The confluence of poor oral hygiene, alcohol and tobacco increases the risk of oral cancer by 30 times

Oral cancer is the seventh most frequent, and with an increasing incidence. It is very aggressive and fast-growing, its prevention and early detection being crucial

Oral cancer is part of the larger group called “Head and Neck Cancer”

What is meant by oral cancer and what impact does it have on our country?

Oral cancer is part of the broader group called “Head and Neck Cancer” which includes, in addition to the oral cavity, the cavum, the nasopharynx, oropharynx, hypopharynx and glottis, the salivary glands, certain areas of the base of the skull and the neck.

“It is one of the few tumors whose incidence will grow in the coming years”

Within this denomination of oral cancer, what tumors are distinguished and what are the main management difficulties they present?

Oral cancer is dominated in more than 90% of cases by a histological variety called epidermoid carcinoma, squamous cell carcinoma or squamous cell carcinoma. All these terms are synonymous and take their name from the histological appearance, which is somewhat reminiscent of the stratified layers of the skin. The remaining 10% is disputed by a huge variety of histological types, much less frequent.

“It is more frequent in elderly men, but a significant change in trend is observed”

Oral cancer presents its main difficulty in the fact that it is a very aggressive, fast-growing and very lympholytic tumor, that is, with a great desire for lymphatic tissue and a brutal capacity to produce lymphatic metastases in the cervical territory. In addition, it is a tumor with a great capacity for perineural invasion.

“Alcohol, tobacco and poor oral hygiene are the main determinants of the appearance of oral cancer

In oral cancer, what impact do tobacco and alcohol have on the risk of developing this type of tumor?

One of the best known and most endorsed issues in the literature in relation to oral cancer for more than 40 years is that alcohol consumption, tobacco smoking and poor oral hygiene are the main clinical determinants of its appearance. Usually in epidemiology this is measured in terms of relative risk; When these three etiopathogenic factors are present, and converge simultaneously, the relative risk multiplies exponentially, exceeding the value of 30 (a 30-fold increased risk of suffering from oral cancer).

However, in recent years we have been observing numerous cases of oral cancer in younger patients (regardless of gender), who do not smoke or drink alcohol and who are in good oral health. This is a group of patients in whom a high viral load of the human papillomavirus is detected, even in tumor cells, so this virus-cancer association continues to be investigated, for which there is already a certain history in cancer of the cervix.

“We have not managed to improve oral cancer survival; It has remained practically stable for more than 25 years.

To what extent is it important to make an early diagnosis of these cases?

Despite the impressive development of cancer treatment techniques and the dizzying development of surgery that removes malignant tumors and their metastases and performs reconstructions of vital structures to be able to breathe, speak and relate to each other, oral cancer survival has not been achieved. to improve and, in fact, it has remained practically stable for more than 25 years in the 50-60% range.

“The survival rate is directly related to the stage at which oral cancer is initially diagnosed”

The reason for this is that the survival rate is directly related to the stage at which oral cancer is initially diagnosed. There are four stages (I, II, II, and IV, the latter being the most serious), with various variants within each of these groups. For stage I, overall survival is greater than 85%, while for stage IV it barely reaches 15%.

“Early diagnosis is the basic and fundamental element to predict the possibility that a patient with oral cancer will survive”

Well, the main determinant for the stage at which oral cancer is diagnosed is early diagnosis; We must not forget that detecting oral cancer when it is already in stage IV means that it has successively passed through the previous stages without being diagnosed or treated. Therefore, the early diagnosis of oral cancer is the basic and fundamental element when it comes to predicting the possibility that a patient will survive.

“In the early diagnosis of oral cancer, the dentist is essential”

In the early diagnosis of oral cancer, the dentist is essential, because it is this professional who usually first treats patients with warning signs, potentially cancerous lesions or incipient signs of oral cancer. These signs are, fundamentally, ulcerations that (whether painful or not, bleeding or not) remain unhealed within two or three weeks once the possible cause that could have produced them has been eliminated. In this sense, taking a biopsy by the dentist himself in the event of any suspicion of oral cancer is crucial.

“Periodic information campaigns aimed at the general population are essential”

From a therapeutic point of view, what main resources exist to treat oral cancer and what prognosis does it usually have?

The prognosis depends on the stage at which it is diagnosed, and this stage fundamentally depends on the size and depth of the tumor, the invasion of nearby structures, and the presence of distant metastases.

There are four main resources for the treatment of oral cancer: 1) surgery, in its triple aspect of tumor removal, elimination of lymphatic metastases and reconstruction of the excised maxillofacial structures; 2) radiation oncology; 3) medical oncology, mainly in advanced stages and with multi-organ involvement; and 4) medical and dental support treatments. Among the latter, the performance of the dentist is critical and fundamental, conditioning oral health to the most optimal levels possible before addressing the rest of oncological treatments.

“Improving oral cancer survival is easy: we have to ensure that patients are diagnosed at earlier stages”

Any advice to have a positive impact, from oral health, on the risk of appearance and/or evolution of certain tumors?

Insist on the importance of early diagnosis. To this end, periodic information campaigns aimed at the general population are essential, as well as the proactive search for precancerous or potentially cancerizable lesions and signs and warning signs of cancerous lesions; To this end, it is essential that citizens are aware, have a highly developed habit of oral self-examination and regularly attend scheduled check-ups with their dentist at intervals not exceeding six months.

It would be easy to improve the survival of oral cancer that we currently have; we simply have to ensure that patients are diagnosed in earlier stages of the disease.

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