Oral cancer includes cancers of the mouth and pharynx. April is designated as Oral Cancer Awareness Month to highlight this malignancy, where early detection is paramount. The mortality rate remains high because it is often discovered in later stages when treatment is less effective. For many cancers, the five-year survival rate drops significantly once the disease is advanced. Understanding the factors that increase risk and recognizing the initial signs are key to improving outcomes.
Understanding Major Risk Factors
Tobacco use, in any form, remains one of the strongest contributors to oral cavity cancers. Heavy alcohol consumption is another major modifiable risk, and when combined with smoking, the risk is compounded significantly. The risk for those who both smoke and drink heavily can be up to 30 times higher than for those who do neither. Tobacco and alcohol are estimated to be responsible for up to 75% of oral cancers, particularly those originating in the oral cavity, such as the tongue and gums.
A major shift is the rise of cancers linked to Human Papillomavirus (HPV), particularly HPV-16, which causes up to 95% of HPV-positive oropharyngeal cancers. Oropharyngeal cancer, affecting the tonsils and back of the tongue, is increasingly seen in younger patients who do not have a history of heavy tobacco or alcohol use. Non-modifiable factors include age, as risk increases for individuals over 45. Prolonged sun exposure also presents a risk specifically for cancer of the lip.
Recognizing Early Warning Signs
A persistent sore or ulcer that does not heal within two weeks is one of the most common and concerning signs. These non-healing lesions may occur on the tongue, gums, or the lining of the cheeks and can be painless initially.
Patients should look for any unusual red or white patches in the mouth, which are often precancerous conditions. White patches, known as leukoplakia, cannot be scraped off. Fiery red, velvety patches, called erythroplakia, are less common but carry a significantly higher risk of being cancerous.
A lump, thickening, or rough spot on the gums, tongue, or cheek lining warrants immediate attention. The key action for any of these signs is to consult a dentist or doctor if they last longer than 14 days.
- Difficulty or pain when swallowing.
- A chronic sore throat or persistent hoarseness in the voice.
- Numbness or loss of sensation in the face, mouth, or neck.
- Persistent pain in the mouth or ear that does not seem to have a clear dental cause.
- Dentures that suddenly stop fitting properly or unexplained bleeding.
The Role of Professional Screening
Professional screening for oral cancer is performed during a routine dental visit. The examination involves both a thorough visual inspection and a physical assessment, often taking less than ten minutes to complete. The dentist meticulously examines the entire oral cavity, including the lips, the floor and roof of the mouth, the tongue, and the lining of the cheeks.
During the visual inspection, the professional looks for abnormalities such as red or white patches, ulcers, or changes in tissue texture. Specialized tools like screening lights or dyes may be used to make abnormal tissue stand out from healthy tissue, aiding in the identification of lesions.
The physical assessment involves palpation, where the clinician uses gloved fingers to feel for lumps, swelling, or tenderness along the jawline, neck, and lymph nodes. Screening is particularly important for those with known risk factors, such as a history of tobacco use or HPV infection. Early detection significantly improves the chances of a favorable outcome.
Actionable Steps for Prevention
The most impactful step an individual can take to lower their risk is to eliminate tobacco use in all its forms, including cigarettes, pipes, and smokeless tobacco. Stopping the consumption of heavy alcohol is equally important, as the combination of tobacco and alcohol dramatically increases the overall risk. For those who currently use both, cessation will lead to a substantial risk reduction.
Vaccination against Human Papillomavirus is a powerful preventative measure, especially against the HPV-driven oropharyngeal cancers. The HPV vaccine has demonstrated high effectiveness in preventing oral infection with the high-risk HPV types, such as HPV-16.
Maintaining a diet rich in fruits and vegetables provides the body with important nutrients that may offer a protective effect. Protecting the lips from excessive sun exposure by using lip balm with a broad-spectrum sunscreen can help prevent lip cancer. Regular self-examinations and consistent professional screenings ensure early changes are not missed.