A silent killer and too often underestimated: Tomorrow I will tell the umpteenth patient that the histological report confirms the clinical diagnosis of carcinoma spinocellulare. Every year, in Italy, there are about 4 thousand new cases of this type of cancer which is usually diagnosed at an advanced stage. This is also because the About 50 percent of people are unaware that cancer can also affect oral tissues and wait months before seeking advice from your doctor or dentist. That lady is unlikely to live long and during the time she has left she will have serious problems drinking, eating, talking, socializing. Who speaks the professor Antonio Carrassi, director of the complex operative unit of Odontostomatology II-Oral Medicine and Pathology and Geriatric Dentistry, Asst Santi Paolo e Carlo of Milan. Of those cases, many are seen in the structure he manages.
Late diagnosis
The current situation must absolutely be changed: a type of tumor globally more frequent than, for example, melanoma, laryngeal carcinoma, just to name a couple of examples. Furthermore, the mouth can be inspected with great simplicity, and the clinical picture of an initial oral cancer, as a rule, sufficiently typical. but yet patients arrive with advanced cancers and the main reason lies both in the delay with which patients go to the healthcare professional and in the delays that can occur after the first visit, either poor specific competence of the dentist or doctor who first visit the patient you want for bureaucracy. On the other hand, any lesion of the oral mucosa for which the dentist or doctor is unable to categorically exclude a neoplasm should be referred immediately to a specialist or a third-level health facility and in general any lesion of the oral mucosa that does not heal spontaneously within two weeks must be referred for a specialist opinion.
What are we talking about
Let us try to explain well what these neoplasms are. These are malignant tumors that 90% of them derive from epithelial tissue, therefore from carcinomas. Normally when we talk about oral cancer we refer to oral cavity cancer. Sarcomas, melanomas, lymphomas are rare. There are 9,900 new cases of carcinoma of the upper digestive airways per year, of which 7,300 in males and 2,600 in females. Of these, the share attributable to oral cavity carcinoma is approximately 4,500-5,000.
How can you tell?
Symptoms, in the very early stages of the disease, may be modest or even absent. A disorder that may precede the onset of clinical signs is pain where the lesion will occur and which can then be associated with the tumor. They are the signs of the disease, rather than the symptoms (subjective sensations, ed), to assume importance. But what about the presentation of oral cancer is appropriate distinguish between that of the lip and the intraoral one. That of the mouth usually occurs if at the level of the lip, such as an ulcer followed by the formation of a scab.
So should any cuts or ulcerations be suspected?
Many patients underestimate these injuries also because they may have in the past suffered from cold sores which heals with the formation of a small crust. But in the latter case theand lesions resolve spontaneously within two to three weeks. If this period of time is exceeded, the patient should immediately seek the advice of the doctor or dentist. An important risk factor for lip cancer continuous and lasting exposure to sunlight. Fishermen, farmers and sailors are more at risk. Intraoral carcinoma, it mainly affects (in 50 percent of cases) the language and the first clinical sign, as a rule, is represented by a color change of part of the fabric: red, red and white or just white. Less frequently the initial appearance is that of a hard, painful ulcer or a “new formation”
How advisable to behave?
If a person notices the appearance in the tissues of the oral cavity (tongue, mucous membranes of the cheek, floor of the oral cavity, gum, palate) of a red or white or mixed patch or ulcer, or the appearance of a neoformazione who is unable to trace back to a known event (for example burnt while eating a pizza, accidentally bitten, traumatized the mouth by eating) and does not regress in two weeks, must contact the dentist or doctor immediately. What is happening at the moment, not only in Italy, but in various countries where studies have been conducted on that the patient with oral cancer seeks the advice of a healthcare professional very late, often 3-4 months after the onset of symptoms and lesions, with this delay affecting the outcome of treatment and the prognosis of the disease. In turn, the doctor or dentist can further delay the clinical path by seeing the patient with delay or by not adopting the appropriate procedures.
Are men more affected or women?
I’m very men are more affected than women, especially after 45 years of age. Are there risk factors that predispose to cancer? The main ones are tobacco and alcohol. In recent decades, moreover, it has become increasingly evident and documented the role of HPV, the human papilloma virus, specifically its subtypes 16 and 18, which we know is the leading cause of cervical cancer and affects 500,000 women every year. We now know that that virus plays an extremely important role particularly in cancer of the base of the tongue and oropharynx.
How is the diagnosis made?
Diagnosis starts fromclinical examination of the oral cavity, which is very simple to carry out, fast and extremely indicative. It takes a few minutes and is conducted without discomfort for the patient. If it is not possible to attribute a given injury to a specific disease the patient will be referred to the specialist who will be able to make a certain diagnosis based only on the clinical picture or, in case of uncertainty, will plan a biopsy and a histopathological examination.
What are the possible treatments?
Treatment depends on the staging of the cancer. Primary therapies are basically surgery and radiotherapy, also associated with each other. With what results? Normally good prognosis in less aggressive and slow-growing lip cancers. The situation is worse for intraoral carcinomas, extremely more aggressive. In cases where the lesions are diagnosed in the early stages, therapy is early and there is no lymph node involvement five-year survival of about 80 percent for treated patients. The rate drops to 50 percent if there is already a lymph node involvement and al 10-20 percent if the lymph node involvement was massive.
Shouldn’t we focus on prevention?
it is necessary to counteract diagnostic delays with interventions aimed at raise awareness of what the mouth really is, on the fact that caries, gingivitis and periodontal diseases are not the only morbid conditions that can afflict this area and on the more than documented and proven relationships between oral health and general health, emphasizes Professor Carassi. Interventions must be implemented to contrast the main risk factors, tobacco and alcohol, health professionals must be involved in continuous training on this issue e must be developed a hospital network that includes dentistry among its operating units. Implementing initiatives to combat the use of tobacco and alcohol abuse would not only decrease the risk of getting oral cancer but it would benefit all other diseases linked to the same risk factors, such as cardiovascular, pulmonary and all other types of cancer in which tobacco is a cause.
May 17, 2021 (change May 17, 2021 | 19:08)
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