Learning More About Oral Cancer and What It Means
Hi, I'm Dr. Suess. I'm here at Clackamas Smiles Family Dental in Happy Valley. I'm here to answer some questions about oral cancer and give you more information so that you can arm yourself with info.
What is oral cancer?
First things first, oral cancer is about the eighth most common cancer that you can get in the United States. It impacts about 60,000 people every year and worldwide it impacts about 10 times that number of people. It's significant, it's growing, and it can have tremendous impacts on your life if it's not caught early and remedied.
What are the oral cancer signs that you should look out for?
Some of the really common ones are a sore or an ulcer that just won't heal. It looks like a scrape or a cut, and no matter what, it's not going away. It could be in an area that rubs, but it could also be in an area that doesn't rub on the tongue, gums, inside of the cheeks, or lips—just that whole complex. Any area inside your mouth can get oral cancer.
Another common sign is a patch, like a white patch, a change in texture, or a change in color. It's not going away, and it's nothing that you can identify the cause for, but it's just staying there. Most people don't spend a lot of time looking in there. They brush their teeth, rinse out, and go about their business. If you take some time to look in there and get familiar with what the tongue looks like, the gums, the inside of the cheeks, the lips, all of that, then you're better positioned to notice if something's different. One of those things you need to look for is a white patch that just doesn't go away—a change in texture. It doesn't look scary, but that alone can be one of the early signs of oral cancer.
What are the most common kinds of oral cancer?
We have different structures in the mouth. A lot of the structure is covered by soft stuff: skin, gums, mucosa, and the tongue. Those are the soft tissues, and one of the most common for the soft tissue is squamous cell carcinoma (SCC). When we look in there and see something that looks like a white patch, a change in texture, or especially an ulcer that's not healing, that raises our suspicion.
These are commonly the kinds of things that make us want to get a biopsy or look harder, ask more questions. It's the change in the soft tissue. One of the things harder for someone at home to find is a growth or something going on with the hard tissue itself, not the teeth, but really the bone down below and all of the open space inside the bone.
There can be cancers and growths that occur down there, but those have to be pretty far along before someone at home would notice. These are commonly found on X-rays, your regular dental checkup X-rays that look for chips, cracks, and cavities on the teeth themselves, but also the panoramic that goes around the one we usually take every 3 to 5 years. That can be a wonderful screen for not just wisdom teeth and cysts, but also growths that could be concerning.
What does oral cancer look like in its early stage?
We talked about this a little, but it's the spot that has a different texture or color, different from the areas around it. It could be on your tongue, the side of your tongue, floor of the mouth, gum tissue, or inside of your cheeks or lips. If it's a white spot that's different, one patch that's distinctly different, or something that looks like a texture change, different from the surrounding tissue, that's your clue. You need to get that checked by someone who knows what they're doing. That would be your local dentist, your first line of defense.
Another concerning sign is a sore, like a cut or an ulcer that's not healing. It's not getting better, so track that down as soon as possible. Don't just say, "I'll get to it when I get to it." If you see something like that, make your dental appointment right away to get it checked out.
Can a lump in the gums be a sign of oral cancer?
The answer is it could be, but it's most often something else. It's usually related to a gum problem, hidden infection, tooth problem, or nerve issue. A lump itself could be a sign of cancer, but it's not the first thing we think of. No matter what the cause is, get it looked at. It's rare that lumps on the gums come from a good source or reason. Don't let that fester. It would probably be less costly and less trouble to fix it in the short term rather than letting it get bigger.
In the rare case that it is oral cancer, I'd be far more concerned if it was left to grow and not get checked. Give yourself peace of mind by getting it checked out. If there's a bump on your gum, something different from the surrounding areas, get it checked out. Nothing good comes from waiting on something like that.
What's all this talk and hype about HPV?
HPV is a virus, similar to the one that causes ordinary benign warts. This virus, when it lives in and around the oral cavity and particularly the back of the throat and the base of the tongue, can be cancer-causing. This takes time to set up, but we see its rates are increasing. Men are more susceptible to HPV-caused cancers, and younger people than average are more susceptible.
We used to say it's the alcohol, the tobacco—those classic risk factors. HPV is changing that for us. It's a younger population and people who don't necessarily have tobacco and alcohol intake as their risk factors. They can be much more susceptible to oral cancers at the back of the throat and base of the tongue from the HPV virus.
It's a good reason to have a conversation with your child's pediatrician about the HPV vaccine because prevention of that virus, especially the more cancer-causing variants, can have a direct outcome on preventing or reducing the rate of oral cancers related to HPV. These are directly linked, and it's something you can do in your family or with loved ones that can have an impact.
How does a dentsist find oral cancer in a person's mouth?
Let's say you go in for your dental visit, and there's a lump, spot, sore, or ulcer you want checked. First, mention that to your dentist. They're going to screen for all of those automatically, but if you have a concern, share it with us so we give it the scrutiny it deserves. How do we find things like this? The answer is very old-fashioned: it's our dental exam. We do a visual and tactile exam. We look in there, feel around, use our light, and sometimes dry off those areas to get a good sense of the skin's texture, colors, changes, and differences from the surrounding tissue.
We'll particularly look for anything that looks like a sore or cut. We'll undoubtedly ask how long it's been there if we see something. The history of that can raise or lower our suspicion. If we have any questions, it's not uncommon to say, "Why don't you go away for two weeks?" If it's a pizza burn or a minor scrape, it'll be gone in two weeks, and we'll follow up. But if it's still present, we become much more concerned and likely ask for an additional test.
That test could be in the office or at a specialist, but we want to find out what's going on. We don't want something left that could grow or increase. A small problem shouldn't become a medium problem, and medium problems shouldn't become big problems. The answer is a visual exam, a tactile exam with good lighting. That's what we'll do when you come in for your oral cancer screening routinely. But particularly if you mention a spot you're worried about, let us know so we can give it extra scrutiny.
What are the current treatment options for cancerous or precancerous spots?
The answer is it depends. Where is it? Is it soft tissue? Is it hard tissue? Is it big? Is it small? Is it early? Is it late? What skin tissue did it come from? What hard tissue did it come from? We can't decide on the spot, but once it's tested, we'll know more.
Early detection and early treatment are key. It's key for removing it completely, having the least impact on your life, and achieving better outcomes with a higher survival rate and lower life impact. If you find it early, you can treat it early, and it's way less invasive on your life. Outcomes are quite good for the majority of oral cancers if caught early.
Oral cancers that progress to later, more advanced stages have significant impacts, including mortality. Even patients who survive advanced cancers experience tremendous impacts, like losing a portion of their tongue or jaw. Finding it early is the most important thing.
It's in your best interest to be suspicious, conservative, and concerned, to avoid high-risk activities, HPV virus, moderate or zero alcohol or tobacco intake, and to get screened regularly. Your regular dental appointments aren't just for cleaning your teeth. Each exam is an oral cancer screening. Stay up on those.
You’re never alone in caring for your dental health. At Clackamas Smiles Family Dental, our team is here to support and meet you where you are in your dental journey. Call 503-786-3000 or email [email protected] to connect with us today.