Your dentist may be your best friend when it comes to detecting cancers of the mouth and throat. Who else regularly examines your mouth and oral cavity with an eye trained to spot abnormalities?

About 30,000 Americans are diagnosed each year with oral cancers. That’s only two to four percent of all cancer cases, and nearly all are treatable if detected early enough. Yet the relative survival rate for these cancers is low. About 8,000 die of these cancers each year, and only about half of patients are alive five years after diagnosis.

Cancers can occur on the lips, the gums, the lining of the cheeks and lips, the tongue, the floor of the mouth or the part of the throat just behind the mouth. Growths in these areas, except for the lips, are not readily spotted, but symptoms you should look for include:

• a sore that does not heal;
• a lump;
• unusual bleeding, pain or numbness;
• a white or red patch on the gums, tongue or lining of the mouth;
• difficulty chewing or swallowing;
• a change in the voice, or
• pain in the ear.

The same symptoms, however, can be caused by other, less serious problems. And when they are associated with cancer, it is often cancer that is too far advanced for successful treatment.

Your dentist is one person who can keep an eye on your mouth and throat. Make regular dental appointments and be sure that a full mouth examination is included.

Tobacco Users Have High Risk
About 80 to 90 percent of mouth and throat cancers are associated with tobacco use, and studies indicate that cigar and pipe smokers have a risk as high as cigarette smokers. Smokeless tobacco may be at least as dangerous.

Excessive use of alcohol is also associated with an increased risk of oral cancers, particularly in those who smoke or use smokeless tobacco. In fact the combination increases the risk of oral cancer by up to 100 times over those who neither smoke nor drink.

As with lung cancer, tobacco users can substantially reduce their risk by quitting. For many individuals, however, quitting requires help through nicotine withdrawal products, counseling or other smoking cessation methods.

Men are more vulnerable than women, and the majority of oral cancers occur in persons over age 40. The average age at the time of diagnosis is 60.
Older persons–even non-smokers and non-drinkers–are at risk of oral cancers attributed to what scientists call random genetic errors that occur over a lifetime–in other words, normal aging. And excessive exposure to the ultraviolet rays of the sun increases the risk of lip cancer in some individuals.

Heavy smokers and drinkers often have leukoplakia, or whitish patches on their gums or the lining of their cheeks. Erythroplakia, or reddish patches in the mouth, are more common among persons in their 60s and 70s–even those who are not smokers. Although not necessarily cancerous, either whitish or red patches are frequently pre-cancerous.
Once cancer strikes in the oral cavity, it can spread rapidly–not only to other parts of the mouth and throat but to lymph nodes in the neck, from where it can be dispersed to all areas of the body. That is why oral cancers are so often fatal.

Although a dentist or doctor can spot lesions that require further investigation, it’s virtually impossible to distinguish a cancerous growth from a harmless one simply by looking. One screening method, now under investigation, allows a dentist to scrape cell samples of a suspicious area with a small brush and send them to a laboratory for a computer-assisted analysis. In most cases, however, a biopsy is the only sure way to determine if a growth is cancerous.

Once cancer is found, the next step is to determine whether it has spread and to what parts of the body. X-rays, CT scans, sonograms and magnetic resonance imaging (MRI) scans help in this regard.

Treatment consists of some combination of surgery, radiation therapy and chemotherapy, and decisions are often complex, requiring coordination by a team of specialists. The team may include an oral surgeon, an ear/nose/throat surgeon, a cancer specialist, a radiation therapist, a general dentist, a plastic surgeon, a social worker and a dietitian.
Surgery involves cutting away the cancerous tissue along with a margin of healthy tissue. If the cancer has spread, lymph nodes in the neck–and sometimes muscle and other tissue–may have to be excised.

For early cancers, a new approach known as micrographic surgery removes as little normal tissue as possible, using a microscope to examine the area and make sure that no cancer cells remain.

Radiation therapy, or the use of high-energy rays to damage cancer cells and keep them from reproducing, can be directed externally or delivered internally through a tiny seed or implant placed inside the tumor or in nearby tissue.

Radiation can be used as an alternative to surgery or in combination with it. Carried out before surgery, radiation can shrink the tumor; after surgery, it can be used to make sure that all cancer cells are killed.

The higher the dose of radiation, the more cancer cells can be killed, but with a higher risk of damaging normal cells. Fractionation, or the delivery of multiple small doses of radiation, has long been used to minimize complications. And recent approaches have experimented with various fractionation schedules.

Chemotherapy, or the use of drugs to kill the cancer, may also be carried out alone or in combination with either radiation or surgery.

Hyperthermia, a treatment option under investigation, uses a machine to heat the body for a period long enough to kill cancer cells, which are more sensitive to heat than normal cells. Another new approach uses drugs called radiosensitizers, which make cancer cells more sensitive to radiation–thereby lowering the dose needed to kill them.

The lips, mouth and throat are, of course, central to eating, talking and other basic human needs. Treatment often leads to distressing side effects, disability or disfigurement that require the help of a plastic surgeon, speech therapist, dietitian or other health professional.

Considering the potentially severe consequences, there is ample reason to avoid using tobacco products and to make sure your mouth gets regular checkups by your dentist or your physician.

REFERENCES:
Carla Cantor, “New Test Aids in Early Diagnosis of Oral Cancer,” WebMD Health, February 19, 2002.
Rachel H. Chou, et al, “Recent Advances in Radiotherapy for Head and Neck Cancers,” Ear, Nose and Throat Journal, October, 2001.
“Genetic Instability Important Factor During Onset,” Genomics & Genetics Weekly, January 26, 2001.
“Mouth and Throat Cancer May Result from Aging,” Cancer Biotechnology Weekly, May 8, 1995.
National Cancer Institute, “What You Need To Know about Oral Cancer.”
PDQ, “Lip and Oral Cavity Cancer.”
PDQ, “Screening for Oral Cancer.”
PDQ, “Cancer of the Lip and Oral Cavity.”
“Study Finds Radiation Effective as Surgery in Vocal Chord Cancer,” Cancer Weekly, December 11, 2001.