Powers of Observation

Today's post is dedicated to all those battling oral cancer.  

I spend a fair amount of time in my car and enjoy listening to the radio.  Recently, my favorite radio personality noted that he was just diagnosed with throat cancer and would be taking a leave of absence to fight this deadly disease.  His dental hygienist found the lump on his throat and brought it to the attention of the dentist.  His dental hygienist may well have saved his life!

Today's post will  go over signs and symptoms of oral cancer, cancer screening, and how you can screen yourself.  For those in the midst of therapy, I'll include a list of products you can try if you  have oral dryness or discomfort.

The most important thing I do as your dental hygienist is examine your mouth, head and neck for things out of the "norm".  I'm looking for signs of oral cancer, as well as other maladies.  Here's a list of what I look for and want you to be aware of as well:

A sore, irritation, lump, or thick patch in the mouth, lip, or throat
A white or red patch in the mouth 
Ulcers that don't heal in two weeks
Lesions that change color, shape or size
Speech problems
Weight loss
Enlarged lymph nodes
Loose teeth
Lumps or swellings
A feeling that something is caught in the throat.
Difficulty chewing or swallowing
Hoarseness
Taste change
Difficulty moving the jaw or tongue.
Numbness in the tongue or other areas in the mouth.
Swelling of the jaw that causes dentures to fit poorly or become uncomfortable.
Pain in one ear without hearing loss.

The most common signs are either red spots or white spots and things that don't heal within two weeks.  If anything does not heal within the two week margin, GO SEE YOUR DENTIST!  These signs and symptoms could also be associated with other benign causes so check with your doctor or dentist to be sure.
Oral cancer may not hurt, thus, these signs are easy to overlook or miss, but unfortunately cancer is much harder to treat in the later stages. More on screening in a moment.

The right lateral tongue of this patient demonstrated the presence of an indurated, painless ulcer of unknown duration.

Diagnosis: Early stage squamous cell carcinoma

- See more at: http://www.oralcancerfoundation.org

Causes of cancer are mostly due to lifestyle choices: 

Viruses:
1. Oral cancer is not just an old man's disease.  With a decrease in smoking, you would think there would be a decrease in the number of cases of oral cancer.  Unfortunately, there is a virus- Human Papilloma Virus #16, (HPV 16) that is causing oral cancer in younger people.  HPV is transmitted via skin to skin contact, most frequently during sexual activity - and especially during oral sex.  Evidence shows that nearly all cervical cancer is from  HPV 16 or 18.  The rise in oral sexual activity among young people has led to a rapid increase in the incidence of oral cancer in this age group. Thus, everyone, regardless of age should be screened for signs at every dental recare appointment. Vaccination against HPV is highly recommended for both boys and girls before they become sexually active.

Another virus connected to head and neck cancers is the Epstein-Barr virus (EBV).  Most adults have antibodies to this virus meaning they have been exposed to is sometime throughout their life.  Mononucleosis is the most common source of EBV exposure. This virus has been linked to nasopharyngeal carcinoma, a rare cancer except in Southern China.

UV light:
2. Ultraviolet light can be another cause of cancer in the head and neck region.  Tanning beds are a big source of UV light exposure, again especially for younger people.  (As well as sun exposure itself, which we don't have a lot of in the Pacific NW.)

Diets:
3. Diets high in meat and low in vegetables account for up to 30%  of cancers.  Vegetables and fruits contain vitamins and mineral your body needs that eliminate free oxygen radicals which damage cell DNA.  Processed meats contain nitrates which have the potential to convert to carcinogenic nitrosamines.  Diets low in vitamins A and B are also at higher risk.  A well rounded, healthy diet is always in good taste.

Alcohol and tobacco:
4. Smoking tobacco, chew tobacco, and alcohol use.  Tobacco and alcohol  are the main causes of oral cancer according to the American Institute for Cancer Research.  Chew tobacco is not safer than smoking.  75% of head and neck cancers are related to alcohol and tobacco use.  Also, precancerous lesions have been connected to marijuana use.

Gender:
5. Used to be, men would get oral cancer at a much higher rate-- six to one males to females.  That is no longer true.  Now the statistics say it's lowered to two men to every female.  Decreases in smoking and increase in HPV contributed to rounding out the gender bias of this cancer.

6. Weak Immune Systems and GERD/Reflux:
No surprise here.  Those that are not as healthy are more at risk for head and neck cancers.

7. Chewing Betel Quid, Paan, and Gutka:
Chewing betel quid is an age old tradition  in  Asia and India.  There are upwards of 600 million betel quid or "nut" chewers.   It becomes an addiction.  Gutka is a combination of betel quid and tobacco. Paan is a betel pepper.  All are definitely connected to an increased risk of oral cancer. Combining betel nut chewing, alcohol and smoking raises the risk of oral cancer 123 -fold!  Just don't even start!

These are just risk factors that increase the odds of getting head and neck cancer.  It can happen to any one at any age.  While rare, children are not immune from head and neck cancers.

Cancer Screening: 

Screening for this disease is vital to catching it early.  Early detection greatly increase your chances of beating it.  Our office conducts visual and tactile screenings at every recare appointment.  A through examination  ( I.E. your mouth, throat, head and neck) is not painful and does not  take a lot of time. If your dental office is not doing a screening, ask them to look closely.  They should be looking and feeling inside and outside your mouth for lumps, bumps, red spots and white spots.  There are also technologies that help your dental professional look even deeper within the tissues to see changes not visible to the naked eye.  The three technologies I am know: ViziLite, the Velscope and Identifi all work differently (if you would like specifics, I'd be happy to share!) but are worth doing once a year.  Insurance probably won't pay for it but compare the cost of treating oral cancer versus the $50+ this screening may cost you once a year, especially if you are in a high-risk group it is well worth the investment.

Step one of a screening!

 Meanwhile, you should be looking too!  Just like women are encouraged to perform monthly breast cancer screening, I encourage you to pull your tongue out, look at the edges, underneath, and all the way in the back.  Know what's normal for you and bring anything new to your dental hygienist's or dentist's attention.  Click here to see how to do it!  Again, know what's normal for you.  If you engage in any of the higher risk activities above, then definitely add oral cancer screening to your monthly "to do" list.  Finding abnormalities early greatly increases your odds of a speedy recovery. 

Products for those Undergoing Therapy:

Dry mouth, mucositis, pain, tenderness.  Cancer therapy can be decidedly uncomfortable or downright painful.  No sugar coating this.  There are products to help your mouth feel better.
Here's the best list I have so far but will continue to add to this as products come to my attention:

Prescription products:

     Gelclair  -  a rinse that coats and soothes
     Neutrasal - a rinse that relieves pain- use right from the start of chemo or radiation therapy
     "Magic Mouthwash"-  a combination of Benadryl, Lidocaine, Nystatin and Maalox is helpful for some folks.

Non-prescription rinses:
     Medactive makes a series of rinses for dry mouth and pain relief.
     Baking soda and water- 1 cup warm water, 1/4 teaspoon baking  soda and 1/8 teaspoon salt - rinse as needed

The softest toothbrush I know- the Nimbus - worth every penny!  They even have a children's brush- the Nimby!
For other products see my post- Elixir Fixer for Your Dry Mouth

Be well my friends!  Prevention is always the best medicine.
and keep smiling,
Barbara