Oral cancer detection, treatment and dental implications for radiation treatment

I attended the Michigan Dental Association conference in mid April and wanted to share some of the information with you, the public. I will keep this simple, but at the same time relevant to you, the reader.

Facts:

There are about 37,000 new cases of oral cavity cancer diagnosed in the US each year. Around 8000 will die each year annually. The majority are squamous cell cancer over half of these have a metastases at a distant site. There is a five year survival rate of around 60% for all stages combined.
HPV or Human Papilloma Virus, a sexually transmitted disease is found in some of these oral cancers.
Those who are most at risk are those who smoke and drink alcohol. The most recent and fastest demographic are sexually active men and women in their 20s and 30s. The HPV virus is transmitted and can contribute to oral cancers in this young group, who in the past were at a very low risk.
The earlier the cancer is diagnosed and treated the better the outcome

Diagnosis:

During a the soft tissue phase of a dental examination it is the standard of care for the dental provider to feel the neck for any swelling or lumps, check out under the base of the tongue and examine the roof of the mouth and soft tissues in the throat. These visual and tactile exams can reveal early signs of oral cancer. Oral cancer can appear as a minor change in the soft tissues. The most common area where oral cancer is located is under the tongue and in the back of the throat so it is very important for your dentist to have you, the patient, stick out your tongue and to roll and pull the tongue to the side. If there is a red or a white lesion that cannot be directly related to a tongue bite or injury, a biopsy is usually necessary.

Biopsies include a brush biopsy which uses a stiff brush to scrape off some of the cells of the lesion or a full blown scalpel biopsy which excises the tissue. Both require the sample to be sent to a pathology lab to be diagnosed under a microscope. If there is a positive diagnosis of oral cancer then swift care is vital to a favorable outcome.

Treatment:

Most patients will receive head and neck radiotherapy with chemotherapy as a primary curative therapy. Surgery is necessary to remove the affected parts of the tongue, bone and sometimes face. This is gruesome at times and really affects the appearance of the patient.

There are specialized protocols and masks that are used to protect those tissues that are in the line of fire of the direct radiation. Multiple visits are necessary to eliminate the cancer in the tongue or neck. The radiation kills off any of the tissues that are in the path of the x-ray beam and since the intensity of the beam is extremely strong and focused is it critical to stay out of the path of important saliva glands in the head and neck.

Since cancer cells and saliva glands are fast growing cells they are both at risk. Of course the objective of treatment is to kill off the bad cells and spare the good cells in the glands.

Side effects of Radiation:

Side effects of head and neck radiation therapy include

Xerostomia or dry mouth
Oral pain, burning tongue pain and difficult time swallowing.
Loss of taste
Jaw muscles tightening and freezing up, limiting opening.
Burning of the skin from the xray beam
Yeast infections of the mouth
High risk of Dental cavities
High chance of periodontal disease
Osteoradionecrosis of the jaw .Radiation of the bone has very negative consequences associated with it. Bone that has been radiated does not heal itself and is very prone to infections. The term osteoradionecrosis is a term that affects bone which means that the bone dies off and is very difficult to heal. Bone that is in the line of the tumor, especially the mandible (lower jaw bone) is the highest at risk. Since bone metabolism is affected, dental treatment before cancer therapy is vital.

Dental Treatment:

Once the cancer has been diagnosed the oncologists usually desire to begin treatment within 2-3 weeks. Since time is vital there are a lot of issues that need to be addressed. Since the side effects mentioned above are real, dental treatment needs to begin just after diagnosis. Teeth that even have the hint of a periodontal or dental infection need to be extracted. Any fillings that need to be completed need to be done immediately. Prompt and aggressive care is vital since the tissues cannot heal normally once radiation therapy begins. It is much better removing any of these questionable teeth since major problems and complications can develop afterwards.

Palliative Care (pain management):

Once treatment begins it is critical to do what is necessary to relieve pain. The oncologist can prescribe mouthwashes to reduce the pain. Fluoride use is important to reduce the high risk of developing cavities at a high rate. For prevention of oral yeast infections medications can be given. This type of infection can make the mouth very uncomfortable and can be very stubborn to eliminate. With a dry mouth, the normal balance of good oral bacteria is affected and the opportunistic yeast infection (thrush) takes over. Saliva substitutes and oral moisturizers are available to help out.

In summary the diagnosis of oral cancer can be devastating to the patient and their family but with good planning and a very fast response by a competent cancer team, including the dentist, is critical. If you or a loved one has been diagnosed you can give us a call to provide possible solutions to your problem. Our phone number is (586)247-3500.

Ask The Gentle Dentist: Shelby Twp Dentist Discusses Oral Cancer

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