"Dentists the first in Wales to install mouth cancer scanner."

The incidence of oral cancer varies markedly world-wide but, globally, it is the eighth most common malignant tumour. Every year in the United Kingdom, approximately 4,600 people are diagnosed with oral cancer. About half these people will die of the disease. On average, in the UK, one person dies every five hours from oral cancer. The number of cases is increasing quite rapidly in recent years.

The disease occurs generally in those over the age of 50 years, but the recent rise in incidence has particularly affected younger age groups. It should now be appreciated that oral cancer can occur in either gender, at any age.

Cancer can occur in any part of the mouth, tongue, lips, throat, salivary glands, pharynx, larynx, sinus, and other sites located in the head and neck area. These mouth cancers have a higher proportion of deaths per number of cases than breast cancer, cervical cancer or skin melanoma.

The aetiology (cause of) oral cancer is complex. However, the majority of patients with oral cancer smoke and/or drink alcohol - the combination of smoking and drinking significantly increases the risk. There is also a clear association between social deprivation and incidence rates of oral cancer.

Unfortunately, many patients with oral cancer present late, and have a resulting poor prognosis. By contrast, early diagnosis and treatment is associated with a good outcome. Late detection makes more radical treatment necessary, leading to increased morbidity associated with loss of function, aesthetics and psychological health.

Unfortunately 5-year survival rate has not improved (50% overall) for the last few decades except in specialized cancer centres. However, the relatively poor five-year survival rates for oral cancer patients can only be improved by increasing an awareness of the disease amongst health professionals and the public, and by instituting appropriate screening methods to ensure early diagnosis.

THEREFORE IN RUABON Dr. BARCLAY USES THE LATEST TECHNOLOGICALLY ADVANCED NON-INVASIVE SCREENING TECHNIQUE OF TISSUE FLUORESCENCE USING A VELSCOPE MACHINE TO SHOW THE EARLIEST SIGNS OF CANCER BEFORE VISIBLE TO THE EYE.

Early detection increases survival from 50% to 90%

Risks of mouth cancer depends on :-

• Your age and sex
• Smoking and Alcohol consumption
• Chewing Tobacco or Betel Quid with Tobacco
• Infection - Human Papilloma Virus (HPV)
• Diet
• Having a weakened Immune System
• Viruses
• Exposure to some chemicals
• Exposure to Sunlight
• Detection and Diagnosis
• IMPORTANT - See your dentist if you have :-

 

Your age and sex

As with most cancers, mouth and oropharyngeal cancers are more common in older people.  Usually over 50 years of age but there are an increasing number of younger people, some are in their twenties, are getting oral cancer.  Oral cancers are also more common in men than women.  But rates of these cancers in women have been increasing in recent years.  This is because women took up smoking in large numbers much later than men and we are only now seeing the effects.

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Smoking and drinking alcohol

Smoking tobacco (cigarettes, cigars and pipes) and drinking a lot of alcohol are the main risk factors for mouth and oropharyngeal cancers in the western world.  If you smoke you are at a higher than average risk of developing these types of cancers. And drinking too much alcohol also puts you at risk.

Cigarettes and alcohol contain nitrosamines and other chemicals that are known to cause cancer.  The nitrosamines in alcohol pass over the mouth, throat and top of the larynx (the epiglottis) as you swallow.  When you smoke, the smoke passes through your mouth, throat and the larynx on its way to your lungs.  Your risk increases the longer you smoke.  If you are a smoker and also drink a lot, your risk is even higher because they act together to cause cancer.

The risk increases with alcohol  2-3 times the risk with tobacco about 8 times in combination up to 40 times. Do not drink and smoke! 

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Chewing tobacco or betel quid with tobacco

Chewing tobacco or betel quid with tobacco is known to cause mouth cancer and oropharyngeal cancer.  Chewing tobacco or betel quid is very common in parts of Asia.  It is also popular in some immigrant groups in Europe, North America and Australia.

The term ‘quid’ means a substance or mixture of substances put in the mouth and chewed, usually for long periods.  It usually contains tobacco, either on its own or mixed with areca nut (from the Areca catechu tree) and slaked lime.  You wrap the mixture in a leaf called a betel leaf, which is where the name betel quid (also called paan) comes from.  The harmful substances in tobacco and betel quid can cause cancer if they are in contact with your gums and tongue over long periods.

People chew tobacco and betel quid for many reasons.  It can make you feel good, prevent hunger and sweeten your breath.  But more important is that it is a cultural and social habit in many parts of Asia.  Mouth cancer is much more common in parts of the world where people chew betel quid.  Of the estimated 390,000 cases of oral cancer worldwide each year, well over half occur in Asia.  In some parts of India, it is the most common type of cancer.

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Infection - Human Papilloma Virus

The human papilloma virus (HPV) is one of the most common virus groups in the world to affect the skin and mucosal areas of the body. Over eighty types of HPV have been identified. Different types of the human papilloma virus are known to infect different parts of the body. It infects the epithelial cells of skin and mucosa. The epithelial surfaces include all areas covered by skin and/or mucosa such as the mouth, throat, tongue, tonsils, vagina, penis, and anus. Infection with the virus occurs when these areas come into contact with a virus, allowing it to transfer between epithelial cells. This family of viruses is the cause of common and genital warts (sexually transmitted) which are not cancerous.

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Cervical Cancer and Oral Cancer

However there are other forms of HPV which are  sexually transmitted, and are a serious problem. These are; HPV-16, HPV-18, HPV-31, and HPV-45. These cancer-associated types of HPV´s cause dysplastic tissue growths that usually appear flat and are nearly invisible. Dysplastic tissue is the presence of abnormal cells on the surface of the skin. Dysplasia is not cancer, but it is a tissue change seen prior to malignancy. A highly studied topic is HPV´s ability to cause cervical cancer. Dysplasia can be detected on the female cervix through a Pap smear test, or seen visually using a magnifying glass called a colposcope. The most dangerous HPV´s, 16 and 18, which are transmitted through sexual contact are known to cause up to 95% of cervical cancers. Now these two HPV´s are also being linked to oral cancer.

A study done by Dr. No-Hee Park showed that the mouth was, at the cellular level, structurally very similar to the vagina and cervix. Both organs have the same type of epithelial cells that are the target of HPV 16 and HPV 18. The majority of oral cancers are cancers of epithelial cells, primarily squamous cell carcinomas, not unlike the cancers that affect the cervix. Dr. Park's study also showed that smoking and drinking alcohol help promote HPV invasion. Combine tobacco and alcohol with HPV, and the epithelial cells in the mouth, and you may have the formula for the development of an oral cancer.

A recent study conducted by Dr. Maura Gillison at the Johns Hopkins Oncology Center furthered the premise that HPV is linked with certain types of oral cancer. In 25% of 253 patients diagnosed with head and neck cancers, the tissue taken from tumors was HPV positive and HPV 16 was present in 90% of these positive HPV tissues. This information helps to confirm that there is a strong link between HPV 16 and oral cancer. 25% of those diagnosed with oral cancer are non-smokers while the other 75% of those diagnosed have used tobacco in some form during their lifetimes. The research into the relationship of HPV and oral malignancies may give us clues as to the origin of cancer in those 25% of diagnosed individuals who did not smoke. Further research is being conducted into the relationship of HPV with oral cancers.

A recent vaccine is being promoted to teenage females to help prevent cervical cancer so  it may also help prevent some cases of oral cancer.

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Diet

A poor diet may increase your risk of certain types of mouth and oropharyngeal cancer.  This may be because of a lack of zinc, or other vitamins and minerals.  If you eat a well balanced diet, with plenty of protein, you are unlikely to be short of zinc.

A diet high in fresh fruit and vegetables seems to reduce the risk of developing cancer of the mouth.  This may be because these foods contain a lot of antioxidant vitamins and other substances that help prevent damage to body cells.  Eating a lot of processed and salty meat may increase risk of mouth cancer.

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Having a Weakened immune system

If you have a weakened immune system, you are more at risk of some types of cancer, including cancers of the mouth and oropharynx.  Several things can cause a weakened immune system, including Medicines taken to damp down your immune system after an organ transplant  AIDS (acquired immunodeficiency syndrome)

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Viruses

Viruses can help cause some cancers.  But this does not mean that you can ‘catch’ these cancers like an infection.  The virus can cause genetic changes in cells that make them more likely to become cancerous in the future.  Many people can be infected with a virus that could potentially help to cause cancer, but may never actually get cancer.  The virus only causes cancer in certain situations.

Mouth and oropharyngeal (mouth and throat) cancers have been linked to the human papilloma virus (HPV). There are about 80 different types of human papilloma virus (HPV).  This is sometimes called the wart virus, because certain types of HPV cause warts on the genitals and other parts of the body.  Other types of HPV are linked to some types of cancers.  These include cancer of the cervix, vaginal and vulval cancers.

In one large study, scientists found signs of HPV in about 1 in 25 people with mouth cancer (4%), and in nearly 1 in 5 people with cancer in the oropharynx (18%).  HPV 16 was the most common HPV type in these cancers.  This is also the most common strain found in cervical and genital cancers.  There are likely to be other factors at work.  But these researchers found that oral HPV can increase risk of oropharyngeal cancer in particular.

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Exposure to some chemicals

Through your job, you could be exposed to harmful chemicals that can increase risk of mouth and oropharyngeal cancer.  If you have been regularly exposed to Wood dust, Paint fumes, Soot over some years, you may be at increased risk.  If these irritants are around you, you are likely to breathe in and swallow small amounts.  Chemicals in these substances can irritate the lining of your nose, mouth, throat and larynx.

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Exposure to Sunlight

Skin cancers are relatively common on the face and neck, as these areas often see the sun.  Melanoma is the most serious type of skin cancer.  You can get melanoma of the lip and the sun may well cause this.  Most cases of melanoma are caused by too much sun exposure.  More than 30 out of every 100 people (30%) diagnosed with cancer of the lip work outdoors and have been exposed for long periods to ultraviolet rays from the sun.

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Detection and Diagnosis

In its very early stages, mouth cancers can be almost invisible making it easy to ignore. You can improve your chances of survival if the cancer is detected early and rapidly treated. It is important to have a self-awareness and to perform regular self examinations.

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IMPORTANT - See your dentist if you have :-

• A sore or ulcer in the mouth that does not heal within three weeks
• A lump or overgrowth of tissue anywhere in the mouth
• A white or red patch on the gums, tongue, or lining of the mouth
• Difficulty in swallowing
• Difficulty in chewing or moving the jaw or tongue?
• Numbness of the tongue or other area of the mouth
• A feeling that something is caught in the throat
• A chronic sore throat or hoarseness that  persists more than six weeks, particularly smokers over 50 years old and heavy drinkers
• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable
• Neck swelling present for more than three weeks
• Unexplained tooth mobility persisting for  more than three weeks - see a dentist urgently
• Unilateral nasal mass / ulceration / obstruction, particularly associated with purulent or bloody discharge

 

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Reduce your chances of getting these cancers by :-

• Not smoking  (or chewing tobacco, gutkha/paan )
• Limiting alcohol consumption.  We often fool ourselves on how little we believe we drink.  Be aware  a typical modern red wine may have up to TEN UNITS per bottle so ONE glass is almost your daily allowance!
• Having a healthier "low meat, low fat" diet, rich in vegetables and fruit with servings of bread, cereals or beans everyday.
• Be aware of sexually transmitted HPV.

 

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