What You Need to Know About the Risk, Diagnosis and Treatment of Oral Cancer
According to the National Institutes of Health, oral cancers are the sixth most common type of cancer in the world. In America, they are estimated to affect over 90,000 people each year.
The cancer can impact any of the tissue or bone around the mouth and throat, but most commonly affects the gums, hard palate, tongue and cheek.
Oral cancer affects more men than women and is more commonly found in people of African American descent. The majority of oral cancers are caused by lifestyle factors, which means changing your behaviors may help to reduce your risk.
Like other types of cancer, oral cancers are treatable when caught early, but early detection is easier when a patient knows their risk factors and receives regular checks from trusted providers. Habits like alcohol and tobacco use, for example, increase risk, while a dental check-up can be your first line of defense.
“Diagnoses are usually the result of environmental exposures like smoking, drinking or HPV,” said Andrew Yampolsky, D.D.S., M.D., Director of the Maxillofacial Oncology and Microvascular Reconstructive Surgery program at Jefferson Health–Northeast.
Lifestyle Choices as Risk Factors
“Smoking is the biggest risk factor for oral cancer,” he continued, “and patients who smoke and drink at the same time are compounding that risk.”
Tobacco and alcohol contain carcinogens that can create cancer-causing mutations in the mouth’s cells. Smoking and drinking also dehydrate cells, making them weaker and complicating growth and development, increasing the risk of mutations and defects that can lead to cancer.
There is no safe amount of tobacco use, but damage is mitigated when you quit smoking. In the case of long-term use, your risk of cancer returns to a normal level between 10 and 20 years after your last cigarette.
HPV, or the human papillomavirus, is the most common sexually transmitted disease. The infection can often remain dormant and resolve itself without a person even realized they’ve been impacted. However, in some cases, an HPV infection can lead to chronic health issues or a higher risk of oral and reproductive cancers.
“In general, most cases of HPV-related cancer appear in those between the ages of 40 and 50, or older,” said Dr. Yampolsky. This is because the condition often takes years to present itself, and the safe and effective HPV vaccine was not available to this generation.
“The earliest diagnoses for oral cancer usually happen when a dentist notices something in their patient,” said Dr. Yampolsky. “Dentists get good training in spotting these very subtle changes early.” A dentist will then refer the patient to an oral surgeon for a second look.
These lesions can be an unexplained white spot in the mouth, as well as an ulceration or red spot.
Oncological treatments like chemotherapy and radiation for oral cancer depend on the patient and their disease; however, most will receive surgery to remove the growth. The type of surgery depends on the size of the lesion.
“Smaller or non-cancerous lesions can be lasered or excised without needing reconstruction,” said Dr. Yampolsky. But as the cancer gets bigger or deeper, a more advanced surgical option may be necessary. “We may need to do a dissection of the neck or lymph nodes, as well as reconstructive surgery.”
Most commonly, this type of surgery is known as microvascular reconstruction.
“Microvascular surgery entails a surgeon taking tissue from a healthier portion of the body, complete with the blood vessel, and reconnecting it to the vessels in the mouth using a microscope,” explained Dr. Yampolsky. “We select areas where you can maintain excellent function without that bit of tissue, and there are no lingering performance issues.”