5 Must-Know Facts About Oral Cancer

You may be surprised to learn that oral cancer is one of the deadliest and most disfiguring forms of cancer.

About 53,000 Americans are affected by it each year, including men and women, smokers and non-smokers, young adults and older ones. April is Oral Cancer Awareness Month, a great reminder to review the basics about who’s at risk for this disease and what you can do to monitor for it, so you’re able to spot the signs in the early stages when this cancer is easiest to treat.

FACT 1:  The phrase “oral cancer” can often refer to two very different kinds of cancer.

Oral cavity cancer occurs in the front part of the mouth—most commonly the tongue, floor of the mouth, inside of cheeks, and lips. The primary culprit is tobacco use (smoking or chewing varieties), followed by frequent alcohol consumption, and repeated trauma within the mouth from problems like poor-fitting dentures, loose teeth, or even chronic tongue biting. This type of cancer can be very aggressive and difficult to treat successfully.

Oropharyngeal cancer affects the back of the mouth, including the tonsils, back of the tongue, larynx, and upper throat. While tobacco, alcohol, and mouth trauma can play a role in oropharyngeal cancer, we now recognize that human papillomavirus, or HPV, is the most common underlying cause of this condition. HPV is in the same family of sexually transmitted viruses—often better known to patients as a cause of cervical cancer—for which we now have a widely recommended vaccine for adolescents and young adults. This type of cancer often responds better to available treatments.

FACT 2:  While one type of this cancer is trending downward, the other is on the rise—especially in younger adults.

Decreases in tobacco use in the U.S. have no doubt fueled a decrease in the number of oral cavity cancers. We typically see these among people in their 60s and 70s.

On the other hand, however, we’re seeing a rise in oropharyngeal, or back-of-the-mouth cancers, especially in adults in their 50s and 60s and sometimes much younger. This increase is directly related to certain types of sexually transmitted HPV infections, which can be passed during oral contact. Because these cancers may not appear for decades after exposure to HPV, it’s hard to tell how the HPV vaccine—which debuted in 2006—will affect these numbers in the years ahead, but we’ll likely see fewer cases as more people get vaccinated.

For now, the Centers for Disease Control and Prevention (CDC) recommends routine HPV vaccination for everyone up to age 26, ideally starting before sexual activity. The vaccine is also recommended for other individuals in some cases, so ask your healthcare provider about it.

FACT 3: Oral cancer is often extremely serious.

According to the Oral Cancer Foundation, just over half of people diagnosed with this cancer will live longer than five years, making it the sixth leading cause of cancer death in the U.S. That troubling statistic stems mainly from the fact that these cancers are often not diagnosed early, and the signs can be easy to miss. These can also be fast-growing cancers, especially when related to tobacco and/or alcohol use. (HPV-related back-of-the-mouth cancers have a better prognosis, with 80% to 90% of patients still alive after five years.)

Required surgeries and other treatments can also be challenging and traumatic for a later-stage cancer. They can lead to disfigurements, such as removal of part of the tongue or other tissues, as well as problems with swallowing and speaking. It can be very difficult to return to a normal life after this type of cancer, so prevention and early detection are critical.

FACT 4: You should check regularly for early signs.

This is true for every adult but is even more important if you use tobacco or drink alcohol regularly. Take a look inside your mouth and feel around your neck every so often to be sure nothing has changed.

Here are the signs to act on if they persist longer than two weeks:

• A flat white or red patch anywhere in your mouth (note that, in its early stages, these cancers rarely cause discomfort)
• A lip or mouth sore
• A growth or lump inside your mouth or in your neck
• Discomfort with swallowing
• Hoarseness

Regular twice-yearly dental visits are also an excellent way to monitor this cancer, as dentists are uniquely qualified to spot early signs of it. This kind of examination is typically part of a routine check-up and doesn’t cost extra. Primary care physicians also tend to do oral exams as part of their routine wellness exams.

FACT 5: Early action and a good care team can make a life-saving difference.

If you detect any potential signs of this cancer, don’t wait. Make an appointment with either your dentist, primary care physician, or an otolaryngologist. Your dentist or a medical specialist you’d be referred to would typically do a simple biopsy in their office and refer you for additional testing as needed. The biopsy requires a small sample of cells from the questionable area, and it’s quick and inexpensive. You’ll have results within a few days and, if anything is detected, an imaging test—such as a CT scan or PET scan—can provide more details.

Because this diagnosis can affect many aspects of your life, it’s essential to choose a treatment center that offers a team approach. At MedStar Washington Hospital Center, our otolaryngologists are supported by a coordinated care team that includes medical oncologists, radiation oncologists, speech and physical therapists, oral surgeons, and counselors who can assist with the emotional impact this type of cancer can bring. This approach allows us to consider our patients holistically, recommend the best treatment options, and ensure they’re well cared for every step of the way.

As more people recognize the early signs and take steps to prevent them—such as avoiding tobacco, minimizing alcohol, and getting the HPV vaccine for themselves and their children as recommended—there's hope that the statistics for oral cancer may improve significantly in the years ahead.