Many people would never really consider the concept of cancer in the mouth but statistics show that it's something we should all be aware of.
In 2007, a total of 5410 people in the UK were diagnosed as having oral cancer - and caused 1822 deaths in 2008. If we compare this to cancers with a higher profile such as cervical cancer with 2828 diagnosed in 2007 and 957 deaths, it becomes apparent that it's a very significant cause of suffering and death.
For the latest statistics (March 2012) on the rise of oral cancer in the UK, click here
If a lesion is at the front of the mouth, such as on a lip, then the chance of a cure is higher. It's higher purely because it's more likely to be spotted. As a general rule, the further back in the mouth the lesion is, the more chance it has of progressing to be incurable, so the success rate for treatment falls.
Please let us see new painless ulcers, red patches, red and white speckled patched, lumps and bumps, including in the neck. The vast majority are easily explained and are easily cured (if they even need to be!) The range of signs is so large. Don't put your symptoms into Google and scare yourself half to death unnecessarily! Don't guess, get a Professional to look at it. On that note, see a dentist. We're trained in Oral Medicine for years. Sadly, Medical Practitioners get very little training in this field and may be lacking in the knowledge to give you a definitive answer.
In common with many cancers, the triggers are often chronic, low grade irritation of a tissue. A good example is skin cancer, where long term exposure to ultraviolet light causes various types of skin cancer - or lung cancer caused by the irritant effects of smoking.
So what are the most common triggers in the mouth?
This varies dependent on where we are in the world. Different cultures have their own ways of assaulting the skin inside their mouths. For instance, in the UK our thing has been smoking and alcohol; on the Indian subcontinent it's traditionally been chewing of Betel nut or reverse smoking, (where the hot end is put inside the mouth) but the basic triggers for us in the UK are -
Tobacco smoking - tobacco contains all sorts of nasty hydrocarbons that are irritant to the skin of the mouth, throat and lungs. When the cells in the skin try to repair themselves, the increased rate of turnover increases the risk of a bad cell repair and this is potentially the start of cancer - from one single cell that tried to repair, but did it in an aberrant way. In Britain, it was the norm to smoke. In recent years the proportion of people smoking has fallen, but the numbers of young women taking up smoking has grown worryingly with "ladette" culture.
Alcohol - on its own, alcohol is a trigger. And quite simply, the more alcohol you drink, the more likely you are to get mouth cancer. BUT, add smoking into the mix and the problem is multiplied. The combination of alcohol and smoking are particularly potent. Drink heavily and smoke if you really want to harm yourself efficiently. And don't think smoking cigars will be a better option - on average a cigar is equivalent to seven cigarettes.
· Human Papilloma Virus (HPV) - This group of viruses is the group that causes anything from warts on the fingers to triggering cervical cancer. There's increasing evidence that one of the group, HPV-16 causes a significant number of oral cancers, particularly the ones at the back of the mouth and the throat. It's the same virus that's involved in cervical cancer . Here's what Cancer Research UK say about it -
"There is evidence that infection with high-risk human papillomaviruses (HPV) increases risk of oral cancer, particularly HPV-16. The association is strongest for cancers of the oropharynx. Studies show an increased risk of oral cancer in women with previous HPV-associated anogenital cancer, providing more evidence of a link with HPV infection. In addition, a history of more sexual partners or oral sex partners has been associated with an increased risk of oropharyngeal cancer, and a younger age at sexual debut or history of oral sex with an increased risk of cancer of the tonsil and base of the tongue, again pointing to a role of sexually-transmitted HPV. An increased risk of oral cancer has been shown in individuals with HIV/AIDS or people who have undergone organ transplants, supporting a role of immunosuppression"
There's only really one way to say it - there's a link between oral sex and oral cancer. We're now vaccinating teenage girls in the UK against HPV-16 and HPV-18 but not boys. The headline was that we are protecting girls against cervical cancer. By coincidence we're protecting them against some types of mouth and throat cancer - but we're not protecting the boys. WHY NOT, apart from the short term cost? How about we pay to get our sons vaccinated against HPV? It's not particularly expensive and may save their lives in years to come. They'll also avoid being the reservoir of HPV that causes cervical cancer in years to come, in girls who weren't vaccinated. Look at this article about the growth in HPV as a problem. Apart from that, use a condom, or dental dam as a barrier.
- Ultraviolet light - cancer of the lip, particularly of the lower lip (because it burns more easily in the sun) can be triggered by exposure to UV. Ultraviolet light is irritant - most of us have been naive enough to get sunburnt. Prevention is simple - wear sunblock. Here's a link to an excellent article on the UV index you'll see on weather forecasts. You'll stop yourself triggering cold sores while you're on holiday as well if you're prone to them.
There's a bit of a theme here - smoking, drinking, HPV and UV light. Are we going to see a rise in oral cancer in younger women over the next few years?
Paan - Betel nut, areca nut and slaked lime held in the mouth as a mouth freshener. This is an Indian subcontinental habit. It causes massive irritation to the skin of the cheeks and they gradually go fibrous as a reaction, becoming leathery in texture. Combined with smoking this gives India a rate of 4 in every 10 of their cancers are located in the mouth.
There's a simple but common sense correlation between oral cancer and where it is in the mouth. If it's on the lip, you've a good chance of seeing it and you'll get it sorted earlier, so your chance of survival is higher. The further back into the mouth and throat we go, or under the tongue, then the lower the chances, because on average it will have progressed further before anyone knows it's there. The HPV based cancers are mostly at the back of the mouth and throat. And the early cancers rarely hurt, even if they present as an ulcer.
So it's important to get regular dental check ups - dentists don't just look at your teeth. We look at the whole head and neck. So you'll find documented on your notes that all the soft tissues inside and outside the mouth have been checked. You'll see that anything unusual has been described or photographed and is being monitored or has been referred for specialist advice. We're not giving you an Indian Head Massage, we're checking you for signs of head and neck cancer, among other things! The idea is to catch things early when they're easier to cure. If you've an ulcer and it doesn't hurt, or doesn't go away in a week, we want to see it. We'll tell you if it concerns us, don't you be the judge. We'd rather see it and say it's okay than not see it for months.
And use some common sense - stop smoking, cut back on the alcohol and eat a healthy diet. It'll save you a fortune financially and will improve the quality and length of your life.
For more information, follow this link - Cancer Research UK
© Hesslewood Lodge Dental Practice, 16.11.2015
© Hesslewood Lodge Dental Practice, 16.11.2015