Dr Amanda Phoon Nguyen, Oral Medicine Specialist, looks at the unique position of dental practitioners in spotting the signs of oral cancer
When clinicians talk about oral cancer, they often mean oral cavity squamous cell carcinoma. However, the term “oral cancer” really refers to a heterogenous group of conditions encompassing the main subsites of the external lip, oral cavity and oropharynx.
It is important to consider and think of these as distinct entities, as they have differing presentations, aetiologies and risk factors and treatment options. A very large portion of oral malignancies are oral squamous cell carcinoma (OSCC), of epithelial origin. This is the eighth most common cancer worldwide. Early detection and prompt management is key to improving prognosis.
Despite technological advances over the past, the five-year survival rate of OSCC remains poor and is approximately 50% for all anatomical sites and stages. Cases that present with regional lymph node infiltration (Stages III and IV) are reported to have a five-year survival rate of 9–41%, compared to the 66–85% survival associated with cases without lymph node involvement (Stages I and II). The poor prognosis of oral cancer can largely be attributed to its frequent diagnosis at an advanced stage. Therefore, early detection is key.
OSCC is more common in the older population, and more common in females. It appears to be rising in the younger (<40 years) population. OSCC may be preceded by lesions termed oral potentially malignant disorders (OPMDs). The most common OPMDs are leukoplakia, erythroplakia, oral submucous fibrosis, actinic chelitis and oral lichen planus. The aetiology of oral cancer is multifactorial. Human papillomavirus (HPV) infection, most commonly HPV16 and 18, is implicated in oropharyngeal SCC. Alcohol and smoking are considered major risk factors, with a synergistic effect when used together. Other risk factors for OSCC include areca nut or betel quid chewing, other smokeless tobacco use, marijuana and qat use, use of alcohol containing mouthwash, a poor diet and genetic predisposition.
Evaluation of the head and neck area is a fundamental part of a comprehensive patient examination. Dentists play a critical role; there are few health professionals better placed to detect signs of more sinister pathology in the oral cavity and head and neck region.
Some red flags include:
|Non-healing ulcerated lesion
|Flat/slightly raised white, red, mixed white-red lesion
|Exophytic, proliferative, papillomatous lesions
|Pain or numbness in the mouth/face
|Inability to wear dentures
|Fixed, firm, mass
|Solitary pigmented lesion
|Non-healing extraction site
|Mixed radiolucent/radiopaque lesions