• 4/19/2004
  • Stephen Engroff, M.D., D.D.S.
  • PR Newswire

What did former president Ulysses S. Grant, baseball legend Babe Ruth, actor Yul Brynner and musician George Harrison all have in common? They were all diagnosed with, and died from, cancer of the head and neck. This form of cancer often gets little attention, but it remains a significant health-care problem. This disease is often missed in its early stages and, when diagnosed in its later stages, treatment becomes extensive and survival is often compromised.

Most cancers of the head and neck begin in the mucosal lining and are termed squamous cell carcinoma. They frequently involve the mouth and throat and are commonly referred to as oral cancer. It is estimated that about 28,000 cases are diagnosed in the United States every year. Of the reported cases, 1,380 occur in Pennsylvania and about 350 Pennsylvanians die of this disease every year.

Symptoms associated with oral cancer include white and red patches that persist for more than two weeks, non-healing ulcers, persistent sore throat, the feeling of a lump in the throat, loosening of teeth and pain that may radiate to the ear.

The most commonly associated risk factors for development of oral cancer are tobacco (smoking and smokeless tobacco) and alcohol use. When these two things are combined, the risk increases substantially. Although a majority of oral cancer patients have these risk factors, there is a growing number who do not have any known risk behaviors.

Treatment options depend on the stage of the disease and the areas that it involves. Surgery and radiation therapy are the most effective treatments. In the early stages, one form of treatment is sufficient. When the cancer has reached later stages, survival is increased with surgery followed by radiation. In certain instances, chemotherapy may be necessary.

Long-term survival of oral cancer is a major issue. Since the 1950s, overall survival has changed very little. When patients are diagnosed at an early stage, survival is excellent (90 percent). However, there is a low rate of cure for patients with advanced stage disease (25 percent). Low cure rates are attributed to the fact that, for many patients, their disease is not discovered at an early stage. Routine screening is advised by the American Cancer Society, including an oral exam, and should be done every three years for patients age 20 to 40 and yearly thereafter. Your medical or dental provider should do screenings.

Fortunately, one aspect of treatment that has advanced in recent years is reconstruction. In the past, surgery for oral cancer was often accompanied by a high degree of deformity and dysfunction, leaving patients with significant problems with speech and swallowing. New advances in reconstructive surgery have allowed head and neck surgeons to replace missing tissues and significantly improve quality of life for patients. Techniques that “transplant” tissues from other areas of the body to the head and neck have allowed the most ideal types of tissues to be used for reconstruction. Surgeons are now able to replace large sections of bone, soft tissue, and teeth, often allowing patients to maintain their appearance, their ability to eat and their ability to speak.

The most important messages relating to oral cancer are: modify behaviors that put you at risk for this disease, be aware of changes in your mouth and have regular check-ups.

Evaluation and treatment of seemingly small and non-painful lesions of the mouth may, in fact, save your life.

Stephen Engroff, M.D., D.D.S., is in private practice in State College and is credentialed to practice at Mount Nittany Medical Center. He specializes in oral and maxillofacial surgery and has a particular interest in oral cancer treatment.