Oral cancer is one of the most debilitating and disfiguring types of cancer. Tumors affecting the lip, mouth, tongue, and soft palate (the part of the throat at the back of the mouth) can interfere with swallowing and speech. If the cancer spreads to other parts of the body, it can cause disability and even death. But if oral cancer is detected and treated early, it has a very high cure rate. More important is the fact that oral cancer is highly preventable.
Tobacco use is the number one cause of oral cancer. A smoker's risk of oral cancer is two to four times higher than that of nonsmokers. In fact, people who are most at risk of developing oral cancer are men over age 40 who smoke cigarettes, cigars, or a pipe, or who use smokeless tobacco (chewing tobacco or snuff). Smokeless tobacco is particularly dangerous because it contains 100 times the amount of cancer-causing compounds found in other forms of tobacco. This fact is especially disturbing because the use of smokeless tobacco continues to rise, primarily among adolescent boys.
Heavy alcohol consumption increases the risk of developing oral cancer for smokers and nonsmokers alike, but heavy drinking increases the risk by 15 times for heavy smokers. This suggests that smoking and alcohol consumption somehow work together to produce oral cancer by increasing each other's harmful effects. Even high alcohol-content mouthwashes have been implicated in the development of oral cancer.
A type of cancer known as Kaposi's sarcoma develops in about 30 percent of people who have acquired immunodeficiency syndrome (AIDS). The disease produces red or purple patches (lesions) on the skin or the mucous membranes that line the mouth, nose, and anus. This type of cancer can be the first sign of AIDS and is often first detected during a dental examination. Lip cancer has been linked to long-term sun exposure and pipe smoking.
Most oral cancers develop on the surface layer of tissue and are called squa-mous cell carcinoma. Symptoms that can indicate the presence of oral cancer include:
• a sore on the lip or in the mouth that does not heal
• a lump on the lip or in the mouth or throat
• a white or red patch on the gums, tongue, or lining of the mouth (which may be painless in the early stages)
• unusual bleeding, pain, or numbness in the mouth
• a feeling that something is caught in the throat
• difficult or painful chewing or swallowing
• swelling of the jaw that causes dentures to fit poorly
Health concerns These symptoms may be caused by other, less serious problems, but they should always be brought to the attention of a physician or a dentist, who can make a firm diagnosis and provide appropriate treatment.
If an abnormality is found in the mouth, the doctor will perform a biopsy, in which a sample of the abnormal tissue is removed and examined under a microscope. Once cancer is diagnosed, the doctor will attempt to stage the cancer. This means that he or she will try to find out the extent to which the cancer has developed and possibly spread. Cancer can travel through the lymph system and spread to other parts of the body. Oral cancer usually spreads first to the neck. Staging tests may include dental X rays and X rays of the head and chest, a computed tomography (CT) scan (a series of X rays transmitted to a computer that forms detailed pictures of the body), and magnetic resonance imaging (MRI; which links a powerful magnet with a computer to make cross-sectional images of the body). The doctor also will examine the lymph nodes in the neck to check for swelling.
After diagnosing and staging the cancer, the doctor will develop an individualized treatment plan. Treatment for oral cancer depends on a number of factors, including the location, size, type, and extent of the tumor. The doctor also will consider the person's age and general health when developing a treatment plan. Oral cancer treatment generally consists of surgery to remove the abnormal tissue, and radiation therapy to stop the cancerous cells from growing. These treatments may be used alone or in combination. Chemotherapy (treatment with powerful anticancer drugs) also may be used in conjunction with surgery and radiation therapy to relieve pain in advanced stages of the disease.
The doctor will try to plan therapy to minimize side effects, but most oral cancer treatment produces side effects, some temporary and some permanent. Surgery to remove cancerous tissue may require removal of part of the soft palate, tongue, or jaw. Such surgery is likely to affect the person's ability to chew, swallow, or talk. He or she may also look different, prompting depression (see page 345) or lowered feelings of self-worth. Weight loss may become a problem because eating may be difficult. Radiation therapy can cause fatigue, along with red, dry, tender skin that "weeps" fluid. The person's skin also can become darker and more sensitive to the sun.
The most important steps you can take to reduce your risk of developing oral cancer are to stop using tobacco (see page 107) in any form and to drink alcohol only in moderation. To lessen the risk of developing lip cancer, use a lotion or lip balm that contains a sunscreen and wear a hat with a brim outdoors to block the sun's harmful rays.
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