Ask the expert -- Oral cancer

April 03, 2008|By Holly Selby

About 40,000 cases of oral cancer are diagnosed in the U.S. each year. Caught early, many oral cancers are considered by doctors to be curable. But the key is early diagnosis, says Dr. Christine G. Gourin, associate professor in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins School of Medicine and director of the Clinical Research Program in Head and Neck Cancer. To help publicize the warning signs of this disease, the third week of this month has been named oral, head and neck cancer awareness week, she says.

Johns Hopkins Medicine is offering free oral, head and neck cancer screenings 10 a.m.-4 p.m. April 24 at the Johns Hopkins Outpatient Center, Sixth Floor, 600 N. Wolfe St. The screenings are free, but appointments are necessary (no walk-ins will be accepted). To schedule an appointment, call 410-955-1080. For more information, go to hopkinsmedi cine.org/otolaryngology.

What are the most common kinds of oral cancers?

The most common oral cancers are squamous cell cancers, a particular type of cancer that arises from the lining of the mouth when the cells undergo a malignant transformation. This kind accounts for about 90 percent of the tumors and oral cancers we see.

What are among the other kinds of oral cancers?

There are other cell types in the mouth, including salivary gland tissue and mucus gland tissue, that can give rise to cancer as well. Some rare cancer types also can arise from muscle. And there are precancerous lesions, too, that can be hard to differentiate from cancerous growths that can become cancer if they are not removed or treated early.

Who is at particular risk for oral cancer?

A history of tobacco or alcohol use is a risk factor. More than half of the cancers we see arise in people who a have a history of heavy tobacco and alcohol use combined.

These cancers have more commonly been seen in men historically. But in recent years, there has been an alarming increase in the use of tobacco in women, and so women are catching up.

Are there other risk factors?

Yes, we also see cancers arise in people who have had repeated trauma to the oral cavity, such as areas that have been repeatedly bitten. Or, dental trauma caused by the edge of a tooth rubbing against the gum can sometimes give rise to cancer.

And, finally, there are certain areas of the world, such as India, where chewing beetle nuts is associated with the ... cancer.

Is there anything new in oral cancer research?

Recently, researchers at Hopkins have identified a virus -- the human papillomavirus -- that seems to be associated with the development of cancers in the oral pharynx, which is the area behind the back of the tongue and the tonsils, in people who don't have a history of alcohol or tobacco use.

What are the symptoms of oral cancer?

There are some warning signs that everyone should be aware of: pain; bleeding from the mouth; difficulty swallowing; ear pain, particularly if it is one-sided; a dental problem like a loose tooth; a lump in the neck. Many dentists do inspect [at a routine checkups] the gums and tongue for cancers.

When a patient does consult you about oral cancer, what typically are the symptoms he has noticed?

The most common presentations include pain or a growth, or they may simply notice something isn't right: an unexplained new pain or ulcer in the mouth. An ulcer that doesn't heal in a few days is of concern.

What is the treatment?

The first step after a thorough head-and-neck exam is to get a biopsy to make sure it is (or is not) cancer and to discover what kind. Treatment depends upon what stage the cancer is. If these cancers are diagnosed at an early stage, the cure rate is very high.

Treatment might include surgery for oral-cavity tumors. When the cancer is advanced, meaning the tumors are large or have spread to the lymph nodes, it usually also requires radiation in addition to surgery and maybe chemo.

Is there any way of preventing oral cancer?

If you have any of the risk factors for oral cancer such as tobacco use or heavy alcohol use, quitting those habits is the first step.

Smoking raises your risk of oral cancer six times above that of the general population, and drinking heavily raises it four times. The combination of both heavy drinking (more than two drinks a day on a regular basis) and smoking raises your risk level by 20 times.

Even without those risk factors, you should be vigilant about having any new symptom checked out by a doctor. Pay attention to your body, and listen to it. Better safe than sorry is a good saying, and it is particularly true for oral cancer.

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