Chapter 14- Oral Cancer

Oral Cancer is a vast subject and of course subject to lots of ongoing research.

There are several very good websites with lots of useful information on them so I am just going to explain a few things and then I am going to point you in the right direction.

Types of cancer.

The first thing to say is there are hundreds of different types of cancers it is not one disease it’s an overall blanket term. So when someone says lung cancer or breast cancer that just tells you where it is not what type it is.

So tumour just means growth, in fact strictly speaking it means swelling [Latin]. Not all growths/ tumours are cancer. Tumours can be caused by all sorts of things; – infections, cysts, new growths, all sorts. A new growth is called a neoplasm.

There are 2 types of neoplasm benign and malignant.

Benign neoplasms just grow, now obviously you could have a benign neoplasm some were where it would be unsightly, or get in the way, or press on other organs and cause trouble but on the whole they just grow.

Malignant neoplasms do 2 things; – they invade and they metastasize. Imagine it like this, in its very simplest form- they put down little feelers [cancer like a crab] into the surrounding tissues and the ends of those little feelers break off, get into your blood or lymph vessels are carried around your body to other places where they form secondary cancers [metastases]. The lymphatic system is an organ system, part of the circulatory and immune systems, draining fluid back into your blood system via lymph nodes. It’s a good idea to check your lymph nodes every month or so, an excellent guide to doing this is provided by The Wessex Cancer Trust at www.wessexcancer.org.uk .

Why do we get cancers?

This is a very simple explanation, it is far more complex than this but this will do for now.

All our cells contain DNA [deoxyribonucleic acid], this contains our genetic information and is a sort of instruction manual/ blueprint for each of our cells. Sometimes this DNA gets damaged somehow. In a normal cell the damage gets repaired or your cell dies off but in in a malignant cell this doesn’t happen, the blueprint in your DNA gets altered and the damaged altered cells carry on growing as if they have a mind of their own. This alteration in your genes is called a mutation. You have to have quite a lot of changes to the information in your DNA in a cell for it to become cancerous.

Mutations can be caused by lots of things;-

The luck of the draw [which means we don’t know what the cause is yet but hopefully we will] – for some reason a cell spontaneously mutates.

Genetic- inherited from our parents.

Risk factors- these are things like smoking, drinking to excess, exposure to too much radiation or UV light. Continuous exposure to these risk factors leads to genetic mutations.

The mouth is the most common site for cancer in the head and neck region.

Mouth [Oral] Cancers].

Different types of cells can form cancers but the majority 9/10 in the mouth are called oral squamous cell carcinomas or OSCC for short. These arise in cells called keratinocytes in the skin [oral mucosa] inside your mouth.

The commonest places to have cancer in the mouth are; – the lips [usually the lower lip], the sides of your tongue [lateral border], the floor of your mouth, the base of the tongue [where it starts right at the back] and the tonsils.

Facts and figures and websites.

The Oral Health Foundation www.dentalhealth.org published ‘the first comprehensive review into mouth cancer’ ‘The State of Mouth Cancer 2018/2019 UK Report’. This report is excellent, very readable and understandable and can be downloaded.

Look it up yourself but here are a few facts and figures from it;-

New cases in the UK have now reached 8,302 per year.

Cases have increases by 49% in the last 10 years and by 135% in the last 20 years.

56% are on the tongue and the tonsils.

In 2018 2722 UK citizens died from oral cancer.

The 10 year survival rate is under 60%.

78% of cases are in over 55 year olds but increasing in younger age groups.

17% that’s 1 in 6 are due to smoking.

1/3rd are due to excess alcohol, drinking over 10 units per week increases your risk by 81%.

Smoking and drinking more than the recommended units of alcohol gives you a 30x increased risk than if you just did one of them!

HPV [human papilloma virus] no 16 and 18 is linked to 73% of oral pharyngeal cancers and 1 in 10 of cancers in the mouth [more about this later].

I also suggest you visit http://www.mouthcancer.org which has 2 very good sections;

‘How to spot mouth cancer’ from which you can also download mouth cancer signs and symptoms, self-examination and a list of risk factors all as PDFs, you could print them and put them up at work!

‘Mouth cancer risk factors’ which explains risk factors in more detail.

Other useful websites are;-

www.mouthcancerfoundation.org very good website, has lots of good information about HPV and also a community forum and support groups for people who have been affected by oral cancer themselves or their loved ones.

www.nhs.uk  a few facts and figures from this are oral cancer is the 6th most common cancer in the world, 1 in 50 of all cancers in the UK, 12.5% ie 1 in 8 in younger people.

www.oralcancerfoundation.org an American website go to the section ‘Understanding Oral Cancer’ this has a lot of info on HPV and a lot of pictures of things to look for.

www.macmillon.org.uk as ever an excellent source of information and support.

www.wcrf-uk.org the world cancer research fund which has more statistics.

www.cancerresearchuk.org brilliant as ever.

Pharyngeal cancers.

Your pharynx is the pipe that goes from the back of your nose, past the back of your mouth and your voice box [larynx] at the top of your trachea [your wind pipe], it also includes the top part of your oesophagus the bit your food goes down. The bit behind your nose is called your nasopharynx, the bit at the back of your mouth is called your oropharynx and the bottom bit is called your laryngopharynx or hypopharynx. Oral cancers and pharyngeal cancers are termed collectively as Oropharyngeal cancers and have the same risk factors.

Risk Factors.

The causes of cancer are a combination of the wrong genes, external factors [such as exposure to radiation, UV light, workplace chemicals] and lifestyle.

LIFESTYLE ACCOUNTS FOR 75%.

A cancer risk factor is something which increases your chances of developing cancer. Things which increase DNA mutations increase your risk of developing cancer. Some risk factors you can’t do anything about such as your age, ethnicity and sex but others you can and these are known as modifiable risk factors. There are things in your lifestyle which you either do or don’t do which increase your chance of developing cancer.

What are the main risk factors for Oral Cancer?

Smoking and other tobacco usage;- snuff, chewing tobacco, water pipes, 2nd hand smoke, snuz, Tobacco contains over 60 carcinogens [cancer causing chemicals]. The stronger the tobacco you use, the longer you smoke for, and the greater the amount the greater the risk.

Drinking more than the recommended units especially if you smoke. The more you drink and the greater the number of years the greater the risk.

Betel nut chewing [usually as Paan/ quid with areca nut and slaked lime]

Diet low in fresh fruit and veg.

Sunlight [for lip cancer].

HPV infection.

These are the main life style risk factors but there are others including Marijuana and Khat use.

Mouthwashes containing alcohol are thought to pose no risk unless used to excess, though you might want to choose an alcohol free one if you have a choice. Poor oral hygiene is probably a greater risk.

Beneficial factors.

Well obviously the reverse of above.

Doing your best to keep a healthy immune system and if you are immune suppressed for reasons such as being HIV +ve or having received chemotherapy, keeping your mouth clean and healthy.

Infections due to poor oral hygiene, periodontal [gum disease], chronic oral candida [thrush] and oral viral infections link very strongly with oral cancer see next section.

Infections.

A pathogen is a disease causing microorganism [micro- can only be seen with a microscope] [organism- living thing].

There are 5 [that we know of] types of organism that cause disease;- Bacteria, Viruses, Fungi, Prions [CJD] and Protozoa [ such as those causing amoebic dysentery]. The first 3 are the ones that concern us.

Bacteria.

Poor oral hygiene leads to caries [tooth decay] and gum disease [periodontal disease]. Periodontal disease has been shown to increase the risk for oral cancer. Some specific bacteria found in the mouth can metabolise alcohol to acetaldehyde which is a carcinogen [cancer causing chemical]. There may be other bacteria associated oral cancer which we have yet to be sure of.

Viruses.

There are various viruses implicated in different oropharyngeal cancers but the one that is most concerning is HPV [human papilloma virus].

There are more than 100 different types of HPV some produce warts on the skin, mouth and genitals.

They are the most commonly shared sexual infections.

The risk factors for HPV infection include;-

Having sex at an early age.

Multiple sexual partners.

Risky sexual behaviour with unknown partners.

Lack of condom use.

One of the problems with the advent of the pill is the increase in the incidence of sexually transmitted disease; – syphilis, gonorrhoea, chlamydia, HIV, HPV. Sex is just how these type of organisms get from one person to another. Picking up a sexually transmitted disease [STD] is not shameful, if you suspect you might have a problem the sooner you get help and advice the better for you and for future sexual partners. You might like to visit this website www.sh24.org.uk [sexual health 24 hours a day] it has lots of useful advice and self-testing kits by post or/and go and see your doctor.

Most sexually active adults will have been affected with high risk HPV at some stage. Most people 90% will clear it from their system. Only a small number of people with HPV will go on to develop oropharyngeal cancer. Numbers 16 and 18 are the ones most implicated in oropharyngeal cancer, other numbers are implicated in other types of cancer; – all cervical cancers and a high number of cancers of the anus, penis, vagina and vulva.

Risk factors for HPV related oropharyngeal cancer are;-

More than 26 lifetime sexual partners.

6 or more oral sexual partners.

Sex at a young age.

Fungi.

Candida albicans is the common yeast [a type of fungi] in the mouth. There are other types of candida some of which produce nasty compounds and some can also convert alcohol to acetaldehyde. Candida likes to live on the back of your tongue, make sure you clean your tongue on a regular basis. Candida will always be there, it lives on us normally, just don’t want it getting out of hand!

What are the things to look for with oral cancer?

Red and/or white patches in the mouth.

Ulcers which don’t heal within 3 weeks.

Lumps or bumps which appear for no good reason.

There are obviously lots of red patches, white patches, ulcers, lumps and bumps which are not at all something to be worried about. As a rough rule of thumb if the cause is traumatic [you have damaged yourself in some way] or infective, it will go away or at least start to look a lot better within 7-10 days. Add another week on for luck, if it’s still there after 3 weeks go and see your dentist or your GP. The dentist’s field of expertise is the mouth they are highly trained to spot signs of oral cancer and other worrying things, it is mandatory for your dentist to keep their training in oral cancer up to date in order to stay on the dental register [ kept by the General Dental Council GDC] and be allowed to practice.

There are a range of conditions which are known as PMDs [potentially malignant disorders]. This means essentially that they are OK in themselves but they have the potential to turn into something nastier at a later date, which doesn’t necessarily mean they will but they should be kept a close eye on by your dentist. Lichen planus is probably the most common one which you may have heard of [affects 2% of the population in the UK]. Your dentist will spot these.

Remember this;-

Go to your dentist regularly at the very least every 2 years preferably every year for the health of your teeth, for the health of your gums and for the health of your mouth in general. This applies even if you have full dentures.

Eat sensibly, drink in moderation, don’t smoke and practice safe sex.

If you find anything suspicious, however trivial go and see your dentist they won’t mind.

The earlier something is found, the less invasive the treatment, the better the outcome for the patient and the better your chances of survival.

PREVENTION IS BETTER, SIMPLER, CHEAPER AND LESS PAINFUL THAN CURE! 

 

 

 

 

 

 

 

 

 

 

 

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