That oral lesion could be cancer

That oral lesion could be cancer


By Dr NORLI IBRAHIM

ORAL cancer is usually associated with older patients, although its prevalence is increasing in younger patients. Oral cancer was once the third most common cause of deaths in government hospitals in Malaysia. There are reportedly about 300,000 new cases worldwide every year.

Are you at risk? The factors associated with oral cancer in the elderly are:

  • Heavy uses of alcohol and/or tobacco and/or betel leaves;
  • Poor diet and low socio-economic status;
  • Family history of cancer; and
  • Exposure to radiation or other carcinogens.

Worldwide findings confirm that oral cancer, specifically the oral squamous-cell carcinoma, is a disease of the seniors, where a majority of the cases involve those over 50.

Oral cancer can present in both men and women, however in Malaysia, studies show that women are more prone to getting it, especially those who have a habit of chewing betel leaves. The elderly who smoke and drink alcohol are also at a higher risk. Hence, the elderly who smoke, drink alcohol and chew betel leaves are at higher risk of getting oral cancer.

Other risk factors include sunlight exposure, nutritional deficiencies, hereditary influence, ethnicity, syphilis, virus infections like human papilloma virus and occupational exposure to carcinogens.

What does it look like

There may be red lesions, mixed red and white lesions or white plaques. The features vary according to affected sites. For example, a locally advanced oral and oropharyngeal cancer may present with mucosal growth and ulceration, pain, referred pain to the ear, malodour from the mouth, difficulty with chewing, speaking, swallowing and opening the mouth, weight loss, and neck swelling.

Extremely advanced cancers present as ulcerative growths with areas of dead tissue and extension to surrounding structures like bones, muscles and skin. Those with a betel chewing habit may present as an indurated ulcer on the inside of the cheek, which may infiltrate the bone.

What to do

It is proven that early detection, diagnosis and treatment significantly enhances survival rates and reduces morbidity.

The five-year survival rates have not improved over the past decade and this has mainly been attributed to delays in detection. Most people ignore the initial painless lesions until it reaches an advanced state. Even then, some elderly are still reluctant to seek hospital treatment, with some opting to go for traditional treatment instead.

By the time they do see a doctor, it is at an advanced stage and treatment options are limited by then.

Examination

Here’s what you can do at home:

  • Stand in front of a mirror in a room with a good source of light.
  • Look for any red or white or mixed red and white lesions or nodules.
  • Look at the upper jaw (gum area and palate), and lower jaw (gum area and floor of mouth).
  • Inspect the tongue thoroughly – the top, bottom and sides.
  • Inspect the inside of your cheeks, especially the back region.

If you see anything that you are unsure of, see your dentist for a professional examination.

Dentists and medical doctors can help examine your mouth properly and, if necessary, they will perform appropriate investigations.

They will also refer you to specific specialists for the best management of oral cancer.

Management

If it is a suspicious lesion which could transform into oral cancer, the doctor might excise this premalignant lesion and monitor the senior citizen’s mouth.

However, not all oral cancers start with a premalignant lesion. The cancer can exist on its own in the oral mucosa (mucous membrane lining inside the mouth). A biopsy will need to be done to determine the type of oral cancer and how aggressive it is.

X-rays will be done to look for the extension of the lesions and whether it has invaded the bone. All these procedures will give some information regarding the outcome of the cancer. The doctors will then plan for a surgical removal of the cancer and they may decide to combine it with radiotherapy.

Dr Norli Ibrahim is a lecturer at the Department of Oral Medicine Oral Pathology, Faculty of Dentistry, Universiti Kebangsaan Malaysia.

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