Oral Cancer

What is Oral Cancer?

Oral cancer is a form of cancer or malignancy that affects primarily the soft tissues and sometimes the hard tissues of the oral cavity. The most common form of oral cancer is Squamous Cell Carcinoma (SCC).


Case 1: (1a) Clinically identified SCC left lateral posterior tongue (arrow). (1b) ViziliteŽ positive (arrow). (1c) Tolonium chloride positive (arrow). (1d) Histologically well-differentiated SCC. Case 2: (2a) Clinically identified SCC right retromolar trigone (arrow). (2b) ViziliteŽ positive. (2c) Tolonium chloride positive (arrow). (2d) Histologically well-differentiated SCC.

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How common is it?

Close to 36,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 36,000 newly diagnosed individuals, only slightly more than half will be alive in 5 years. This is a number which has not significantly improved in decades. The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer, Hodgkin's lymphoma, laryngeal cancer, cancer of the testes, and endocrine system cancers such as thyroid, or skin cancer (malignant melanoma).

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Why is the survival rate low?

The survival rate associated with this cancer is particularly low due to the cancer being routinely discovered late in its development. Often it is only discovered when the cancer has metastasized to another location, most likely the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intra oral area.

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What are the risk factors for developing Oral Cancer?

The risk factors for developing oral cancer include tobacco use in the form of smoking tobacco, heavy alcohol consumption, Human Papilloma Virus (HPV) and heavy mate tea consumption.

It has now been established that the path that brings people to oral cancer contains at least two distinct etiologies; one through tobacco and alcohol, and another via the HPV virus, particularly version 16, though other versions of the virus might be implicated as the research unravels further, though any others identified as of today are considered research data artifacts and not actual causative agents. In general it appears that HPV positive tumors occur most frequently in a younger group of individuals than tobacco related malignancies. (Tobacco oral cancers occur most frequently in the 5th through the 7th decade of life.) They also occur more in white males, and in non smokers. The HPV positive group is the fastest growing segment of the oral cancer population.

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Do I have Oral Cancer?

You should always contact your doctor or dentist immediately if you notice the following symptoms in yourself or a loved one:

These symptoms may be caused by other, less serious problems, but they also indicate the possible presence of oral cancer. Only a professional will be able to tell you definitively. Some think that a visit to their medical doctor is the appropriate course of action. But remember that dentists are trained in this simple, quick screening, which involves the examination of the oral cavity as a whole and not just your teeth.

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What are Premalignant oral lesions?

Premalignant or precancerous (also referred to as “potentially malignant”) oral lesions involve the skin lining of the mouth (known as the epithelium) and may be at risk for becoming (transforming into) an oral cancer, although it is difficult to predict which lesions will transform and how long it will take.

Patches in the mouth that are, red, white or mixed red/white in color, or that may also be ulcerated (ie an area where the lining epithelium is lost), especially when found on “high-risk” sites such as the side (lateral surface), underside of the tongue (ventral surface), floor of mouth, or at the back of mouth/top of the throat (oropharynx) may be a premalignant oral lesion and may or may not be a predisposing lesion to oral cancer.

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How does Dr. Ram evaluate me?

Dr. Ram, the specialist in this area, will listen to your history and perform a thorough clinical examination and a biopsy (taking a small sample of tissue) and will provide a diagnosis and treatment plan. Dr. Ram is an expert in early oral cancer detection and has conducted research using toluidine blue and Vizilite® for early oral cancer detection. To read Dr. Ram’s articles on oral cancer detection and oral cancer management please click on the links below:

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What are the available treatments?

After a definitive diagnosis has been made and the cancer has been staged, treatment may begin. Treatment of oral cancers is ideally a multidisciplinary approach involving the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists, and rehabilitation and restorative specialists. The actual curative treatment modalities are usually surgery and radiation, with chemotherapy added to decrease the possibility of metastasis, to sensitize the malignant cells to radiation, or for those patients who have confirmed distant metastasis of the disease.

Prior to the commencement of curative treatment, it is likely that other oral health needs will be addressed. The purpose is to decrease the likelihood of developing post therapeutic complications. Teeth with poor prognosis from periodontal problems, caries, etc. may be extracted. This avoidance of post radiotherapy surgery is important as it can sometimes induce osteonecrosis, a condition which can develop when tissue damaged by radiation exposes the underlying bone. The bone, which has lost its ability to efficiently repair itself due to reduced blood supply, again from radiation exposure, yields a chronic and difficult to treat situation. A thorough prophylaxis, or cleaning will likely be done as well.

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