Oral health: What symptoms should alert us to oral cancer?

Created 16/12/2023.

Oral health and oral cancer. Diagnosis and prevention.

In oral health, prevention is basic in oral cancer. This type of malignant tumors are among those with the highest mortality rate in the body. Prevention is basic and very simple, an annual visit to the dentist can alert us that something is wrong and facilitate the treatment and solution.

Despite the developments that have occurred in recent years in the diagnosis and treatment of oral cancer, this disease is still associated with high mortality rates, which are due to its late diagnosis.

Carcinoma of the head and neck is the 6th most common cancer in the world and is more frequent in men. It is possible that this is because men have been more prone to smoking and drinking alcoholic beverages in the past. Also, the recent increase in human papillomavirus-associated cancers has been reported primarily among younger men.

Oral cavity and oropharyngeal cancers usually take many years to form and thus are not common in young people. Most affected patients are over 55 years of age when the disease is first detected.

According to the International Classification of Diseases, oral cancer is the group of malignant tumors affecting any part of the oral cavity, from the lips to the throat (including tonsils and pharynx). Its most common location is the pavement of the mouth, lateral border of the tongue and soft palate. Most are designated carcinoma, but there are also lymphomas, sarcomas and melanomas.

Risk Factors

Having a risk factor does not mean that a person will develop the disease and not having any risk factor does not mean that he/she will not suffer from the disease. Some people with oropharyngeal or oral cancer have only a few or no known risk factors; others with several risk factors never develop the disease.

The main risk factors for the development of oral canker are alcohol and tobacco consumption; smoke has a direct effect on epithelial cells. The low consumption of vegetables and fruits is also a factor, as these foods are rich in antioxidants, contributing to a healthier lifestyle.

Tobacco smoke from cigarettes, cigars or pipes can cause cancer in any part of the mouth or throat, as well as cancer of the larynx, lungs, esophagus, kidneys, bladder and other organs. Pipe smoking constitutes a major risk for cancers in the lip area, as the lips come into contact with the pipe mouthpiece. Tobacco products for oral use (snuff or chewing tobacco) are associated with cancers of the cheek, gums and inner surface of the lips. These products also cause gingivitis and destruction of the bony cavities around the teeth.

The risk of these cancers is higher in people who consume alcoholic beverages and tobacco, with the highest risk in people who smoke and drink heavily.

In Southeast Asia and some other parts of the world it is common to chew betel quid, a mixture of areca nut and lime wrapped in a betel leaf. In these areas, many people also chew gutka, a mixture of betel quid and tobacco. The risk of oral cancer is higher in people who chew betel quid or gutka.

Infection with certain types of HPV can also cause some forms of cancer, including cancers of the penis, cervix, vulva, vagina, anus, and throat. Other types of HPV cause warts on different parts of the body. HPV can be transmitted from one person to another during skin-to-skin contact. One way HPV is transmitted is through sexual intercourse. Most people with HPV infections of the mouth and throat show no symptoms. Oral HPV infection is more common among men.

Sunlight is the main source of ultraviolet light. Lip cancer is more common in people who work outdoors and are exposed to sunlight for long periods of time.

A diet low in fruits and vegetables is associated with an increased risk of oral and oropharyngeal cancer.

Certain diseases present at birth, as well as acquired immune deficiency syndrome and certain medications (such as those given after organ transplants) can cause a weakened immune system.

Graft-versus-host disease (GVHD) is a condition that sometimes occurs after a stem cell transplant. During this procedure, stem cells from a donor’s blood are used to replenish bone marrow that has been destroyed by disease, chemotherapy or radiation. Sometimes a donor’s stem cells recognize the patient’s cells as a foreign entity and launch an attack against them. GVHD can affect many tissues in the body, including those in the mouth. This increases the risk of oral cancer, which can occur as early as 2 years after the disease.

– Fanconi anemia: a condition caused by inherited defects in several of the genes that help repair DNA. People with this syndrome usually have leukemia or aplastic anemia and have a very high risk of mouth and throat cancer.

– Dyskeratosis congenita: genetic syndrome that can cause aplastic anemia, skin rashes and abnormal nails. People with this syndrome have a very high risk of developing mouth and throat cancer at an early age.

It is a disease that occurs mainly in middle-aged people and frequently affects the skin. However, it sometimes affects the lining of the mouth and throat, appearing as small white lines or spots. Acute cases may slightly increase the risk of oral cancer.

Unproven risk factors

The study of this possible relationship is complicated by the fact that smokers and frequent drinkers of alcoholic beverages are more likely to use mouthwash than people who do not use tobacco or alcoholic beverages.

Poorly fitted dentures can trap agents that have been shown to cause oral cancer – alcohol and tobacco particles – and denture wearers should make sure they have their dentures checked regularly by their dentist to ensure a good fit.

Signs and symptoms

Carcinomas of the oral cavity may manifest as a spot of variable color (usually white or red), a more or less hardened mass or a non-healing ulcer. Most of them do not cause discomfort at the beginning, but become progressively painful.
Often, the dentist is the first person to detect this type of cancer during a routine examination. The manifestations may be as follows:

– sore in the mouth or on the lip that does not heal

– red or white spot on the gums, tongue, tonsils or lining of the mouth

– lump on the lip, mouth, neck or throat or sensation of thickening of the cheek

– persistent sore throat

– hoarseness

– numbness of the mouth or tongue

– pain or bleeding in the mouth

– difficulty chewing, swallowing, or moving the jaw or tongue

– ear and/or jaw pain

– chronic bad breath

– changes in the way of speaking

– loss of teeth or pain in teeth or molars

– weight loss for no apparent reason

– fatigue

– loss of appetite

– paresthesia (loss of sensation)

– dysphagia (difficulty in swallowing)

– lymphadenopathy (swollen lymph nodes in the neck)

Oral cancer is essentially treated with surgery and radiotherapy. The most important thing is early diagnosis, a factor that improves the survival rate.
As many of the symptoms listed above may be the result of other non-cancerous conditions, it is important to have regular medical and dental screening, particularly if the person regularly drinks alcohol or uses tobacco products.

Prevention

To prevent oral cancer you have to:

– Adopting a healthy lifestyle

– Cessation of tobacco use

– Decrease alcohol consumption

– Limit exposure to ultraviolet light: limit time spent outdoors during midday, when the sun’s ultraviolet rays are strongest, wear a wide-brimmed hat and apply sunscreen and lipstick with a sun protection factor (SPF) of at least 15.

– Wearing well-fitting dentures: avoid sources of oral irritation

– Regular consumption of fresh fruits and vegetables as a protective factor: eat at least 2½ cups of fruits and vegetables every day; choose whole grain breads, pastas and cereals (whole grain products) instead of refined grains; eat fish, poultry or beans instead of red and processed meats.

– Avoid HPV infection: it is possible that HPV vaccines may also reduce the risk of mouth and throat cancers, although this has not yet been confirmed.

– Treat precancerous growths: sometimes areas of leukoplakia or erythroplakia in the mouth progress to cancer; physicians often remove these areas, especially if a biopsy shows that they contain areas of dysplasia when viewed with a microscope.

– Chemoprevention: doctors have been testing drugs (mostly related to vitamin A – retinoids) to try to help reduce the risk of these cancers, which is particularly necessary for people at high risk for these cancers.

– Periodic dental visits, which allow for early detection of lesions

The dentist makes an observation of all the oral structures (lips, tongue, gums, palate, cheeks and floor of the mouth) and their adjoining structures (salivary glands and neck). Palpation of the oral and perioral structures is also important to detect volume increases and hardened areas. X-rays may be necessary and in case of a lesion a biopsy may be recommended to confirm the initial diagnosis and signs of malignancy.

People who use alcohol and tobacco should have a general screening test once a year. It is a simple and quick procedure in which the doctor looks for abnormalities inside the nose, mouth and throat, and feels the neck for nodules. Early diagnosis of oral cancer can reduce or mitigate the disease, as it allows for appropriate and more effective therapeutic intervention.

At IMOI Barcelona and IMOI Ibiza, we follow editorial principles that guarantee the authenticity of all the information we disseminate. If you are interested in learning more about how we ensure that our content is always up-to-date and accurately supported, we invite you to review our editorial commitment.

This article has been supervised by Dr. Ferran Novell Costa and Dra. Erjona Demiraj, specialists in Dental Health and Dental Aesthetics treatments. Responsible for the treatments provided at IMOI Barcelona and IMOI Ibiza and for the supervision and/or updating of the contents of this blog entry. (7/11/2023). The recommendations described are not generic and do not replace the diagnosis and evaluation of a professional in a dental office. If you want us to clarify any aspect or you want a personalized diagnosis and advice we recommend you to come to our dental clinics.

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