Northern Arizona UniversityDental Hygiene

Maxine Janis, RDH, MPH

Oral Cancer

A Public Health Intervention in

Dental Hygiene Practice

What is Oral Cancer?

• Group of neoplasms (abnormal tissue growth) that involve of the lip and oral cavity which can be benign (not cancer) or malignant (cancer).

• Oral Cavity:buccal mucosa, gingiva, front or under tongue, hard palate, and the retromolor region

Oral Cavity and Throat

What is Oral-pharyngeal Cancers?

• Cancers that arise from the back of the throat.

• Base of tongue, palatine tonsils, soft palate, and posterior pharyngeal wall

• 90 % are squamous cell carcinoma

Robert Hermans Cancer Imaging. 2005; 5(Spec No A): S52–S57. Published online 2005 November 23. doi: 10.1102/1470-7330.2005.0030PMCID: PMC1665316

Head and Neck Cancer Statistics

• 41,000 people diagnosed yearly in the U.S.

• Approximately 12,000 deaths per year

Oral Cancer: Changes in Patterns

• Past risk factors: Tobacco, alcohol and over 40 yrs of age

• Today risk factors: HPV –independent risk factor with the highest incidence among those 18-40 yrs of age

www.oralcancerfoundation.org www.cdc.gov

Oral Cancer: Changes in Patterns

• 41,000 HAVE HEAD AND NECK CANCERS EACH YEAR: 50-65% ARE HPV RELATED

• HPV related incidence has doubled since 1974 (National Cancer Institute)

www.oralcancerfoundation.org www.cdc.gov

At Risk

• Newer demographics emerging in addition to traditional demographics

1. Age (younger)2. Non-smokers3. No excessive alcohol use

Oral Cancer Facts

• Oral cancer is cancer that arises in the head or neck region, including the nasal cavity, sinuses, lips, mouth, thyroid glands, salivary glands, throat or larynx (voice box). According to the American Cancer Society, an estimated 52,610 new cases of cancer of the oral cavity and throat, and an estimated 11,500 deaths from these cancers, are expected in 2012.

Signs and Symptoms

• Most oral cancers arise on the lips, tongue or the floor of the mouth.

• They also may occur inside your cheeks, on your gums or on the roof of your mouth.

• Other head and neck cancers arise from the throat.

Some Signs and Symptoms include:

• A sore in your mouth that doesn't heal or that increases in size

• Persistent pain in your mouth• Lumps or white or red patches inside your mouth• Difficulty chewing or swallowing or moving your tongue• Soreness in your throat or feeling that something is

caught in your throat• Changes in your voice• A lump in your neck

Risk Factors• Tobacco (including smokeless tobacco) and alcohol use are the most

important risk factors for oral, head and neck cancers, particularly those of the tongue, mouth, throat and voice box.

• Eighty-five percent of head and neck cancers are linked to tobacco use. • People who use both tobacco and alcohol are at greater risk for

developing these cancers than people who use either tobacco or alcohol alone. (Source: National Cancer Institute).

• Anyone can develop thyroid cancers, although a family history or exposure to radiation is often a factor.

• Salivary gland cancers do not seem to be associated with any particular cause.

Human Papillomavirus (HPV) and Oral Cancer

• Researchers have attributed the increase of head and neck cancer incidence in young adults, a group traditionally at low risk, to the human-papillomavirus (HPV), a cancer-causing virus that can be transmitted through oral sex.

Human Papillomavirus (HPV) and Oral Cancer

• Many studies support that oropharyngeal cancers -- those affecting the tonsils, back of the mouth (throat) and base of the tongue -- have been on the rise since the mid-1980s, and currently 50-70 percent of these cases are caused by HPV infection.

• Many studies show that patients with HPV-positive oropharyngeal cancers are more responsive to treatment and have better survival rates than HPV-negative patients.

Oral Cancer Adjunct Screening Device

Oral Cancer Adjunct Screening Device

Technology of OC Adjunct Devices

• Emits a safe blue light into the oral cavity, which excites natural fluorophores from the surface of the epithelium through to the basement membrane (where premalignant changes typically begin) and into the stroma beneath, causing it to fluoresce.

• The filter makes fluorescence visualization possible, by blocking reflected blue light, and by enhancing the contrast between normal and abnormal tissue.

Pre-clinical discovery

Left palate : low-grade mucoepidermoid carcinoma

SCC

Moderate Dysplasia (cellular changes precancerous)

Lichen Planus – VELscope Confirmed Benign Etiology

What is OHANCAW?• Oral, Head and Neck Cancer Awareness Week® (OHANCAW®) is a

weeklong series of events that aim to educate the public about these potentially life-threatening but eminently treatable cancers and to promote prevention, screening and early detection.

• OHANCAW is highlighted by the free screenings and related activities held at participating medical centers across the country.

• The screenings are quick, painless, and designed to advance early diagnosis, which can lead to better outcomes.

• OHANCAW is sponsored by the Head and Neck Cancer Alliance (HNCA).

Hopi Men’s Night Out

ORAL CANCER SCREENING Event

When is OHANCAW?

• The primary focus of our media efforts will be directed toward awareness activities occurring during this week, but HNCA is encouraging all supporters to pick a week during the year that works best for their group to host a free screening event.

• For more information, go to www.headandneck.org, e-mail info@ohancaw.com or call 866-792-4622.

ConclusionDental Public Health

• Through intra/extra oral examinations is critical

• Oral Cancer Screenings• All lesions must be differentially diagnosed• Persistent lesions must be biopsied• Oral Cancer Awareness campaigns to include

tobacco cessation, alcohol use, sexual practice are critical

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