What is this?
Mouth cancer is a highly lethal disease and is one of the most debilitating and disfiguring of all malignancies. It is estimated that two to three Irish people die from the disease every week, which is more than skin melanoma, Hodgkin’s Lymphoma or cervical cancer, and the incidence of the disease is increasing particularly among younger people, particularly in respect of cancer of the tongue.
Oral cancer starts in the cells that line the inside of the mouth, and can form on the lips, inside the cheeks, on the gums, the tongue, the bony palate, or the surfaces underneath the tongue. Lip and oral cancer can occur on any surface lining the lips and oral cavity.
What causes Mouth Cancer?
Research show that smoking and drinking alcohol are the main risk factors and the risk is even greater if a person smokes and drinks. Those who both smoke and drink, have a 15 times greater risk of developing oral cancer than others. A diet deficient in fruit and vegetables also predisposes towards the development of oral cancers and it has been estimated that this may be responsible for 10-15% of cases in Europe. For lip cancers only, over exposure to UV light is implicated.
There is evidence that exposure to second-hand smoke may increase oral cancer, with a 63% risk increase shown for never smokers exposed to SHS at home or at work. Among those exposed at home and at work for more than 15 years, there was an 84% risk increase.
How dangerous is this Mouth Cancer?
The death rate associated with this cancer is particularly high not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development. Often it is only discovered when the cancer has metastasized (spread) to another location, most likely the lymph nodes of the neck.
Who is most at risk of Oral Cancer?
While historically the majority of people are over the age of 40 at the time of discovery, it is now occurring more frequently in those under this age. Exact causes for those affected at a younger age are now becoming clearer in peer reviewed research, revealing a viral aetiology (cause). There are also links to young men and women who use conventional “smokeless” chewing or spit tobacco. Promoted by some as a safer alternative to smoking, it has in actuality not proven to be any safer to those who use it when referring to oral cancers.
Campaigns to promote the safety of smokeless are being initiated, but it is clear that while it may reduce lung cancers, it has a negative effect on the rates of oral cancers, pancreatic cancer, periodontal disease, and the chronic infections that it produces may even link it to heart disease as well. The gains against lung cancers may occur, but there will be new losses in other areas. The jury is out on other new smokeless tobacco dissolvable products, and until their use has acceptable research behind it we recommend avoiding it.
What can your dentist do?
Oral cancer is an ideal cancer to identify early by screening. It is frequently preceded by an identifiable pre-malignant lesion and the progression from dysplasia occurs over a period of 2.5-8 years. However, current analysis of Oral Cancer patients shows that the majority of oral cancers present at an advanced stage (III and IV), when the chances of successful treatment are low.
This may partly be due to the stereotypical oral cancer patient (an elderly male, who abuses tobacco and alcohol) not presenting to his dentist or other health care professional. Our Dentists at Portobello Dental Clinic do an Oral cancer screening at each examination (check-up) visit.
Gender and Oral Cancer:
Interestingly, in this regard there are gender differences between women and men relating to smoking and oral cancer. The relative risk is much higher in women at all levels of smoking. Additionally, it has also been suggested that women may be more susceptible to cancers that are provoked by alcohol.
What are the symptoms of head and neck cancers?
The symptoms of head and neck cancers depend on where the tumour is found. Some common symptoms include:
A sore or ulcer that does not heal
Difficulty or pain on chewing and swallowing
Sore throat, difficulty speaking or a hoarse voice
Changes in your breathing at rest
Unexplained loose tooth
A swelling or lump
Pain in the face or jaw
Earache or ringing in the ear or hearing problems
Blocked or bleeding nose
White or red patches in the lining of the mouth or on the tongue that do not go away
Uncertain, unproven or controversial risk factors:
Some studies have suggested that mouthwash with a high alcohol content might be linked to a higher risk of oral and oropharyngeal cancers. But recent research has questioned these results. Studying this possible link is complicated by the fact that smokers and frequent drinkers (who already have an increased risk of these cancers) are more likely to use mouthwash than people who neither smoke nor drink.
b-Irritation from dentures
It has been suggested that long-term irritation of the lining of the mouth caused by poorly fitting dentures is a risk factor for oral cancer. But many studies have found no increased risk in denture wearers overall. Since poorly fitting dentures can tend to trap agents that have been proven to cause oral cancer, such as alcohol and tobacco particles, denture wearers should have them checked by a dentist regularly to ensure a good fit. All denture wearers should remove their dentures at night and clean and rinse them thoroughly every day.
c-Irritation from a broken tooth
Any long term irritation of the lining of the mouth—e.g. cheek repeatedly being cut by a broken tooth, can potentially predispose you to Oral Cancer.
d-Human Papilloma Virus infection
Human Papilloma Viruses (HPVs) are a group of more than 100 related viruses. Most HPV types cause warts on various parts of the body, but a few HPV types seem to be involved in Oral Cancer. The current estimate is that HPV may be a factor in about one-fourth of oral and oropharyngeal cancers. People with oral and oropharyngeal cancer linked with HPV infection are less likely to be smokers and drinkers, but oral cancers that contain HPV DNA seem to have a better outlook than those without HPV. Most people with HPV infections of the mouth and throat have no symptoms and only a very small percentage develop oral or oropharyngeal cancer.
Treatments for Oral Cancer:
Small oral cancers respond equally well to either surgery (which is generally very aggressive and disfiguring) or radiation therapy; advanced cancers are treated with both and sometimes with chemotherapy to relieve symptoms. For recurrent cancer, radiation therapy is the primary treatment.