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Oral Cancer

I know it is scary, but oral cancer is a fact of life, and it makes sense for everyone to know at least a little about it. There are over 30,000 cases every year of oral cancer in the USA, and about 300,000 cases worldwide.

There are no numbers specifically for Canada, but there are certainly several thousand cases every year. Late diagnosis of this kind of cancer accounts for its high death rate. In fact, oral cancer has a higher death rate than cervical cancer, testicular cancer, brain cancer, cancer of the kidney, ovarian cancer, malignant melanoma, or Hodgkins disease. For some reason, oral cancer is something very few people think about.

The role of tobacco and alcohol in oral cancer are well established. Actually, tobacco, both smokeless and cigarettes and cigars, and alcohol are significant risk factors by themselves. Together they do not have an additive effect as one might expect. They have a synergistic effect. Meaning one plus one does not equal two, it equals more than two.

The dentist is trained to recognize oral cancer in an examination of the mouth along with much more common mouth problems like cavities or periodontal disease. You might have wondered what the dentist is doing when he looks carefully at the tongue or has you say, “Ah” and looks at something. This is an important part of early detection of oral cancer. As in other forms of cancer, early detection is imperative because once oral cancer gets well established, it often spreads to other parts of the body and gets out of control. A lump that is getting larger is suspect especially if it doesn’t hurt. White patches here and there again especially if they do not hurt are also suspect. Difficulty in swallowing is something to get checked out. Often areas that are enlarging and nonpainful end up not being cancer at all but should be checked out to make sure. I remember well a lady of about 85 years who had not seen a dentist in over 20 years who came to see me because at the back of her upper denture very close to the middle of her palate she had a growth. The denture was not fitting well, and there was a hard white lesion (unidentified “thing”) on the posterior part of the palate. I sent her to the oral surgeon who planned to do a biopsy. He did a panoramic radiograph (x ray) and identified a tooth that had somehow managed to find its way to the middle of the posterior edge of her denture and decided to erupt. It was a relief for everybody that the situation turned out this way. She had the tooth out and went on with normal life.

I mentioned something in the last paragraph that might be a new word for you. When a dentist or oral surgeon does a biopsy, it means that either part or all of a lesion (unidentified “thing”) will be removed and sent to a lab where it will be looked at under a microscope. In this way, it will be known what kind of cells make up the lesion. Often a growth is not cancer but something else and having a biopsy is how it is discovered what a growth actually is. There are two kinds of biopsies-incisional, and excisional. An incisional biopsy is a piece of the suspect tissue. This can be done when the involved area is large. An excisional biopsy is when the entire suspect area is removed. This is the more common case in dentistry. You might wonder why a person would care what a bump was if it is now gone? It is important to know because some kinds of lesions have a high recurrence rate or other reason some sort of tracking should be done after its removal.

As said before, early detection is essential to insure the least amount of damage and the best chance of long term survival. Routine well patient exams (the patient knows of no pain or other problems) are the front line defense against oral cancer. The dentist calls this kind of exam a recall exam, and a regular dental patient gets this done every six months or every year. In truth, only about half of the people out there are regular dental patients (those who receive regular recall exams). The others either only see the dentist when there is pain or never see the dentist at all. There are a couple of high tech lights that are available to provide earlier detection of oral cancer. In some areas—like Ontario—officials in our dental organizations have been slow to recognize the benefits of these devices and have made their use difficult or impossible. At any rate, early detection is essential. Ask your dentist if you have questions about oral cancer.

- This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)

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