Oral cancer is the uncontrolled growth of cells that invade and cause damage to surrounding tissue that occurs in the mouth, including the cheeks, lips, gums, tongue, floor and roof of mouth. Oral cancer is part of a group of cancers referred to as Head & Neck Cancers, and oral cancer accounts for 85% of the total number of the group. Approximately 1/3 of all Americans will develop some form of cancer at some point in their life, but oral cancer accounts for less than 3% of all cancers diagnosed in the United States. The most common cancer found in the mouth is squamous cell carcinoma, which is a cancer of the most superficial or outermost portion of tissue. Other types of cancers that can be found to a much lesser degree are cancers arising from salivary glands (adenocarcinoma), bone, muscle and fat, as well as malignant melanoma.
Oral cancer can occur at any point in life, but like cancers found elsewhere in the body, increases in frequency a person ages. Aging cells are more prone to malignant transformation. A person’s gender and race are also determinants. For example, white men have a higher risk of oral cancer after 65 years of age than do any other group, but the highest incidence in middle age is found in African American men. Females have a much lower incidence than males at any age, with oral cancer found in men more than 3x as often as females. Similar to lung cancer, oral cancer is often the result of accumulative damage from other factors such as alcohol and tobacco use. Tobacco and alcohol are also syngergistic, meaning that together they are worse than either one is alone. Tobacco and alcohol users are more than 15x more likely to develop oral cancer than those who do not. Exposure to HPV virus is also playing a role, and as a percentage is increasing in prevelance as the triggering factor. There are over 200 strains of HPV, but the majority are thought to be harmless. Only HPV 16 is currently thought to be a risk factor for development of oral cancer, but patients exposed to HPV 16 are 30x more likely to develop cancer.
Now for the good news. We are getting better. With improved cancer awareness and more frequent oral cancer screenings by oral health professionals, survival rates are climbing. More patients not only seek regular dental care, but they also look for signs themselves. One of the difficult aspects of oral cancer is that in the early stages, cancer can appear as numerous non-malignant entities, which is why cancer is often dubbed The Great Masquerader. Thanks to both more regular dental care and ongoing efforts to educate the public, instead of hopefully watching something for weeks to months to year, people are getting the early diagnosis that is critical for improved success in treatment. In our office we have daily referrals for evaluations and/or biopsies. The majority of those patients end up having something other than cancer. I commonly tell patients that we prefer to biopsy anything abnormal in the mouth that cannot be explained. It’s not because I think everyone has cancer. It’s because I don’t want to miss the small portion of patients that may actually have a malignancy.
So be aware. Know your risk factors. Do regular self exams, but also see your dentist regularly, because a little bit of prevention goes a long way.