Don’t delay seeking treatment for a mouth sore that doesn’t go away

About 60,000 Americans will be diagnosed with oral or oropharyngeal cancer this year, and only slightly more than half will be alive in five years, according to the Oral Cancer Foundation.

Many of those deaths are linked to tobacco and HPV infections, causes that can be prevented, according to Courtney Miller, MD, an otolaryngologist with Cape Cod Ear, Nose and Throat Specialists in Hyannis.

“When we think of oral cancer, there are two different types,” she said. “One is oral cancer related to the virus HPV, and the other is not HPV-related. If it’s HPV-related, it has much better outcomes, even if it’s found a little bit at a later stage. Non-HPV-related oral cancer has worse outcomes, since it’s a little bit more aggressive and tends to be found later in life.”

Non-HPV-related oral cancer is usually linked to excessive tobacco use (smoked or chewed) or alcohol intake, said Miller. “We tend to see those cancers in older patients, just because it takes time for those exposures to accumulate. They result in damage to the cells lining the tongue and the cheek or the tonsils, becoming precancerous and then cancerous.”

Oral cancer is more common in people in their 70s and 80s, but Dr. Miller has seen it in patients as young as in their 30s.

HPV-related oral cancers are usually diagnosed when patients are in their 50s or 60s.

“When I see someone in my clinic with a tonsil lesion or a neck mass, and they're 50 or 60 and don’t smoke and don't drink, one of my first thoughts is, is this an HPV-related oral cancer of the tonsil or the back of the tongue?” she said.

Get Screened

Any time is a good time to be screened for oral cancer. These types of cancers, especially HPV-related cancers, usually come to the attention of a medical provider because of a lump in the neck. Dentists often play a key role in detecting oral cancers.

Historically, the death rate associated with oral cancer is particularly high, not because it is hard to discover or diagnose, but due to the cancer being routinely discovered late in its development.

Symptoms to look out for, according to Dr. Miller, are:

• Any lesions in the mouth, on the tongue, on the inside of the lip or the cheek that aren’t going away.
• A sore that is bleeding or painful in one spot that has been there for at least one month.

If you have either symptom, she advises people to bring it up to your primary care doctor or dentist, who can refer you to an ear, nose and throat doctor [an otolaryngologist] who can do a biopsy.

“If they see something that doesn’t look quite right, they’ll send it to us so we can evaluate and determine if a biopsy is needed or not,” Dr. Miller said.

Treatment and Prevention

Treatment, which depends on the location in the oral cavity and the size of the tumor, can either be surgery or radiation.

Dr. Miller encourages people to consider the HPV vaccine for themselves or their children or grandchildren, because it can decrease the incidence of oral pharyngeal cancer related to HPV.

“The vaccine is indicated for children 11 to 12 years old, but people can get it all the way up to 26 and beyond,” she said. “Up to age 45, they can have a conversation with their primary on whether to get it. If you get the vaccine before you’re exposed to HPV, it’s more effective.”

Medical experts anticipate that the incidence of HPV-related cancer in the throat, in the mouth and throat will decrease sometime in the next two decades, if enough people are vaccinated, she said, but right now the incidence is still rising.

“If there’s ever any concerns about cancer in the mouth, don’t delay. Get it checked out. Start with your primary care provider and they can refer you if needed.”