Page 28 - GP Spring 2020

Oral Cancer for the Oral Health Care Provider

By Mohammed Qaisi, DMD, MD, FACS

Statistics and role of the oral health care (HPV) is associated with the development placement and exposed bone should also be
provider: of cancer in the oropharyngeal region, there scrutinized.
Oral cancer is an important public health is little evidence at this time to support that
issue and is of special importance to dental it contributes to cancer in the oral cavity. White lesions have a transformation rate
providers because of the role they play in While oral cancer historically was consid- of 3-6% and can range on histology from
the care of these patients. According to the ered a disease of elderly smoking men, the frictional keratosis to dysplasias and carci-
National Cancer Institute there were rough- number of young patients with no risk fac- noma. Other premalignant lesions include
ly 53,000 new cases of oral cavity and oro- tors developing oral cancer is increasing. 11 verrucous hyperplasia and proliferative ver-
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pharyngeal cancers in 2019. The number rucous leukoplakia (PVL). These tend to
of estimated deaths in 2019 was roughly The overall 5-year survival rate for oral can- be generalized and affect the gingiva and
th
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10,860. Oral cancer is the 8 most common cer is roughly 50-60%. Despite all the ad- buccal mucosa. Transformation rates of up
cancer in males. vances in medicine, imaging, radiation and to 60 - 80% have been reported with PVL.
surgical techniques, the survival rates have 15 Lichen planus is not premalignant for the
Despite these statistics, there is very little not improved over the last five decades. most part, with the exception of the erosive
awareness amongst the public with regards Early detection remains the most important variant which shows transformation rates of
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to oral cancer. If one was to look at cervical prognostic indicator of patient survival. 0.5 – 2%. 14
cancer in comparison, the number of cases Stage I cancers have 5 year survival rates
expected in 2019 was 13,170, significantly approaching 90%, while stage IV cancers Treatment:
lower than that of oral cancer. Similarly, have survival rates of 20-40%. 10, 12 The role Early-stage cancers usually tend to be treat-
the predicted number of deaths from cer- of the oral care provider in early detection ed with surgery alone. Late stage cancers
vical cancer in 2019 was 4,250, less than cannot be over-emphasized enough. are usually treated with a combination of
half of that for oral cancer. Yet despite the surgery and radiation therapy. Chemothera-
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lower incidence and death rates for cervical Clinical Exam: py is added depending on margin status and
cancer, there is more of a general aware- Clinical oral exam is the most effective way other adverse features of the tumor. 10, 13
ness of cervical cancer amongst the public. of screening and examining the oral cavity
Many are aware that their children need to for these precancerous and cancerous le-
be vaccinated for HPV to prevent cervical sions. The exam consists of palpation of the Screening adjuncts:
cancer as recommended by their pediatri- neck for any enlarged or firm lymph nodes. Although multiple screening adjuncts exist
cians. Similarly patients are reminded fre- A positive cancerous node automatically de- such as the ViziLite and Veloscope, 2017
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quently of cervical cancer as they undergo creases survival by 50% . The oral exam American Dental Association (ADA) guide-
gynecologic exams and pap smears. should include close inspection of all as- lines state that screening adjuncts didn’t
pects and mucosal surfaces of the oral cav- show sufficient diagnostic accuracy to sup-
The lack of oral cancer awareness is like- ity in a systematic manner. High-risk sites port their routine use as triage tools. When
ly multifactorial but partly due to the edu- such as the lateral border of the tongue and a suspicious lesion is identified, a scalpel
cational gap with regards to oral health in the floor of mouth have higher transforma- biopsy or referral to a specialist should
medical school curricula, 4, 5 and the lack tion rates and should be examined closely. be performed. This remains as the single
of guidelines that promote oral exams and Any white or red lesion that is present in the most important recommendation for clinical
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oral cancer screenings amongst medical oral cavity for longer than 2-3 weeks should practice. It is the author’s opinion that if
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practitioners. These factors position den- be biopsied and a tissue diagnosis should be screening adjuncts help increase compli-
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tal professionals as the experts on the oral obtained. ance of the providers in performing com-
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cavity and the head and neck region. With prehensive oral exams, then their use should
this status comes the responsibility of do- Suspicious lesion may present as white or be continued however emphasis needs to
ing right by our patients and taking owner- red lesions in the oral cavity. Erythropla- be placed on the direct clinical oral exam.
ship of this disease through reinforcing the kias and erythroleukoplakias tend to have Should a suspicious lesion lasting longer
culture of oral cancer screening, bolstering a higher chance of being premalignant or than two weeks be noted on clinical exam,
dental school curricula, and through advo- malignant. Involvement of high-risk sites immediate biopsy or referral to an oral sur-
cacy efforts. 8, 9 tends to confer higher transformation rates. geon should be initiated.
14 Other suspicious or concerning lesions
Oral cavity cancers, when considered sep- include ulcers, raised lesions with rolled
arately from oropharyngeal cancers, af- borders, and red granular friable lesions. Oropharyngeal Cancers:
fect men more frequently than their fe- Numbness of the lips or the inferior alve- Oropharyngeal cancers involve the orophar-
male counterparts. Some of the associated olar (V3) or infraorbial (V2) nerves with- ynx or back of the throat. The disease pro-
risk factors include cigarette smoking and out a definite cause should be investigated. cess for these tumors tends to be different
smokeless tobacco use. Smoking in combi- Extraction sockets that don’t heal for ex- from those for oral cavity cancers. Oropha-
nation with alcohol has a synergistic effect tended periods of time should be evaluated ryngeal cancers tend to be caused by the hu-
and increases the risk in a multiplicative further and not be dismissed as a dry socket man papilloma virus (HPV) with about 70%
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fashion. While the human papilloma virus or osteomyelits. Tooth mobility, tooth dis- of these tumors harboring the virus. These
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