What You Need to Know
Today, we will discuss the Risk Factors, Signs, and Symptoms.
Approximately 53,000 people in the U.S. will be diagnosed this year with oral cancer (cancer of the mouth).
One hundred forty-five new people every day will be diagnosed with oral cancer, and EVERY HOUR OF THE DAY, 24/7/365, will die from it — nearly 9,000 deaths from oral cancer every year.
Of the newly diagnosed people with oral cancer, only about 60% will live longer than five years.
Many benign lesions mimic oral cancer, the most common being aphthous lesions.
Many who do survive to suffer have long-term problems such as severe facial disfigurement or difficulties eating and speaking. The death rate associated with oral cancer remains high because cancer tends to be discovered in the late stages.
Oral cancer awareness in the general public is low.
While smoking and tobacco use are major risk factors, the fastest-growing segment of oral cancer patients is the young, healthy, non-smoking individuals due to the connection to the human papillomavirus (HPV).
We cannot stop this virus from spreading; our only hope to save lives is professional involvement and public awareness. This is your opportunity to get involved and give back to your community in hopes of raising oral cancer awareness and the need for early detection to save lives. Together, we have the opportunity to make a difference in the world of oral cancers.
Risk factors for developing mouth cancer:
- Smoking tobacco (including cigarettes, pipes, and cigars and using smokeless tobacco) increases your risk of developing mouth cancer by up to ten times. Around two in every three (more than 60 percent) mouth cancers are linked to smoking.
- Heavy drinking increases your risk of mouth cancer. Alcohol is linked to just under a third (30%) of all mouth cancers.
- Smoking and drinking together triple a person’s mouth cancer risk.
- Too much ultraviolet (UV) radiation is a known cause of skin cancer. This can occur either from natural sunlight or tanning bed.
- Skin cancer can develop on the lips, as this area is often exposed to UV radiation.
- Secondhand smoke at home or in the workplace also may increase a person’s risk of mouth cancer.
The fastest-growing cause of oral, head, and neck cancers is HPV. In fact, if you have HPV, you’re 30 times more likely to develop oral cancer.
Oral cancer can be treated when detected early. People can learn how to examine themselves for possible signs and symptoms. (Link to self-exam) See your dentist, doctor, or another healthcare professional immediately if something looks suspicious.
The only hope to save lives is awareness.
The five-year relative survival rate is approximately 80% to 90% if detected early. Unfortunately, the majority of cases are found as late-stage cancer.
As with any cancer, early diagnosis saves lives. If detected early, oral cancer has an 80% survival rate. The most effective way to manage oral cancer is to combine early diagnosis with timely and appropriate treatment.
The most common locations for cancer in the oral cavity are:
- Oropharynx (the middle part of the pharynx – throat – behind the mouth)
- The floor of the mouth
Signs and symptoms of oral cancer, which is predominantly caused by tobacco usage and/or excessive alcohol usage, may include one or more of the following:
- Persistent mouth sore: Any sore or ulceration that does not heal within 14 days
- A red, white, or black discoloration of the soft tissues of the mouth
- Any abnormality that bleeds easily when touched
- A lump or hard spot in the tissue, usually on the border of the tongue
- A sore under a denture, which, even after adjustment of the denture, does not heal
- A lump or thickening that develops in the mouth
- A painless, firm, fixated lump felt on the outside of the neck, which has been there for at least two weeks
- A sore throat or a feeling that something is caught in your throat
- Difficulty chewing, swallowing or speaking
- Difficulty moving your jaw or tongue
- Swelling of your jaw
- Numbness in your tongue or other areas of your mouth
- Ear pain
- Loosening of the teeth
- Pain in the teeth or jaw
- Voice changes
- A lump in the neck
- Weight loss
- Persistent bad breath
If any of these oral cancer signs or symptoms are present for days, weeks, or months, your doctor may recommend tests to check for oral cancer. As with any cancer, having your cancer diagnosed as soon as possible helps ensure that any treatment is as beneficial as possible.
Your Mouth’s Worst Nightmare!
The pandemic has forced many of us to reconsider our health and the health of our loved ones. With approximately 7,500 annual deaths in the U.S. alone, Oral Cancer remains one of the most dangerous types of cancer in the world today!
Related Article: Mask Mouth <span data-preserver-spaces=”true”> (LInk)
Unfortunately, if the disease continues to remain undetected and is allowed to progress to advanced stages, the resulting damage will likely be irreversible and might become potentially life-threatening. Certainly, such a bleak prognosis is not the news that anyone wishes to get, but remember. It doesn’t have to be that way! Look in your mouth, don’t ignore warning signs.
Oral Cancer Screening During Exam
While you might not be aware that you are receiving an oral cancer screening during an exam, rest assured this is an imperative measure in identifying and treating oral cancer at its earliest stages and is often the best bet in fully overcoming the disease due to cancer not having enough time to progress or spread.
During the exam, many dentists or dental hygienists will perform this exam during your regular dental check-up. They will check your face, neck, lips, and entire mouth for possible signs of cancer. When you come in for your routine dental check-up, you are simultaneously receiving an accurate screening for any early signs or symptoms of oral cancer.
Because oral cancer can spread quickly, early detection is important. The exam is painless and takes only a few minutes.
Signs we look for in the mouth at an exam:
- White or red patches in your mouth
- A sore in your mouth that doesn’t heal
- Problems or pain with swallowing
- A lump in your neck, lips, or face
- Your gums
- Your tongue from all sides and underneath
- The insides of your cheeks
- The roof of your mouth
- The back of your throat
If your dentist sees tissue that looks suspicious, they may recommend a biopsy. This procedure usually requires local anesthesia and may be performed by your dentist or a specialist. They take a small piece of tissue from an area that looks troublesome and sends it to a lab to test it for cancer cells. These tests are necessary to detect oral cancer early before it has had a chance to progress and spread.
A thorough oral, head, and neck cancer examination can quickly be completed in less than 2 minutes. It primarily consists of inspection and palpation. Common changes noticed in a person’s face, and body weight loss and/or fatigue may be the first sign of malignancy.
The initial physical evaluation actually begins as soon as you meet the patient. While taking the patient’s history, it is helpful to note any facial asymmetry, masses, skin lesions, facial paralysis, or swelling—inspection of the lips, both moving and at rest. Listening is an important part of this examination. Throughout this oral, head and neck cancer examination, it is helpful to remember to look, listen, AND feel every site that is being examined. The sound of one’s voice and speech are important and may signal the presence of an oropharyngeal tumor, whereas a raspy, hoarse voice could be the first sign of a problem.
The entire face should be examined with an external light source (overhead light or headlight) to evaluate for pigmented (red, brown, black), raised, ulcerated, or firm areas of the skin, including the hair-bearing regions of the face and scalp. The facial bones, skeleton, and soft tissue should be palpated, particularly noting asymmetry or masses.
As part of the cranial nerve examination, extraocular movements should be tested in each direction and visual acuity. Any swelling of the eye should be noted and can be a late sign of cancer which may have started in the palate, maxillary, or sinuses.
The routine nasal examination should include palpation of the external nose and maxillary sinus. A flexible nasopharyngolaryngoscope can also be used to examine the nasal cavity. This technique will be discussed later.
As part of the cranial nerve examination, the hearing should be tested by conversing with the patient during the physical exam.
The Oral Cavity:
For this portion of the exam, patient positioning can vary. Dental patients tend to lie on their backs while their dentist examines their oral cavity. On the other hand, physicians usually have their patients sit up straight and face them eye-to-eye during the exam.
The mouth must be examined with an external light source, which allows both hands-free for bimanual palpation or to hold gauze or tongue blade(s) for improved visualization. Suppose a hands-free light source is not available. In that case, an assistant may provide invaluable help in the visualization of difficult areas such as the posterolateral border of the tongue and floor of the mouth. It is important to gently dry those surfaces with a gauze or air syringe, so that color or texture changes will become more obvious.
The lips should not be overlooked as part of the oral cavity. They may be involved with squamous cell carcinoma (SCC). The lips should be evaluated with the mouth open and closed, noting any symmetry, contour, color, or texture abnormalities. Notice the frenum of the lip in the midline. With the lip still retracted, one can also inspect the gingivolabial sulcus, the gingival mucosa, and the teeth. Next, palpate the lip with your thumb and index finger, noting any firm or nodular submucosal areas. Note any signs of smokeless tobacco use (ulcers, red or white discolorations, texture variations) on the labial mucosa.
The Buccal Mucosa:
The cheek or buccal mucosa inside must be spread away from the teeth and gums to visualize the sulcus, which connects this area to the gums (gingiva). Examine one side and then the other. It is not uncommon to see a white line on the inside of the cheek from a habit of biting.
Examine the entire buccal mucosa, tonsillar pillars, and the parotid gland. Any irregularity in texture or color, or other signs listed above should be noted. With your index and middle fingers inside the patient’s mouth on the buccal mucosa and with your thumb on the cheeks.
Ask the patient to open wide while relaxing the tongue; note any abnormalities, swellings, or swelling. Then have the patient stick out their tongue and move it from side to side. It should move easily and completely to both sides without spasm or asymmetry.
One of the most common sites of oral cancer is on the lateral aspect of the tongue, and it must be evaluated completely. This often requires using gauze to pull the tongue out and roll it from side to side while retracting the cheek. This area is best viewed by pulling the tongue forward while holding it with 2X2 gauze and will roll it up into a position enabling a clearer view. Finally, touch the roof of their mouth with the tip of their tongue. This will allow the examiner to inspect the ventral surface of the tongue and look for a possible tongue tie. When you are open wide, if you cannot touch the roof of your mouth with the tip of the tongue without closing your hand, you have some type of tie or tethered tissue.
The floor of the Mouth:
The floor of the mouth is horseshoe-shaped. If needed, we wrap a piece of gauze around the tip of the tongue and pull the tongue gently forward and to one side.
Hard and Soft Palate:
Loose teeth, red spots, white spots, ulcerations, rough areas, asymmetry, growths, or other masses may be the first sign of cancer in this area as in all head and neck areas. Open widely and tilt your head backward to view the hard and soft palate adequately. If needed, depress the tongue base with a tongue blade to provide a better view of the soft palate.
Note that the examination of the oropharynx is essentially a continuation of the oral cavity examination, and the two are often completed simultaneously.
Ask the patient to open widely, relax and slowly breathe in and out, saying, “Ahhh.” This relaxes the tongue allowing a view of the oropharynx. It may be necessary to press down on the back of the tongue to get a full view of the oropharynx. Simply depressing the tongue with a tongue blade and having the patient say “ah,” often gives only a superficial view of the oropharynx, and many early cancers may go unnoticed.
The soft palate is part of the oropharynx and should be evaluated for symmetry at rest and on elevation and for abnormal lesions. The mobility of the soft palate can be examined by having the patient say “Ahhh”.
Posterior Pharyngeal Wall:
The posterior pharyngeal wall can be seen behind the soft palate. Using a tongue blade to depress the middle portion of the tongue and having the patient say “Ahhh” may provide a better view of the posterior pharyngeal wall. Inspect the wall for any of the aforementioned signs of cancer.
The base of Tongue:
Inspect the base of the tongue using a laryngeal mirror. Note in the previous section the comment about rolling this portion of the tongue up into clearer view by pulling on the tongue with a 2X2 piece of gauze. Being careful not to gag the patient, palpate this area quickly by inserting a gloved finger.
Bilateral palpation of the neck, comparing both sides simultaneously for signs of enlargement. Palpate carefully for enlarged lymph nodes.
Please note that if a patient over the age of 40 presents with a neck mass that is painless – that the first differential diagnosis is oral cancer, and this not being the site of the primary, requires a reexamination of the interior of the mouth to ensure that primary locations are identified. Enlarged nodes that are painless are seldom the result of an infectious process.
Thyroid: First, inspect the thyroid gland before proceeding to palpation. In normal patients, the thyroid gland is often difficult to feel. Some clinicians prefer to palpate the thyroid while positioned behind their patients, but it is perfectly acceptable to examine the gland from the front as well.
Nasopharynx: Examination of the nasopharynx is one of the more difficult portions of the oral, head, and neck cancer examination. We may Instruct the patient to open widely and breathe through his or her mouth. This should cause the soft palate to rise. With a tongue blade, carefully depress the mid-portion of the tongue. Then insert a warmed nasopharyngeal mirror over the tongue blade and into the oropharynx. Ask the patient to now breathe through his or her nose. This should cause the soft palate to fall forward, allowing the examiner to see the nasopharyngeal region reflecting in the mirror.
Hypopharynx and Larynx
Like the nasopharyngeal examination, this part of the exam can be challenging. A thorough inspection of the hypopharynx and larynx is a critical component of the oral, head, and neck cancer examination. All key laryngeal structures need to be closely inspected for any signs of malignancy. This examination can be accomplished with either a laryngeal mirror or a fiber optic scope.
Traditionally the laryngeal mirror has been the instrument of choice for examining the hypopharynx and larynx. Ask the patient to sit up straight and slightly protrude the chin upward and forward. Next, have the patient open widely and protrude the tongue. Grasp the tip of the tongue with gauze and gently pull it forward. The patient should be concentrating on breathing in and out through the mouth
Fiber optic Nasopharyngolaryngoscope Exam
The flexible fiber optic nasopharyngolaryngoscope has become invaluable for detecting head and neck cancers. The nasal cavity, nasopharynx, a portion of the oropharynx, hypopharynx, and larynx can all be thoroughly inspected with the help of a flexible fiberoptic scope. The flexible scope is passed transnasally into the nasopharynx after topical vasoconstricting and anesthetic agents have been sprayed into the nasal cavity. As the scope passes through the nasal cavity and nasopharynx, look for any mucosal lesions or other abnormalities. Gently advance the scope into the oropharynx and then down into the hypopharynx. Examine all of the laryngeal structures as you would for the mirror exam. Then slowly remove the scope.
People’s lives can be saved through early detection of oral, head, and neck cancers. Dentists and physicians must do a better job screening their patients for these malignancies. By following a systematic approach to the oral, head, and neck cancer physical examination, clinicians will be more effective at diagnosing such cancers at an early and more treatable stage.
If you have ever heard the old adage, “The best defense is a good offense, ” you can probably guess how it applies here; the best way to fight oral cancer is to prevent yourself from ever getting it in the first place! Indeed, there are several ways you can go about preventing oral cancer. While there are apparent lifestyle changes (such as giving up tobacco use and practicing moderation when consuming alcohol), there is a less obvious but equally important prevention measure to take.
You can take an active role in detecting oral cancer early by doing the following:
- Conduct a self-exam at least once a month. Using a bright light and a mirror, look and feel your lips and the front of your gums. Tilt your head back and look at and feel the roof of your mouth. Pull your cheeks out to view the inside of your mouth, the lining of your cheeks, and the back gums. Pull out your tongue and look at all surfaces; examine the floor of your mouth. Look at the back of your throat. Feel for lumps or enlarged lymph nodes on both sides of your neck and under your lower jaw. Call your dentist’s office immediately if you notice any changes in the appearance of your mouth, a sore is not going away, or any of the signs and symptoms of oral cancer mentioned above.
- See your dentist on a regular schedule. Even though you may be conducting frequent self-exams, sometimes dangerous spots or sores in the mouth can be very tiny and difficult to see on your own. The American Cancer Society recommends oral cancer screening exams every three years for persons over age 20 and annually for those over age 40. During your next dental appointment, ask your dentist to perform an oral exam. Early detection of oral cancer can improve the chance of successful treatment.
Not all spots or lumps your dentist finds turn out to be cancer But if they are, catching the condition early means you may have more treatment options.
Routine Oral Cancer Screenings are without a doubt a key component in stopping oral cancer from dead in its tracks and preventing it from causing any further harm to both your oral and overall health.
Now, if you question what an oral cancer screening is and how to receive one, chances are you’ve had one before and didn’t know it! As one most important and underappreciated procedures within the dental industry today, Oral Cancer Screenings are a quick and painless procedure performed as part of your standard dental exam.
When oral cancer is detected early, it is treated with surgery or radiation therapy. Oral cancer that is further along when it is diagnosed may require a combination of treatments. The choice of treatment depends on your general health, where in your mouth or throat cancer began, the size and type of the tumor, and whether the cancer has spread.
Treatment of oral cancers is ideally a multidisciplinary approach involving the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists, and rehabilitation and restorative specialists. After a definitive diagnosis has been made and cancer has been identified and staged, treatment may begin. The actual curative treatment modalities are usually surgery and radiation, with chemotherapy added to decrease the possibility of metastasis, sensitize the malignant cells to radiation, or patients who have confirmed distant metastasis of the disease.
Patients with cancers treated in their early stages may have little in the way of post-treatment disfigurement. For those whose cancer is caught at a later stage, the results of surgical removal of the disease may require reconstruction of portions of their oral cavity or facial features. There may be needed adjunctive therapy to assist in speech, chewing of foods, the problems associated with the lack of salivary function, and the fabrication of dental or facial prostheses.
You can see why an oral exam and awareness for early intervention are key when it comes to finding oral cancer. Get yours as soon as possible, and when you go to the dentist, ask if you are unsure if they do an exam. You are allowed to ask questions and take ownership of your health. We only get one body.
A healthy mouth is a healthy body and a healthy life!
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