If you're a woman, you're probably no stranger to breast self-exams. If you're a man, you may examine your testicles once a month. But, woman or man, do you ever take a look inside your mouth? It's a good idea to add a monthly oral exam to your preventive checklist (see “Oral Self-Exam” sidebar). As with most cancers, the earlier oral cancer is caught, the more effective — and the less traumatic — the treatment.
About the disease
More than 35,000 people are expected to be diagnosed with oral cancer this year, making it about as common as leukemia. It usually strikes after age 40, and most of its victims are men. Not surprisingly, tobacco use (that includes cigarette, cigar and pipe smoking, as well as chewing tobacco and dipping snuff) is linked to higher risk, as is heavy alcohol consumption. Even so, oral cancer can develop in anyone at any age.
It may affect any part of the oral cavity, including the lip, tongue, palate, cheeks, gums and throat. Left undetected, oral cancer tends to spread to the lymph nodes in the neck. Once it reaches the lymphatic system, the cancer can spread to other parts of the body.
Treating oral cancer
The treatment of oral cancer ranges from minor — simple surgical removal of a localized tumor — to major, as in partial removal of the jaw, tongue or palate. In severe cases, treatment may involve a team of specialists that includes an oral surgeon; an ear, nose and throat surgeon; a medical oncologist; a radiation oncologist; a dentist; a plastic surgeon; a dietitian and a speech therapist. Radiation therapy is commonly used before surgery to shrink tumors or after surgery to kill any remaining cancer cells. (It's a good idea for patients to see their dentists and attend to any problems before radiation treatments begin.) Chemotherapy in combination with surgery or radiation may be used in advanced cases.
Aftermath of treatment
The side effects of oral cancer treatment are many. Artificial saliva can help relieve sores and dryness in the mouth caused by radiation. Darkening, or "bronzing," of the skin that was exposed to radiation may occur, and it's important to keep those areas protected from sunlight. Men may temporarily lose their facial hair. For patients whose treatment affects the way they look, speak and eat, rehabilitation may require reconstructive surgery, a dental or facial prosthesis and speech therapy. If weight loss becomes a problem, a dietitian can help.
Because oral cancers may recur, close follow-up care — including visits to the doctor and dentist — is necessary. And certainly, anyone who has been treated for oral cancer should stop using tobacco and alcohol.
Prevention is best
Quitting smoking, drinking only in moderation if at all, seeing your dentist regularly and doing monthly self-exams are ways to either reduce your risk or help ensure that oral cancer is detected early.
Use a mirror to look for these signs and symptoms of oral cancer. Use your finger to feel for bumps and other irregularities, such as:
• a sore that bleeds easily and does not heal
• a lump or thickening
• a red or white patch that persists
In addition, see your dentist or doctor if any of the following persists for more than two weeks:
• difficulty chewing or swallowing
• difficulty moving the jaw or tongue
• numbness of the tongue or other area of the mouth
• swelling of the jaw that causes dentures to fit poorly or become uncomfortable
Remember, oral cancer is usually not painful, so don't wait for discomfort to occur before seeing your health care provider.
Dr. Nila Novotny is an otolaryngologist with Columbus Otolaryngology Clinic.