The Seven S's of Early Detection for Oral and Oropharyngeal Cancers

Dennis M. Abbott, D.D.S.

April is Oral Cancer Awareness Month.  Each year, I make an extra effort during the month to participate in activities related to raising awareness about and promoting the early detection of oral and oropharyngeal cancers outside of the lectures I give throughout the year.  Yesterday, I was honored to be a part of one such event:  the Oral Cancer Foundation’s Walk/Run in Dallas, Texas.  Over the years, I’ve had the privilege of participating in these OCF Walks from Milwaukee, Wisconsin to San Antonio, Texas; and at every event, I am humbled by the stories of hardship and struggles of cancer treatment as told by oral cancer survivors and their families.

There are, unfortunately, many who still believe that oral cancer is something they will never have to worry about since they do not use tobacco or drink alcohol.  Such naiveté could not be further from the truth!  Oral and oropharyngeal cancers no longer affect only older men with a social history of smoking and drinking.  The human papilloma virus (HPV) is now known to play a role in the development of many oropharyngeal cancers in men and women from their mid- to late-twenties and older.  Everyone should be educated about HPV and know how he or she can protect themselves from the virus’ effects.  Below are some quick facts about HPV that everyone should know…

• HPV is known to play a role in the development of oropharyngeal cancer in men and oropharyngeal and cervical cancers in women.
• HPV is transmitted via homosexual and heterosexual contact including oral sex, vaginal sex, and anal sex.
• Infection with HPV is the most common sexually transmitted infection.
• The majority of persons who are or have been sexually active have been infected at some point with HPV.  Most people are unaware of when they are infected.
• Unlike other sexually transmitted infections and diseases, HPV can normally be cleared by the body’s immune system within six to seven months.
• In a very small percentage of infections, the virus leads to cancer through a process that is not yet completely understood.  We do know that effects of the virus may take months to years to produce cancer.
• The approved HPV vaccines have been shown to be effective against cervical cancer in women and, based on the evidence we have, are believed to be effective in protecting against oropharyngeal cancer in both men and women.

Consumers should discuss the benefits of the latest vaccine to guard against the effects of the human papilloma virus (GARDASIL^®9) with their healthcare provider.  This vaccine, approved for males and females ages 9 to 26, represents the most effective means of preventing not only cancers caused by HPV but anal and genital warts as well.  While vaccination is our best means of preventing HPV-related cancers, educating those who did not receive the HPV vaccine before their first sexual encounter remains our best line of defense for increasing awareness and advocating early detection.  At the OCF Walk, I had the opportunity to share with the walk participants a simple schematic to remember warning signs and that heeding these signs may assist in finding oral and oropharyngeal cancers early.  I explained them as The Seven S’s of Early Detection:

• Screening.  Remember that screening by a dental professional is the best thing that someone can do to detect any abnormalities in the mouth early.  There are many places in your mouth that you cannot see.  You really need the help of a mouth expert like your dentist or dental hygienist.  Make an oral cancer screening part of your annual wellness plan as you would a mammogram, PAP smear, or PSA test.
• Signs.  Even the most effective oral cancer screenings cannot evaluate changes in the lower throat and voice box area without the use of a scope or other camera or imaging device.  You must know the warning signs and be diligent in seeking medical help when one appears.
• Swallowing.  Difficulty in swallowing should not be ignored.  Many cancers related to HPV manifest as a tumor at the base of tongue (which is in the throat), resulting in an inability to swallow food and drink.
• Something.  The sensation of something in the throat that cannot either be swallowed down or coughed up is one of the most common symptoms reported by people with HPV-related oropharyngeal cancer.  Such a sensation can be attributed to seasonal allergies or a common cold at times, but these should be transient and resolve with medication or resolution of the causing condition.  That feeling of something caught in the throat that persists must not be ignored.
• Sabor.  “Sabor" is the Spanish word for flavor.  At times, flavor or other taste sensations can be altered when the tongue is affected by a tumor.  Changes in taste unattributed to nasal congestion or flu are not normal.  Do not ignore the warning signs your body gives you!
• Swelling.  A swelling in the neck, face, or under the jaw cannot be ignored…especially when that swelling is not painful when you push on it.  Do not ignore even a small swelling.  Lymph nodes are relatively small, yet they can become enlarged when filled with cancer cells.  Swellings in the head and neck must NEVER be ignored.
• Scope.  Realize that a laryngoscope is necessary to visualize the anatomical structures in the lower throat:  base of tongue, posterior pharyngeal wall, and larynx and the surrounding structures.  Having a scope exam may be necessary to fully understand what is going on if other signs or symptoms in the throat are present.

As a “bonus S,” I would say, “Don’t be afraid to seek a Second Opinion.”  Even if you’re told that  “it’s nothing,” do not be afraid to seek a second opinion.  There are too many stories I’ve heard from people I’ve encountered who were misdiagnosed or under diagnosed for months as a cancer grew within their bodies.  Realize that cancer in the mouth, neck, and throat usually moves quickly.  Do not delay in seeking that second or even third or fourth opinion if necessary, and seek out the most expert care available to you.  Your choice to do so just may save your life.