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Oral cancers include
those of the lips, tongue, throat and mouth. These malignancies are among
the most debilitating and disfiguring of all cancers. As a general rule,
oral cancers take several years to reach an advanced stage and respond well
to early treatment. In addition, early detection minimizes the need for
extensive, debilitating treatment. A recent study by the American Dental
Association found that only 50 percent of patients treated for oral cancer
survive their disease. The most startlingly fact about this statistic is
that despite advances in surgery, radiation and chemotherapy the mortality
rate for oral cancer has not improved over the past forty years. Such a low
survival rate coupled with little change in two decades suggests the
obvious: oral cancers are detected at late stages. The purpose of this
up-date letter is to discuss advancements in the detection of oral cancers
and the role each individual can play in monitoring their own oral health
with regard to oral cancers.
The mouth can play
host to a wide-variety of lesions, which can vary from asymptotic to others
that are so painful as to prevent proper nutrition and significantly
interfere with an individual’s quality of life. In this respect, diagnosing
and managing lesions is important in terms of improving an individual’s
quality of life. Lesions can develop from chronic irritation or an
infection by bacteria or viruses. For some individuals, lesions are genetic
or autoimmune related. All too often, however, lesions persist in an
individual’s mouth and are ignored. In other instances, lesions are
incorrectly self-diagnosed as a cold sore or a canker sore and
ineffectively treated with an over the counter medication. In the end, when
a lesion is detected in the mouth common sense must prevail. Simply put,
lesions, which are not pre malignant or malignant, will disappear in a
reasonable period of time such as two to four weeks.
Regular oral exams are
important for early diagnosis of oral cancers. Part of a regular exam includes
a visual exam and an exam by palpation of the lips, cheeks, gums, tongue
floor of the mouth, roof of the mouth and oropharynx. While most patients
are screened for signs and symptoms of oral cancers twice a year, an
awareness of deviations from the normal must become part of each
individual’s a daily home care regiment. Lumps, bleeding, red or white
spots or ulcers are clinical features typical of malignancies in the mouth,
which require further diagnosis. Pre-cancerous lesions need to be recognized
and treated before they progress to malignancy, spread to regional lymph
nodes and metastasize.
While a biopsy is the
definitive way to determine if any lesion is pre malignant, malignant or
benign, a recent advancement has been made in the detection of oral cancers
through the use of a procedure called the brush biopsy. The brush biopsy
allows the testing of any lesion, which is suspicious but lacks any
clinical evidence of malignancy without subjecting the patient to an
invasive biopsy. Testing with the brush biopsy involves placing a brush
against the suspicious lesion and rotating the brush. The material
collected on the brush is transferred to a glass slide and sent for
laboratory testing. At the laboratory, a computer analyzes the slide and
the computer output is then used by a pathologist in conjunction with a
standard microscopic evaluation of each specimen. A positive result must
still be followed-up with a scalpel biopsy. The brush biopsy has been found
to have a zero false-negative rate, and, most importantly, has been found
to increase early detection of oral cancers.
Proper diagnosis and
treatment of lesions is important as 30,000 new cases of oral cancer are
diagnosed in the United States each year. Early detection, one of the most
effective weapons against oral cancers, will result in a higher survival
rate for individuals with malignancies. Equally important is reducing risk
factors associated with oral cancers. Unfortunately, not all causes of oral
cancer are known. We do know that tobacco and alcohol are contributing
factors. Other risk factors include not consuming fruits and vegetables,
and not using methods of sun protection. For instance, the outer border of
the lip is often a leading site for cancer as it is exposed to the
ultraviolet rays of the sun, which are carcinogenic.
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