‘Oral Cancer: the crucial role of early detection and diagnosis’

Chances are if you are not wearing loupes and benefitting from the use of magnification in your clinical practice, you may be missing subtle changes in the oral environment.  If those subtle changes are related to an aphthous ulcer, there is not too much at stake.  However, the oversight of a pre-cancerous or cancerous lesion may have a devastating outcome for the patient in the chair.  It may even be a matter of life or death. 

 

The real numbers behind Oral Cancer

Here are the facts:

  • The estimated number of new cases of oral cavity and pharyngeal cancer in 2020 is 53,260. (1)
  • The five-year relative survival rate is 66.2% with estimated deaths in 2020 to be approximately 11,000. (1)  
  • To illustrate this, cancer of the tongue possesses an 81% five-year survival rate if discovered in a localized stage, meaning there is no indication that the cancer has spread outside of the organ in which it started. (2)
  • If discovered in the regional state, where there has been spread to nearby structures or the lymph nodes, the survival rate falls to 68%. (2)
  • If the cancer has further spread to distant parts of the body, the five-year survival rate plummets to 39%.(2)

As you can clearly see, the stage of discovery is a powerful predictor of both chance of survival and quality of life.  Unfortunately, oral cancer is routinely discovered late in its development, contributing to a particularly high death rate. (3)

 

The challenges of the oral cavity anatomy

A newer profile attributed to a persistent infection with a high-risk strain of the Human papillomavirus (HPV) is fueling an escalation in head and neck cancers, particularly of the oropharynx.   Due to posterior anatomical occurrence, these areas are challenging to identify.  The high-risk anatomical areas affected by the historic etiological pathways of smoking, smokeless tobacco products and alcohol are the palate, tongue and floor of the mouth. 

Quality of life is significantly improved when oral cancer is discovered in an earlier stage or better still, a pre-cancerous stage.  The disparity in quality of life for an early stage cancer patient vs. a late stage cancer is glaringly obvious.  Gross disfigurement, skin grafting, inability to speak or swallow and continual fear of a recurrence are just a few of the daily challenges an oral cancer patient with later stage discovery will face. 

 

 

Magnification and its impact in early detection

In any anatomical area, it’s crucial to early identify mucosal changes in surface texture, color and friability, rather than having the patient bring those to our attention several months later at a re-care appointment.  Often these changes are so subtle that our own unassisted vision will not easily reveal a deviation from normal.  This is where magnification and optimal illumination are essential components to ensure the best possibility for earlier discovery of oral abnormalities and oral cancer.

As an oral cancer advocate and international speaker on this subject, I strongly urge all dental professionals to offer every patient the best possible opportunity for early stage discovery. That’s accomplished through the use of magnification and optimal illumination. Our patients deserve the best care we can offer. It is our responsibility to give them that.

It’s great to save a tooth, however, there is no greater sense of elation than having discovered oral cancer in a stage early enough to save a life. The value of magnification coupled with enhanced illumination increase our capability to notice subtle changes, improve the chance of earlier discovery and impact the quality of life for those battling oral cancer. 

 

Variable magnification