Oral cancer is now often referred to as mouth cancer; it is claimed that this is better understood by lay people and patients. It continues to receive a lot of attention in professional and public circles. Although not a new condition, the increase in awareness has also been driven by an unfortunate increase in its incidence, particularly so in younger people, who traditionally have been far less affected by it. The latest recorded figures show that over 6,000 people a year are diagnosed with oral cancer in the UK and that the incidence in Great Britain has steadily increased over the last 20 years with a 66 per cent increase between the years 1988-90 and 2007-09 (30 per cent in the last decade). There is a bias towards men by two-thirds to one-third in women and just under half of cases are diagnosed in people aged 65 years or over. The predisposing factors are classically listed as the use and abuse of tobacco (smoking and chewing) and alcohol, although not all users develop oral cancer and not all sufferers have these habits. Additional factors include poor diet (deficiencies in vitamins A, E or C or possibly trace elements), an impaired ability to metabolise carcinogens and immune defects.
Since there is no overall definition of oral cancer, figures can include oro-pharyngeal and lip lesions as well. However defined, all are on the increase. The majority of lesions are oral squamous cell carcinomas, one of the 10 most common cancers worldwide with only about half of those affected surviving beyond five years. The low survival figures are usually ascribed to late detection and many efforts are currently being applied to raise awareness in the population and increased vigilance in the profession to get suspicious lesion checked out quickly. Diagnosis is based on biopsy of suspicious lesions, some of which may turn out to be pre-cancerous and require specific continuing surveillance. Those most frequently implicated include white patches, red patches, lichen planus and lesions on the lips. Any ulcer which fails to heal within two to three weeks should also be regarded as being of potential threat.
As with all such conditions, prevention is rightly regarded as better than cure, even when detected early. Given the multifactorial aetiology this is not all that easy. Certainly sensible use of alcohol and complete abandonment of tobacco use are key first steps and these can be targeted both on an individual level as well as in the public health domain. But good diet and oral hygiene are also of great importance too. Regular and effective plaque removal is of obvious benefit and the use of whatever oral hygiene aids help towards this end is to be commended, especially twice daily use of oscillating-rotating power brushing and a toothpaste containing stabilised stannous fluoride.
There has been much head-scratching as to the reasons for the increase in incidence in oral cancer in younger people. Some research suggests that an increasing tendency for oral sex may be behind the rise in numbers due to the involvement of the Human Papilloma Virus (HPV). However, although HPV is sexually transmitted, the degree of the involvement of the microorganism remains a hotly debated topic. Certainly, only one in 20 people (five per cent) know HPV is a cause of mouth cancer. On the other hand, there is no doubt in the rise in the consumption of alcohol by young people and the toll of this could also be of significance. For example over two-thirds of 12-16 year olds admit to drinking alcohol and one in seven have admitted to smoking. Despite this, 87 per cent of young people say they are aware of the harmful effects of drinking alcohol to excess although one third says they have not heard of mouth cancer and only 14 per cent had ever received any educational material on the subject.
The perceived need for greater public awareness has spawned many helpful and informative websites in recent years as well as several charities and the annual Mouth Cancer Action Month every November.
Treatment is generally by surgery and resection, and by radiotherapy to ensure that any malignant cells are also removed from the local and regional lymph nodes. The degree of surgical intervention depends on the extent of the tumour, and thus to the speed of detection and diagnosis, but this also has obvious consequences for the subsequent restorative and rehabilitative care, which can be extensive and life changing. The advent of dental implants has had a beneficial aspect in this respect and recent research confirms that they can enhance oral rehabilitation in most irradiated patients, even being an acceptable option for patients who have suffered osteoradionecrosis.