Oral and oropharyngeal cancers are malignancies that include the lips, tongue, lining of the cheeks (buccal mucosa), floor of the mouth, gum (gingiva), the area behind the lower wisdom teeth (retromolar trigone), the roof of the mouth (hard and soft palates), the back of mouth and throat (oropharynx), and the sides of the throat (tonsil areas).
Oral and oropharyngeal cancers are most often diagnosed in older adults (average age at diagnosis is between 60 and 63), with over 95% of the oral cancer cases occurring after the age of 45. Men are diagnosed with oral and oropharyngeal cancer twice as often as women. Over the past several decades, the overall number of oral and oropharyngeal cancers has not changed; however, the number of men being diagnosed with the disease is decreasing and the number of women with the disease is increasing.
All forms of tobacco and excessive use of alcohol have been identified as major risks factors for oral and oropharyngeal cancers, and are suspected to account for 75% of all oral and oropharyngeal cancers in the United States. Sun exposure is a risk factor for lip cancer, while smokeless (snuff or spit) tobacco increases the risk for cancers inside the lips and cheek. Other risk factors for oral and oropharyngeal cancer are vitamin A deficiency and Plummer-Vinson Syndrome (a very rare iron deficiency).
The American Cancer Society estimates that 7,800 people will die because of oral or oropharyngeal cancer in the year 2000. Overall, people surviving five years after a diagnosis of oral and oropharyngeal cancer have shown little improvement; half of the people diagnosed with this disease survive five years. Deaths due to oral and oropharyngeal cancer vary greatly with the stage (spread) of the cancer at diagnosis. Oral and oropharyngeal cancers that are detected and treated early, and are localized, have greatly improved survival compared to those that have spread.
Early localized oral and pharyngeal cancers often are not bothersome and therefore go undetected until the cancer has spread. About half of oral and oropharyngeal cancers have spread to the lymph nodes (spread to the neck) at the time of diagnosis or treatment. Three sites within the mouth are high-risk for the development of oral and oropharyngeal cancer: the floor of the mouth, the sides of the tongue, and the soft palate complex (soft palate, inside the retromolar trigone, and tonsil area).
Detection of an oral and oropharyngeal cancer also identifies an individual who is at high risk for developing or having a cancer of the respiratory system and upper digestive tract (larynx, lung, and esophagus).
Warning signs and symptoms of oral and oropharyngeal cancer:
Pain may not be present with early oral and oropharyngeal lesions. Traumatic oral lesions will resolve or greatly improve after the cause of the trauma is removed (such as a sharp tooth or denture). A biopsy, to rule out or confirm a malignancy, is indicated if an oral lesion persists after two weeks. A dentist and/or physician should evaluate all suspicious lesions.
By Denise J. Fedele, DMD, MS