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This issue is about oral cancer and was written by a local oral and maxillofacial surgeon, Dr. Anthony Captline. This is the largest category of those cancers which fall into the head and neck cancer category. Common names include mouth cancer, tongue cancer, and throat cancer. Each year in the US almost 30,000 people are newly diagnosed with oral cancer. When found early, oral cancers have an 80 to 90 % cure rate, unfortunately, the majority are found as latter stage cancers, accounting for the very high death rate. For more info, read on....

What is cancer?
Cancer is a group of diseases. It occurs when cells become abnormal and divide without control or order. There are more than one hundred different types of known cancer.

Like all organs of the body, the mouth and throat are made up of many kinds of cells. These cells normally divide in an orderly way to produce more cells only when the body needs them. This process helps keep the body healthy. Cells that divide when new cells are not needed form too much tissue. The mass of extra tissue, called a tumor, can be benign or malignant.

Benign tumors are not cancerous. They usually can be removed, and in most cases, do not grow back. Most important, the cells in benign tumors do not invade other tissues and do not spread to other parts of the body.

Malignant tumors are cancerous. They can invade and damage nearby tissues and organs and they can break away from the malignant tumor and enter the blood stream or the lymphatic system. This is how cancer spreads and forms a secondary tumor in other parts of the body. The spread of cancer is called metastasis.

Key statistics about oral cancer
The American Cancer Society estimates over 28,000 new cases of oral cavity and oral pharyngeal cancer will be diagnosed in the United States this year. An estimated 7,000 people will die from these cancers. Of those newly diagnosed cases, only half of those individuals will be alive in five years. This is a number that has not significantly improved in decades. The death rate for oral cancer is higher than that of cervical cancer, Hodgkin's disease, cancer of the brain, liver, testes, kidney or skin cancer (malignant melanoma.)

The death rate associated with oral cancer is particularly high due to the cancer being routinely discovered late in its development. Often it is only discovered when the cancer has metastasized to another location - most likely the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is recognized in a localized area. Besides metastasis, at these later stages the primary tumor has had time to invade deep into local structures.

Oral cancer is particularly dangerous because it has a high risk of producing second, primary tumors. This means that patients who survive a first encounter with the disease have a twenty times higher risk of developing a second cancer. There are several types of oral cancer but ninety percent are squamous cell carcinomas.

For decades, from a gender perspective, this has been a cancer that affects six men for every woman. That ratio has now become two men to each woman. This increase is due to lifestyle changes. Primarily. the number of women smokers over the last few decades has increased. Oral cancer is a cancer that occurs twice as often in the black population as in whites. and survival statistics for blacks over five years are also poorer at thirty-three percent compared to fifty-five percent for whites.

What causes oral cancer?
All forms of tobacco (including smokeless) are important causative agents of oral cancer. Human papilloma virus has been associated with some oral cancers particularly verrucose forms. Alcohol and chronic irritation are regarded as modifying rather than initiating factors. Tobacco use, that is, cigarettes, cigars, pipes, chewing tobacco or dipping snuff account for eighty to ninety percent of oral cancers. Studies indicate that smokeless tobacco users are at particular risk of developing oral cancer. In prolonged time users, the risk is much greater, making the use of snuff or chewing tobacco among young people a special concern. Pipe smokers are especially prone to cancer of the lip.

Chronic and/or heavy use of alcohol also increases the risk of oral cancer, even for people who do not use tobacco. However, people who use both alcohol and tobacco have an especially high risk of oral cancer. Researchers believe these substances increase each other's harmful effects. Cancer of the lip can also be caused by exposure to the sun. Your risk can be avoided with the use of a lotion or lip balm containing a sunscreen. Wearing a hat with a brim can also block the sun's harmful rays.

What are the symptoms?

• A sore in the mouth that does not heal
  
• Pain in the mouth that does not go away
  
• A lump or thickening in the cheek, gums or floor of the mouth
  
• A persistent white or red patch on the gums, tongue, tonsils or lining of the mouth
  
• 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 in the jaw
  
• Voice change
  
• A lump or mass in the neck
  
• Persistent bad breath
  

Oral cancer appears most commonly in the lateral tongue (twenty-five to forty percent) and the floor of the mouth (fifteen to twenty percent). It may appear as a non-healing ulcer or as described previously a persistent white or red patch on the gums, tongue, tonsils, or lining of the mouth. In the early stages, it is painless. Metastasis (spread to other areas of the body) is typically associated with a lesion greater than one inch in diameter.

How does your doctor know?
If an abnormal area has been found in the oral cavity, a biopsy is the only way to know whether it is cancer. The patient is referred to an oral surgeon or an ear, nose, and throat surgeon who removes part or all of the lump or abnormal-looking area. A pathologist examines the tissue under a microscope to check for cancer cells.

Almost all oral cancers are squamous cell carcinomas. Squamous cells line the oral cavity.

If the pathologist finds oral cancer, the patient's doctor is informed to know the extent of the disease in order to plan the best treatment. Staging tests and exams help the doctor find out whether the cancer has spread and what parts of the body are affected.

How is oral cancer treated?
A team of specialists may treat patients with oral cancer. The medical team may include an oral and maxillofacial surgeon, ear. nose and throat surgeon, a medical oncologist, a radiation oncologist, a general dentist, plastic surgeon, dietician, social worker, nurse, and a speech therapist.

Surgery: Surgery to remove the tumor in the mouth is the usual treatment for patients with oral cancer. If the cancer has spread, the surgeon may also remove lymph nodes in the neck. If other muscles or tissues are involved, the operation may be more extensive.

Radiation therapy: (Radiotherapy) This is the use of high-energy rays to damage cancer cells and stop them from growing. Like surgery, radiation therapy is local therapy and it affects only the cells in the treated area. Radiation therapy may be given before or after surgery. Before surgery, radiation can shrink the tumor so it can be removed. Radiation after surgery is used to destroy cancer cells that may remain.

Chemotherapy: The use of drugs to kill cancer cells. Researchers are looking for effective drugs with drug combinations to treat oral cancer. They are also exploring ways to combine chemotherapy with other forms of cancer treatment to help destroy the tumor and to prevent the disease from spreading.

In Summary
An oral examination with your dentist should occur at a minimum of six-month intervals. Regular examinations are an opportunity for noting changes in the tissues of the oral cavity, thereby discovering a potential serious conditions, that require immediate attention and treatment. Early diagnosis is an important factor in the treatment of oral cancer.

TWO EXAMPLES OF ORAL CANCER
Malignant tumors often present initially as painless ulcers, most commonly on or around the tongue.  They sometimes present as an ulceration within a pre-existing white or thickened patch in the mouth which does not wipe off and differ from other ulcers by persisting for more than two weeks