Oral cancer is caused by the unregulated growth and reproduction of cells in some regions of the mouth. It can occur inside the cheeks, under the middle and front of the tongue, or on the tissue lining of the mouth or gum. Experts think that mutations in the genetic code of a cell cause cancers by stimulating abnormal cell proliferation. It was estimated that in 2019, 5,300 Canadians will be diagnosed with oral cancer with one third resulting in fatalities. Further, the statistics showed that oral cancer affects primarily men.
This condition has a greater mortality rate than breast cancer and prostate cancer combined. However, oral cancer can be successfully treated if caught at an early stage. While it remains unclear what triggers the initial mutation(s) in many cases, specific factors can increase the risk of oral cancer.
What are the causes and risk factors of oral cancer?
Tobacco. Any form of tobacco—whether it is smoked as a cigarette, cigar, pipe, or bidi (a small, hand-rolled cigarette commonly used in Asia), or used as a chew, plug, or snuff— involves carcinogenic substances entering the mouth, which significantly increases the risk for oral cancer.
Excessive alcohol. Alcohol alone can increase the risk of oral cancer, however tobacco and alcohol consumption work together synergistically, increasing the risk of oral cancer more than 30 fold relative to those who do not smoke or drink. Age. The risk of oral cancer increases with age, with the average age of diagnosis being 62. However, oral cancer can occur at any age and seems to be increasing lately in patients less than 40 years of age.
Human papillomavirus (HPV), especially type 16. This is a sexually transmitted infection (STI) that has strong associations with several forms of oral cancer. Having human papillomavirus increases the risk of oral cancer especially on the tonsils, palate, and the base of the tongue. In combination with smoking and drinking, the HPV infection may have an additive effect on risk of oral cancer.
Sun exposure. The sun emits rays that can burn the lips and trigger the development of oral cancers.
Gender. Males are twice as likely to develop oral cancer than women; however, it is unclear why.
Others. Being immunologically compromised (patients with bone-marrow transplantation)
What are the warning signs and symptoms of oral cancer?
The symptoms of oral cancer vary, but anyone experiencing any of the following for more than two weeks should visit a healthcare professional:
• persistent mouth, teeth or jaw pain
• unexplained bleeding in the mouth
• difficulty chewing or swallowing
• persistent lump or sore area in the mouth, throat, or on the lips that bleeds/ does not heal
• a lump in the neck
• any white or red patch on the gums, tongue, lining of the mouth, or on tonsils
• numbness of the tongue or other area of the mouth
• a loosening of the teeth
• tenderness, pain, or lumps (thickening) anywhere in the mouth or on the lips
• voice changes
• changes in taste
• persistent bad breath
• swelling that makes denture wear sore and ill-fitting
• unexpected weight loss
With that said, it is important to remember that these are not definitive signs of oral cancer, but may be caused by other conditions, such as an allergy or an infection.
Why is early Diagnosis and Treatment so important?
In most forms of cancer, early diagnosis is crucial.
Many oral cancers are found during routine dental exams. But because the disease doesn’t usually cause symptoms in its early stages, paying attention to changes in the oral cavity is critical, especially for people who regularly smoke tobacco and drink alcohol. Along with a clinical exam of the mouth, other procedures designed for diagnosing oral cancer include: x-rays, biopsies, endoscopies, barium swallow or imaging tests (MRI, CT, or PET scans), pharyngoscopies and laryngoscopies.
Treatment for oral cancer usually involves a combination of surgery, radiotherapy, and chemotherapy, which are much more effective in the early stages. If the cancer has spread to other areas, it becomes much more difficult to isolate and treat. If cancer has not spread to surrounding tissues, the five year survival rates for oral cancer of the lip, tongue, and floor of the mouth range from 75-93%. These figures fall if the cancer has spread to surrounding tissues. Early detection and treatment of oral cancer can help prevent the cancer from developing further or spreading to other areas.
What can I do to reduce my risk of oral cancer?
As with most other cancers, it is not always possible to prevent oral cancer. Some risk factors for oral cancer—such as being male or aging—are not preventable. However, some lifestyle factors that can reduce the risk of oral cancer include:
• avoiding tobacco
• avoiding excessive alcohol consumption
• maintaining a balanced diet; several studies have shown that higher levels of vitamin C or carotene consumption reduce the risk of oral cancer
• using sunblock, or a lip balm on the lips when exposed to the sun
• regularly visiting a dentist for check-ups
• being immunized with the HPV vaccine
Early warning signs of oral cancer include mouth sores, white or red patches, and tenderness or pain. Anyone who experiences these symptoms should see their dentist or family doctor. Early diagnosis means there is a higher chance of successful treatment. Stopping smoking and the use of tobacco products, reducing alcohol consumption, and being vaccinated against HPV infection can reduce the risk of developing oral cancer.
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