Head and Neck Cancers: Oropharyngeal Cancer
Often called throat cancer, cancer of the oropharynx can also be detected early. Patients who have been infected with HPV and smokers are typically more at risk than others. Symptoms of oral cancer in the back of the throat include a sore throat or a lump found in the neck. In some cases, a person affected by this type of cancer may notice a change in their voice.
While signs of mouth cancer in other parts of the mouth are sometimes more visible in the form of a lesion, oropharyngeal cancer can sometimes be felt by the patient. An annual oral cancer screening may include a questionnaire to determine if any of the symptoms of oropharyngeal cancer exist.
Tests for Oral Cancer
The first line of defense against oral cancer is a total mouth cancer screening that occurs during annual appointments. If any changes in the mouth are noted that raise suspicions of oral cancer, Dr. Lazare can request a biopsy or refer the patient to their primary care doctor.
Blood work, an endoscopy, and imaging tests like PET scans can assist in the diagnosis of cancer of the oral cavity. When the first symptoms of oral cancer and premalignant lesions are diagnosed through oral cancer testing, treatment can begin right away. In general, these early-stage cancers require less extensive treatments and have much higher survival rates.
What Are the Warning Signs of Oral Cancer?
The two types of lesions that could be the precursors to cancer are white lesions (called leukoplakia) and red lesions (called erythroplakia). The red lesions are less common, but they have a greater potential to become cancerous. If a red or white lesion does not resolve itself within two weeks, it should be reevaluated, and a biopsy should be considered for a definitive diagnosis.
Other possible signs and symptoms of oral cancer include:
- Difficulty in chewing or swallowing
- Numbness of the tongue
- Ear pain
- Difficulty when moving the tongue or jaw
- A lump or a thickening of the soft tissues in the mouth
If any of the above symptoms last for more than two weeks, a thorough exam and lab tests may be necessary.
What Can Be Done to Detect Oral Cancers?
With oral cancers, the earlier the detection, the greater the prognosis. Oral cancer is known to spread fairly quickly, with only half of those diagnosed surviving more than five years. Your dentist should incorporate or request your permission to perform an oral cancer screening exam each year as part of the office protocol. If they don’t offer the exam to you or perform this task, you should request the exam or seek care elsewhere.
The exam should include an overall evaluation of the face, lips, head, and neck, with a thorough inspection of the inside of the upper and lower lips, the gums, the inside of the cheeks, the floor of the mouth, the tongue (the sides, top, and underside), and the roof of the mouth. Newer types of oral cancer exams include tests that use fluorescent lights and special rinses and dyes (such as Toluidine Blue) to help dentists spot abnormal changes in the mucous membranes that line the inside of the mouth and throat.
Oral Cancer Treatment
Surgical excision of the affected tissues might be necessary during all
phases of mouth cancer but depending on the stage and spread of the disease,
additional treatments might be necessary. Radiation therapy and chemotherapy
are commonly used in the treatment of all types of cancer, including oral
cancer. In more advanced cases, immunotherapy can be provided in advanced
stage oral cancer that persists despite traditional cancer treatments.
Non-Cancerous Lesions in the Mouth
It can be alarming to discover changes to the soft tissues in the mouth, but many common lesions and abnormalities can occur in the mouth that may not be related to cancer.
During an oral cancer screening test, Dr. Lazare may notice physical changes that are ultimately benign. These may include:
Aphthous Stomatitis (Canker Sore)
These common lesions occur in about 20% of people, more commonly in those who are experiencing stress. Certain irritants are thought to trigger canker sores. These painful bumps appear as small yellow or white lesions surrounded by a circular red area.
They may form on the lips, cheeks, gums, or even the sides and base of the tongue. An especially painful site is the floor of the mouth. Canker sores can occur as a single sore or multiple sores. They may last from a week-and-a-half to two weeks and can be treated with topical ointments.
Traumatic Oral Ulcers
After trauma to the upper tissue layers in the mouth, traumatic ulcers can form. Typically caused by dental work or injections, biting the tongue or cheek, or hard pieces of food, these ulcers often look like canker sores.
With an inner core that is white or yellow in color surrounded by a red border, the difference in traumatic ulcers is that rather than being an inverted sore, they can contain a pocket of pus. Topical numbing products can help ease the pain of these sores, and they should heal on their own.
Herpes Simplex Virus (HSV)
The two strains of HSV are Type I (HSV-1) which appears as cold sores or fever blisters on the face and lips and is spread through saliva, and Type II (HSV-2) which is sexually transmitted and causes local sores in the genital area.
In either type, there may be ulcers that are reddish in color and eventually scab over. The virus is incurable but is generally dormant and can appear during times of stress, both physical and psychological, that affect the immune system.
People may have enlarged lymph nodes or fever during a herpes outbreak. Avoiding physical contact with another person’s sores and antiviral medications, both oral and topical, can prevent their spread and help control an active infection.
Oral Lichen Planus Ulcers
Lichen planus is an inflammatory condition that can affect many areas of the body, including the mucous membranes. In the mouth, this tissue is known as the oral mucosa. The white marbled patches, small bumps, and ulcers occur in the mouth (lips, tongue, gums, cheeks, throat) but cannot be transmitted to others.
Lichen planus is characterized as a chronic autoimmune condition, but why it occurs is unknown. It is prevalent in many hepatitis C patients. Sometimes, flare-ups last weeks, but other cases may not resolve for months or years.
There is no cure for oral lichen planus, but the condition can be controlled through medications and homeopathic remedies.
Acute Necrotizing Ulcerative Gingivitis (ANUG or “Trench Mouth”)
A common disorder in soldiers during World War I, ANUG can occur with stress, smoking, bad oral hygiene, and poor nutrition. Those who are immunocompromised may also be at risk for this oral infection.
ANUG appears as ulcers in the mouth, swollen tissue, and tissue sloughing in mouth, including gum sloughing. Sufferers of trench mouth also can have bad breath. When affected by ANUG, people may have a fever, swollen lymph nodes, and may feel fatigued. The disorder can be treated with an antibacterial rinse, nutritional supplements or a change in diet, and rest.
It should be noted that some foods and toothpaste may cause a minor sloughing of the cheeks or gums, and this is often harmless.
Linea Alba Buccalis or White Line Inside Lower Lip
The white scar that occurs on the inside of the cheeks due to repeated biting can also be seen inside the lower lip for the same reason.
Sometimes confused for a malignant sore, oral leukoplakia or any oral cavity lesion that is white in color are not precancerous lesions. Patients may have an issue with their bite patterns, teeth grinding, or bite their cheeks and lips as a nervous habit.