboratory’s Oral CDx website (http://www.oralscan.com):

Using a special, handheld brush, dentists take a small sample of tissue from the suspicious lesion. The sample is put on a slide and sent to OralScan Laboratory, based in Suffern, New York. At the lab, computers use advanced robotics, scanning and imaging techniques – technology originally developed for the defense industry – to accurately examine the thousands of cells on the sample. The computer is able to look at every cell, compare them to libraries of normal and abnormal cells and determine which cells are potentially problematic. A summary report is returned to the dentist for his/her files or for further discussion with the patient. If the OralCDx test is positive or atypical, the dentist will then confirm it with a standard incisional biopsy. And even if the OralCDx test turns out to be negative, but if the lesion persists, it should receive a follow-up evaluation.

I have used this technique for many of my patients. They have all found it to be painless. Reports show the reliability of this relatively new test to be high.

Treatment of oral cancer usually involves radiation and surgery. Chemotherapy may be used as well.

Finally, remember that denture wearers are not immune to oral cancer. Denture wearers should be examined by a dentist at least annually to check their dentures’ fit and to check for signs of oral cancer and other disease. Much more information and photographs may be found on the Oral Cancer Foundation’s website: http://www.oralcancerfoundation.org .

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