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Review by Dr. Gregg Bobier Oral cancer represents approximately 3% of all cancers. This, however, translates to 30,000 new cases every year in the United States. The single greatest risk factor is tobacco. While cases of oral cancers are seen in patients who do not use tobacco, these constitute a very small percentage of all oral cancers. All forms of tobacco have been implicated as causative agents including cigarette, cigar, and pipe tobacco as well as chewing tobacco. In India and Sri Lanka, where chewing tobacco is used with betel nuts and reverse smoking (placing the lit end in the mouth) is practiced, there is a striking incidence of oral cancer- these cases account for as many as 50% of all cancers! Heavy alcohol usage is an additional causative factor. Lip cancer, while included in statistics for oral cancer, is more similar to skin cancers. Sun exposure is the primary cause of these, while pipe smoking is also a factor. Cancers of the mouth present in various forms. Any persistent white patch must be regarded as being suspicious. Additionally, velvety red patches- particularly those with white speckles- should be areas of concern. Finally, any non-healing ulcer (erosion) merits evaluation. More often than not, these areas are painless. The tongue is the most common site of oral cancer. Typically, the side of the tongue (farthest back in the mouth) is involved. The floor of the mouth (that area beneath the tongue) is next in order of frequency followed by the insides of the cheeks with involvement of other areas showing a lesser incidence. While self-examination is advised, some areas cannot be adequately viewed and, of course, there is no substitute for examination by a professional. The best method for detection is to be sure to have semi-annual check-ups by your dentist. Should an area of concern appear in between these appointments, arrangements should be made for examination. If your dentist has any concern or question, he or she will refer you to an oral and maxillofacial surgeon for evaluation and possible biopsy. Biopsy is a quick office procedure which allows the surgeon to take a sample of the tissue in the area of concern for examination under a microscope. Certainly, it is best to err on the side of caution. However, one should not be unduly alarmed by every white area in the mouth nor by every ulcer since there can be a multitude of harmless causes. As with any other cancer, treatment of oral cancer is best undertaken at the earliest stage. This maximizes chances of successful treatment. Smaller areas may be treated by radiation or surgery while larger areas will often necessitate combined therapy. Prevention, of course, is the best approach and can best be achieved by avoiding risk factors- refraining from all tobacco products and consuming alcohol in moderation. |