For decades tobacco was the primary cause of oral cancer but a more insidious culprit has emerged.
Jerry Wilck had no reason to suspect anything. Why would he? He only smoked for a couple of years and gave it up more than 40 years ago. He didn’t drink excessively, didn’t have a family history of cancer, and took good care of himself.
In fact, maybe the only reason the 59-year-old consulted an oral surgeon about the small sore on his tongue – the result of a habit of running this particular spot along his teeth – was that there happened to be such a specialist right there in his office.
Wilck was a general practice dentist in Langhorne, Pa., and particularly attuned to anomalies of the soft tissues of the mouth. His oral surgeon took no chances and ordered a biopsy.
Wilck was “floored” the night in March 2005 when the lab report arrived by fax from the oral pathology department at Temple University in Philadelphia – squamous cell carcinoma.
Wilck immediately consulted with John Ridge, MD, PhD, FACS, chief of head and neck surgery at Temple’s Fox Chase Cancer Center. After surgical removal of part of his tongue and lymph nodes from his neck, along with a round of physical and speech therapy, Wilck is now cancer free and has full use of his jaw, throat and voice.
“I was lucky,” confessed Wilck, who retired from practice in 2009 and now spends a large part of his time speaking to dental students, advocacy groups and the media about the dangers of oral cancers. “The surgery was successful and I didn’t need radiation or chemotherapy. A lot of people in other lines of work might have ignored the symptoms. My story could have ended very differently.”
Under the Radar
Wilck was one of the fortunate cases caught early and treated effectively.
Oral cancer, along with cancers of the head and neck, respond well to treatment when detected early in their development, explained Dong Moon Shin, MD, FACP, Frances Kelly Blomeyer Chair in Cancer Research and professor of hematology, medical oncology and otolaryngology at Emory University School of Medicine in Atlanta.
A leading researcher in the field of oral cancer, Shin has authored more than 220 peer-reviewed articles and is principal investigator of Emory’s National Cancer Institute-funded Head and Neck Cancer Specialized Program of Research Excellence (SPORE), an interdisciplinary research collaborative on the forefront of discovering treatments and preventive measures for these cancers, along with other NCI-funded research programs.
Shin’s current research directions center on prevention with natural compounds (including green tea and cancer-fighting agents found naturally in vegetables), along with anti-cancer drug delivery with nanotechnology – using nanometer-sized particles with novel properties engineered for the targeted delivery of anticancer drugs into cancer cells, while sparing healthy cells. Such “smartly” formulated nanoparticles carrying anti-cancer drugs can be specifically delivered to the cancer cells, thus minimizing side effects and maximizing the anti-cancer activity of the drugs, explained Shin. “Nanotechnology has the potential to revolutionize cancer care.”
Despite these encouraging research avenues, oral cancer is a specialty area deserving of more physicians and scientists such as Shin devoted to it, said Terry Day, MD, FACS, director of the division of head and neck oncologic surgery and the Head and Neck Tumor Center at Hollings Cancer Center at the Medical University of South Carolina in Charleston.
What You Need to Know about Oral Cancer:Christine Brader an oral cancer activist who has survived three bouts with the disease.
While oral cancer kills almost three times as many people as cervical cancer – one person dies every hour of every day from the disease, according to the Oral Cancer Foundation – it often receives less attention than more recognizable forms such as cancer of the skin or lungs.
“During my medical school training I began to see that these patients often had nowhere to turn,” said Day of the dearth of qualified specialists. He decided to make it his career’s mission to treat this complex, disabling, and potentially deadly subgroup of oncology.
“To look in the mirror and not recognize the person looking back at you – it’s shocking,” said Christine Brader, 49, an oral cancer activist who has survived three bouts with the disease. “I couldn’t believe it was me. Children would be scared of me out in public. I looked like a monster.”
After “too many surgeries to count,” including the removal of her teeth and half of her jaw, implantation of a titanium plate (which her body rejected), and radiation and chemotherapy, Brader is now cancer free and maintains the use of her voice.
But it wasn’t an easy road. Oral cancer affects everything, said Brader – the way you look, the way you speak, your ability to eat and swallow. She spent two weeks in a medically induced coma, months in the hospital, and a grueling year-long recovery to get where she is today. She had to give up her job, her dogs, and her beloved home in Lehighton, Pa. The single mother of two had no caregiver to depend on, making the treatments even harder to get through.
“This is different than breast cancer and [cancer of] the internal organs,” said Brader, who is now independent but lives with many aftereffects and tires easily. “There’s no hiding it with clothing.”
She spends much of her time volunteering for the Oral Cancer Foundation’s public forum, helping new members and speaking at awareness events. She speaks to young people and the media regarding the dangers of smoking and chewing tobacco. She shares her story freely with the media, attends oral cancer screening events and volunteers for anti-smoking groups. She appeared in a TV commercial for Truth, a national anti-smoking prevention campaign, and the CDC’s Tips From Former Smokers Campaign.
“I try to make a difference,” Brader said. “I tell young people, ‘if someone you know starts smoking, be a friend and try to help them quit.’ It could save their life. By never starting to smoke, you never have to quit.”
Emergence of HPV
Brader began smoking as a teenager as a result of peer pressure, and continued the habit throughout her life. Her journey with oral cancer represents the traditional path – for decades, oral cancer was a disease of lifelong tobacco users that showed up later in life.
Fortunately, patient education regarding the riskiness of smoking, chewing tobacco and alcohol abuse has lowered the incidence of oral cancers from those origins, said Day.
However, a new contributing factor has moved into its place – human papilloma virus number 16 (HPV16). HPV16 is a common sexually transferred virus that is also responsible for the majority of cervical cancers in women. It’s now responsible for about 52% of newly diagnosed patients with oral and oropharyngeal cancer, according to the Oral Cancer Foundation.
The emergence of HPV16 as a risk factor has changed the demographic of oral cancers in the U.S. The disease is trending younger; the fastest growing segment of the oropharyngeal cancer population is those between the ages of 25 and 50, said Day. This is primarily due to HPV16, and cancers from this origin typically occur in the area of the throat behind the mouth, in the oropharynx, tonsils, and at the base of the tongue.
It also means oral and oropharyngeal cancers can strike in subtle silence; when in years past, a history of smoking or using chewing tobacco might prompt primary care physicians and their patients to be more diligent in screenings, HPV is a silent invader that can display little or no symptoms until it’s too late.
“HPV is definitely the coming epidemic in oral cancer,” said Brian Hill, a stage four oral cancer survivor and founder of the Oral Cancer Foundation. Hill had never used tobacco and his cancer – of an HPV16 etiology – was detected after bilaterally metastasizing and progressing into his cervical lymph nodes.
“My own journey included radiation and surgery, back in the days before IMRT [intensity modulated radiation therapy], and a very difficult and protracted recovery with significant quality of life issues, now a decade out,” Hill said.
Partners in Prevention
For Day, the ideal strategy to get a handle on the disconcerting mortality rates associated with oral cancer arises from a partnership between primary care physicians and dental professionals providing routine screenings for early-stage symptoms and swiftly referring to specialists.
Survival rates after early detection (stages 1 and 2) can be 80%-90%, while survival rates of late-stage detections (after the disease has advanced to stage 3 and 4) fall to 40%-50%, said Shin.
Head and neck screenings for cancer are relatively simple, painless, two- to three-minute visual and tactile exams performed in the dentist’s office, said Seung-Hee Rhee, DDS, FAGD, a general practice and cosmetic dentist in New York City, and spokesperson for the Academy of General Dentistry.
“You’re looking for any asymmetries, sores that don’t heal, abnormal lesions that seem suspect,” said Rhee, who makes these screenings part of her regular dental exams along with obtaining a thorough patient history to uncover potential signs and risk factors before they become major problems.
And new technology is making these screenings even easier for dentists, explained Rhee. Handheld blue-spectrum light emitters such as the Velscope shined inside the mouth will illuminate soft tissue abnormalities in different patterns than healthy tissue. This can aid dentists in detecting cancers even before they can be picked up by the unassisted eye.
“Early detection is where we’ll make a difference,” said Rhee. “[Dentists] are often the first line of defense.” She adds that HPV vaccinations for cervical cancer administered in the pre-teen years are another potential course of action being studied to help prevent these diseases. The Oral Cancer Foundation supports the use of the HPV vaccine for its potential in reducing the incidence of oral cancer, though the FDA currently prohibits drug manufacturers from making this specific claim.
“We highly encourage people who have precancerous lesions in the oral cavity or voice box [to] participate in clinical trials of chemoprevention to block the progression to invasive cancer,” said Shin.
Spreading the Word
While dental professionals work on the front lines to detect cases early, and researchers work tirelessly to unearth promising new treatments,
Wilck, Brader and a small army of former patients and activists travel the country speaking to schools, community groups and media outlets to underscore the importance of avoiding risk factors and receiving periodic screenings.
To mark Oral Cancer Awareness Month, the Oral Cancer Foundation is teaming with dental offices nationwide to offer free oral cancer screenings throughout April. Over 1200 free screening events are taking place in dental offices across America. A list is viewable at www.oralcancer-screening.org/events/.
The Head and Neck Cancer Alliance this year sponsored the 16th annual Oral Head and Neck Cancer Awareness Week April 14-20, said Day, who serves as president of the HNCA. This weeklong series of events promotes awareness and offers free screenings. Details are at http://www.ohancaw.com/.
“Reducing the high death rate associated with oral cancer is a tangible opportunity today,” said Hill. “We do need increased public awareness, coupled with an engaged professional dental and medical community doing opportunistic screenings.”
“My role these days is to keep people from taking the same path I did,” said Wilck. “If I reach just one person, it’s been worth it.”
*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.