The term oral cancer includes cancers of the mouth and the pharynx, part of the throat. About two-thirds of oral cancers occur in the mouth and about one-third are found in the pharynx. Oral cancer will be diagnosed in an estimated 28,000 Americans this year and will cause approximately 7,000 deaths. It is the 6th most common cancer in men and the 14th most common cancer in women.

Each year, more than 30,000 new cases of cancer of the oral cavity and pharynx are diagnosed and over 8,000 deaths due to oral cancer occur. The 5-year survival rate for these cancers is only about 50 percent. Mortality from oral cancer is nearly twice as high in some minorities (especially black males) as it is in whites. Methods used to treat oral cancers (surgery, radiation, and chemotherapy) are disfiguring and costly. Preventing high risk behaviors, that include cigarette, cigar or pipe smoking, use of smokeless tobacco, and excessive use of alcohol are critical in preventing oral cancers. Early detection is key to increasing the survival rate for these cancers.

Oral cancer can form in any part of the mouth or throat. Most oral cancers begin in the tongue and in the floor of the mouth. Anyone can get oral cancer, but the risk is higher if you are male, over age 40, use tobacco or alcohol or have a history of head or neck cancer. Frequent sun exposure is also a risk for lip cancer. Smoking and other tobacco use are associated with 70-80% of oral cancer cases. Smoke and heat from cigarettes, cigars, and pipes irritate the mucous membranes of the mouth. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes. Heavy alcohol use is another high-risk activity associated with oral cancer.

Oral cancer is as common as leukemia and kills more Americans each year than either skin or cervical cancer. Patients with oral cancer have a poor prognosis, and the 5-year survival rate of approximately 50% has remained unchanged for the past 50 years. Perhaps the single most important reason for this is the fact that oral cancers continue to be diagnosed in advanced stages. Research studies have repeatedly demonstrated that the survival rate for oral cancer patients increases dramatically when the diagnosis is established in early stages.

Oral cancer can spread quickly, early detection is important. An oral cancer exam can identify early signs of this disease. The exam is quick and painless, and can be done during your regular dental check-up. Be sure to tell your dentist if you notice persistent changes in your mouth or throat, such as sores, swelling, or numbness, or if you have difficulty eating or swallowing.

Approximately 35,000 new cases of oral cancer are diagnosed each year in the United States. Some 25 percent of those people will die of the disease. According to the American Cancer Society, oral cancer occurs almost as frequently as leukemia and claims more lives than melanoma or cervical cancer. Oral cancer’s incidence is rising among women, young people and non-smokers.

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Oral cancer cases have grown 225% from 1974 to 2007, and the main factor that scientists could link to the new victims is the number of sex partners involved in oral practices they had prior to developing cancer. Oral sex allows for the passing of the human papillomavirus, or HPV. This can lead to the onset of many common STDs, as well as many forms of vaginal, penile, anal, or oral cancers. 40 of the 150 different types of HPV can be passed through sexual intercourse in one way or another, so the spreading of oral ractices and cancel risk go hand in hand.

The US Centers for Disease Control have estimated that more than half of the adult population in America will have some form of HPV in their lives. Some cases may not ever develop into anything, but others could be severe and sometimes fatal. There are some vaccines available now to help prevent the contraction of HPV, but only 40% of the female population in the country has gone through any sort of treatment at this point. Even fewer have actually made it through all three doses of the treatment, and that raises oral sex and cancer risk levels higher than ever before.

It is important in the coming years that more members of the population get the HPV vaccine. This is especially true for the younger sector of the population, as oral sex and cancer risk seem to impact them more than other generations. People with more than six oral sex partners in their life are eight times more at risk of developing a form of cancer from oral sex than those who have a limited number of partners. Proper education in schools and the public as a whole should help to diffuse the growing number of cancer patients in the United States and Europe.

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Other than the lips which are not a major site for occurrence any longer, common areas for oral cancer to develop in the anterior (front) of the mouth are on the tongue and the floor of the mouth. Individuals that use chewing tobacco, are likely to have them develop in the sulcus between the lip or cheek and the soft tissue (gingiva) covering the lower jaw (mandible) where the plug of tobacco is held repeatedly. There are also a small number of cancers that are unique to the salivary glands, as well as the very dangerous melanoma. While the occurrence of these are dwarfed by the other oral cancers, they are a small percentage of the total incidence rate. Cancers of the hard palate are uncommon, though not unknown. The base of the tongue at the back of the mouth, the oropharynx (the back of the throat) and on the pillars of the tonsils, and the tonsillar crypt and the tonsil itself, are other sites where it is now more commonly found, particularly in young non smoking individuals. If your dentist or doctor decides that an area is suspicious, the only way to know for sure if it is something dangerous, is to do a biopsy of the area. This is not painful, is inexpensive, and takes little time. It is important to have a firm diagnosis as early as possible. It is possible that your general dentist or medical doctor, may refer you to a specialist to have the biopsy performed. This is not cause for alarm, but a normal part of referring that happens between doctors of different specialties.

We know that all cancers (neoplastic transformations) result from changes (mutations) in genes which control cell behaviors. Mutated genes may result in a cell which grows and proliferates at an uncontrolled rate, is unable to repair DNA damage within itself, or refuses to self destruct or die (apoptosis). It takes more than one mutation to turn a cell cancerous. Specific classes of genes must be mutated several times to result in a neoplastic cell, which then grows in an uncontrolled manner. When a cell does become mutated to this point, it is capable of passing on the mutations to all of its progeny when it divides. Genetic mistakes randomly happen each day in the course of our bodies replacing billions of cells. Besides these random occurrences, genetic errors can be inherited, be caused by viruses, or develop as a result of exposure to chemicals or radiation. Our bodies normally have mechanisms that destroy these abnormal cells. We are now discovering some of the reasons this fails to take place, and cancers occur.

The actual curative treatment modalities are usually chemotherapy with concurrent radiation, sometimes combined with surgery. Chemotherapy while able to kill cancer cells itself is currently not used as a monotherapy for oral cancers. Added to decrease the possibility of metastasis, to sensitize the malignant cells to radiation, to reduce the size of any malignancy prior to surgery, or for those patients who have confirmed distant metastasis of the disease, it is a powerful component of treatment.

Prior to the commencement of curative treatment, it is likely that other oral health needs will be addressed. The purpose is to decrease the likelihood of developing post therapeutic complications. Teeth with poor prognosis from periodontal problems, caries, etc. may be extracted. This avoidance of post radiotherapy surgery is important as it can sometimes induce osteonecrosis, a condition which can develop when tissue damaged by radiation exposes the underlying bone and remains chronically non healing. The bone, which has lost its ability to efficiently repair itself due to reduced blood supply, from radiation exposure, yields a chronic and difficult to treat situation. A thorough prophylaxis, or cleaning will likely be done as well prior to begining treatments.

Whether a patient has surgery, radiation and surgery, or radiation, surgery, and chemotherapy, is dependent on the stage of development of the cancer. Each case is individual. Patients with cancers treated in their early stages, may have little in the way of post treatment disfigurement. For those whose cancer is caught at a later stage, the results of surgical removal of the disease may require reconstruction of portions of their oral cavity or facial features. There may be adjunctive therapy required to assist in speech, chewing and swallowing of foods, the problems associated with the lack of salivary function, as well as the fabrication of dental or facial prostheses.

Every phase of how a cancer develops is potentially an avenue to finding a new therapy for treatment. Research into these mechanisms has yielded new exploration into therapies based on the molecules and genes involved in the cancer process. Apoptosis, (cell suicide), angiogenesis inhibitors, genetic “cocktails” whose ingredients could stimulate immune system activity that was specific to a particular tumor, viruses that only kill specific cancer cells, and techniques which would allow the replacement of a damaged p53 gene, are all being researched now. It is possible that in our lifetimes we will see cures for cancer develop from this ongoing research. Targeted therapies such as the use of monoclonal antibodies are now an FDA approved adjunctive treatment for combating head and neck cancers. Make an appointment to Your Doctor or Dentist every six months to make sure that your Oral health is under control.
Aila R. Cruvinel

Aila R. Cruvinel is a Doctor Dental Surgery in Brazil

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