Dear Doctor Column, March 10, 2003

Question:

My brother has cancer in his mouth and throat, and we were all shocked. What are the early signs of mouth cancer to watch for? If he had known, maybe he could have caught it sooner.

Answer:

Cancer of the mouth and throat, medically known as oral cavity and oropharyngeal cancer, will strike about 27,700 Americans this year, and about 7,200 will die from it, according to the American Cancer Society (ACS). Precancerous changes often appear in the mouth 2 years to 4 years before malignancy develops, making early detection and treatment easier.

The ACS and the American Dental Association (ADA) emphasize that adults can take an active role in the early detection of oral cancer by doing regular self-examinations. This means looking into a mirror and checking the lips, gums, cheek lining, and tongue, as well as the throat and the floor and roof of the mouth for symptoms of the disease. Signs and symptoms to look for include:

• A red sore on the lips, gums, or inside of the mouth that does not heal within 2 weeks and bleeds easily;
• Flat, soft, gray, or white areas commonly found on the lip, the tongue, and the floor of the mouth, which account for 85% of precancerous lesions;
• Swelling or lumps in the mouth, neck, lips, or on the tongue that do not go away within 2 weeks;
• Numbness or pain in the mouth or throat;
• Difficulty in chewing, swallowing, speaking, or moving the jaw or tongue;
• A change in the way the teeth fit together or loosening of the teeth or pain around the teeth or jaw; or
• Swelling of the jaw.

If you spot even one of these symptoms, see your dentist right away for a professional examination.

A risk factor is anything that increases a person's chance of getting a disease. For example, unprotected exposure to strong sunlight is a risk factor for skin cancer, and a diet high in fat and low in fruits and vegetables is a risk factor for colorectal cancer. Scientists have found certain risk factors that make a person more likely to develop oral cavity and oropharyngeal cancer, such as:

Tobacco: About 90% of people with oral cavity and oropharyngeal cancer use tobacco, and the risk of developing these cancers increases with the amount smoked or chewed and duration of the habit. Smokers are six times more likely than nonsmokers to develop these cancers. Tobacco smoke from cigarettes, cigars, or pipes can cause cancers anywhere in the oral cavity or oropharynx, as well as causing cancers of the larynx, lungs, esophagus, kidneys, bladder, and several other organs. In addition, pipe smoking has a particularly significant risk for cancers in the area of the lips that contact the pipe stem. Smokeless tobacco (chewing tobacco) is associated with cancers of the cheek, gums, and inner surface of the lips.

Alcohol: About 75% to 80% of all patients with oral cancer frequently consume alcohol. These cancers are about six times more common in drinkers than in nondrinkers. People who smoke and also drink alcohol have a much higher risk of cancer than those using only alcohol or tobacco alone.

Ultraviolet light: More than 30% of patients with cancers of the lip have outdoor occupations associated with prolonged exposure to sunlight.

Age: The number of people with oral and oropharynx cancer increases with age, especially after age 40.

Gender: Oral and oropharyngeal cancer is twice as common in men as in women. This may be because men are more likely to use tobacco and alcohol.

About 15% of patients newly diagnosed with oral and oropharynx cancers will have another cancer in nearby areas, such as the larynx, esophagus, or lung. Another 10% to 40% will develop cancer of one of these organs or a second cancer of the oral cavity or oropharynx at a later time. For this reason, it is very important for patients with oral and oropharyngeal cancer to have follow-up examinations for the rest of their lives and avoid risk factors, like smoking and drinking, which increase the risk for these second cancers.

The ACS and the ADA stress that knowing the risk factors and taking steps to prevent precancerous lesions from developing can go a long way toward limiting the influence oral cancer can have on your life. Starting today, make it a point to join your dentist in maintaining good oral health for life.

For more information, visit the ADA Web site and the ACS Web site.