Oral Cancer

Vicki:

Welcome to an HMC Health Works podcast. Today, we’re going to be talking about oral cancer. The American Cancer Society estimates that 53,260 people in the U.S. Will be diagnosed with oral cancer sometime in 2020. Today, we’re joined by Megan Saima, who is a dental hygienist in the Advanced Dental Practice, and they have offices in Berlin and Cromwell, Connecticut. Thanks for joining us, Megan.

Megan:

Thank you so much, Vicky, for having me here today.

Vicki:

Talk to me a little bit about the importance of oral cancer awareness.

Megan:

Because symptoms of oral cancer can mimic those of a less serious condition, awareness is extremely important. If you have persistent pain in your mouth or a sore that won’t go away, you may need a diagnostic evaluation to rule out if you have cancer or not. A dentist who is experienced and identifying cancers of the oral cavity may help determine whether an evaluation is necessary and if you need to be referred out to a doctor who is experienced in treating oral cancers.

Vicki:

Tell me some of the symptoms of oral cancer.

Megan:

There’s a lot of symptoms of oral cancer. A couple of them are a mouth sore that won’t go away, mouth pain that won’t go away, a lump or a thickening in the cheek, a white or red patch on the gums, tongue, tonsils, or lining of the mouth, a sore throat or a persistent feeling that something is caught in the throat – and that usually last longer than two weeks – difficulty swallowing or chewing, pain and the teeth or jaw, and lastly, a change in voice.

Vicki:

It sounds like a lot of these symptoms that could be oral cancer might be mistaken for maybe a less serious thing, like a toothache or a mouth sore. If somebody has one of those and it persists, what should they do?

Megan:

Since it can be serious, you should definitely call your dentist or your doctor. At that point, they may recommend further testing to check to see if it is oral cancer.

Vicki:

Let me ask you about what you do and your important works to dental hygienists. How do you check for an oral cancer when a patient comes in?

Megan:

I check for oral cancer at every single hygiene recall visit. Usually that’s either two, three or four times a year. I first start off, as soon as I see the patient, I assess for abnormal movements, speech, or asymmetry upon greeting the patient. I then obtain an updated dental, medical, and social history. It’s important to see if there’s any changes with all of that to see what’s going on. Next, I go into the oral cavity and look around. I look everywhere. I look on the side of the tongue, the soft palate, the hard palate, and the cheek to check to see if there’s any abnormalities that concern us. In our office, we actually use an oral cancer screening tool. We usually do those one time a year, or when we have a new patient come in. It’s called a VELscope and it’s a hand piece that emits a safe, visible, blue light to the oral cavity is to help detect cancers early. So that’s some things that we do in our office.

Vicki:

Megan, you guys are covering all the bases, so that sounds great. And I can speak from having you as my own hygienist. I feel so much better when I leave there. When I went to Advanced Dental to start with, I had never had the screening with the light before. That’s many, many years of seeing different dentists. So, thanks for that robust talk and letting us know what you do. The other thing I wanted to ask you: is oral cancer different from other cancers?

Megan:

Almost all it were oral cancers are squamous cell carcinoma. That’s why treatment is often guided, not by the cancer type, but by its location. Even though the oral cavity is a small space, it’s made up of many different types of tissues. The most common locations for cancer in the mouth are your tongue, your tonsils, your throat, your gums, and the floor of the mouth. Those are all the places that we definitely look for when we do the head and neck oral cancer screening at each of your visits.

Vicki:

What type of doctor should people see if they think they have oral cancer?

Megan:

If you think you have oral cancer, those are all the symptoms that we went over before, anything that lasts longer than two weeks, you might want to consider requesting a diagnostic evaluation with either your dentist or your doctor. They can determine whether you should see an oncologist that is specifically trained in treating diseases of the mouth and the throat.

Vicki:

Okay. Good information. If you had one important message regarding oral cancer for our listeners, what would it be?

Megan:

It would definitely be that oral cancer is more treatable when caught early. Delayed or mistaken diagnosis are a significant concern in catching oral cancer early, largely because early symptoms don’t seem serious, like anything else. A primary care physician may recommend an antibiotic for a mouth sore, for example. By the time it becomes clear that the antibiotic isn’t working, it maybe several weeks before the doctor recommends a visit with a specialist. That’s why you should consider seeing your primary care physicians if you do have any symptoms that may be indicated of oral cancer, and then they’ll refer you out to a specialist if they’re concerned.

Vicki:

Okay. That makes sense. How is the oral cancer typically treated if someone is identified?

Megan:

Typically you will have an oral cancer treatment plan. It’s determined by where the cancer originated, whether it’s spread, and how severe the side effects might be. Treatment also may be influenced by the stage of cancer and the patient’s individual needs and treatment goals. Oral cancer can be treated by either one therapy or a combination of therapies, depending on where the cancer started and if it has advanced. Surgery is usually often used to treat oral cancer if it hasn’t spread, but you also may need radiation therapy, chemotherapy, or targeted therapy.

Vicki:

That makes sense. That’s good to know. I think you have multiple tools to use to try to help you if you do have oral cancer. Can you tell me what some of the risk factors are for oral cancer that people should be aware of?

Megan:

Some of the risk factors are your gender. Oral cancer is twice as common in men as it is in women. Another risk factor is your age. Usually people that are over the age of 55 are at a higher risk, but it can occur in younger people as well. Ultraviolet light… That’s people that have a lot of exposure to sunlight, especially those people that work outside or visit tanning beds. Poor nutrition. There is a link between diets that have low fruit and vegetables and an increased oral cancer risk. And there’s also genetics as well. So, there’s all different types of risk factors for oral cancer.

Vicki:

Okay. So definitely these ones that you just described, your age people’s age, their gender or any hereditary trait, those are just things that we can’t control. Are there risk factors for oral cancer that we can control?

Megan:

Absolutely. Some of those are tobacco use and alcohol use. With those two things you have increased risk for oral cancer, like anything else. Especially if you use tobacco use and alcohol use put together, then you’re at an even more higher chance of getting oral cancer.

Vicki:

That’s definitely something to think about. I had also read that for people who smoke and drink heavily that their risk of oral cancer is like a hundred percent more than people who don’t smoke or drink at all.

Megan:

Correct.

Vicki:

If they haven’t stopped smoking, they should. And if they drink a lot, maybe stop or just drink more moderately.

Megan:

Exactly.

Vicki:

Are there any other conditions that may pose a risk factor for oral cancer?

Megan:

There is. One of them is an HPV infection. That’s also known as the Human Papillomavirus. HPV includes about 200 similar viruses. Many HPVs caused the warts, but some can lead to cancer. The CDC estimates that 70% of the us oral pharyngeal cancers are associated with HPV, but luckily there is a vaccine to help protect ourselves from HPV. Specifically HPV 16. So we can try to protect ourselves against that.

Vicki:

That’s good. Hopefully females and males will get that vaccine. That’s good to know. I also wanted to ask you what are some of the potential side effects of oral cancer treatment?

Megan:

Aside from side effects that may affect appearance and function of the oral cancer treatment, you may also experience weight loss, fatigue, nausea, diarrhea, taste changes, dry mouth and constipation.

Vicki:

So even if they experienced like a permanent effect related to the oral cancer treatment, are there supportive services that might help?

Megan:

Yes, there are. You can go to a therapist that can help address those problems with dry mouth, difficulty swallowing, loss of voice and cognitive changes. But providers also may suggest some supplements to prevent and treat nausea, and reduce acid reflux, heartburn, bloating, and gas and diarrhea.

Vicki:

Yeah. That’s good to know that there are support people out there for all of those different conditions. I did want to ask you, Megan, before we close today, can you tell me any of your your final thoughts of how we can maintain good oral hygiene that will help us avoid oral cancer?

Megan:

Yeah. Number one is definitely go to your dentist on a regular basis, at least twice a year to help prevent either oral diseases, but also these oral cancers that we can help detect as a dental professional. Hopefully we will be able to catch those oral cancers before it’s too late.

Vicki:

That definitely makes sense. And on a personal note, you recommended for me to get a water pack and that has been very helpful for me. So I would tell our listeners that was one of Megan’s great suggestions, and it has definitely helps me with gum issues. Megan, I really want to thank you for giving us your valuable insights and all this important information today.

Megan:

Thank you so much for having me here. And I hope everyone stays safe during this pandemic we are facing at this time.

Vicki:

Yeah. Thanks so much, Megan. I want to remind our listeners, please be sure to join us for future HMC Health Works podcasts. Go to www.HMChealthworks.com for information on having a healthy body and a healthy mind. And for our Connecticut listeners, be sure to check out www.advanceddental.com for more information on seeing Megan or getting some support from Dr. Maroon. Thanks so much.