Assessing Oral Malignancies -- American Family Physician

www.aafp. org/afp AMERICAN FAMILY PHYSICIAN 1379 History The first step in patient assessment is obtaining a thorough history including the presence of risk factors and symptoms. Most neoplastic diseases occur from an inherent tendency or enhanced genetic susceptibility combined with multiple exposures to substances that contribute to the initiation or promotion of carcinogenic change. The two major risk factors for oral cancer—tobacco use and heavy alcohol consumption—are responsible for about 75 percent of oral cancers. The remaining 25 percent are caused by other factors, which may include nutritional and genetic influences. The etiologic role of these factors is not well understood, and methods for modifying them need to be developed. All forms of tobacco have been implicated as causative agents, including cigarette, cigar and pipe tobacco as well as chewing tobacco and snuff. Although oral cancers occur in patients who do not use tobacco, this constitute a very small percentage of cases. Patterns of alcohol consumption, particularly among smokers, also are considered important. There is a higher incidence of oral cancer in people who are heavy smokers and heavy drinkers. The reason for the increased cancer risk associated with increasing alcohol consumption is not completely understood. It may be due to the carcinogenic effect of the F orty percent of head and neck cancers occur in the oral cavity, including the tongue, floor of the mouth, palate, lips and oropharynx. Oral cancer is the sixth most common cancer worldwide. The incidence rate of oral cancer in the United States is about 11 cases per 100,000 persons per year, and the incidence increases with age. Cancers of the head and neck region account for approximately 3 percent of cancers in men and less than 2 percent in women. Oral cancer is responsible for 2 percent of all cancer deaths in the United States. Sixty percent of these cancers are well advanced by the time they are detected. Therefore, cancers of the oral mucous membranes continue to cause considerable mortality and morbidity in the United States, with a five-year survival rate of about 30 percent. Lip cancer, while included in statistics for oral cancer, is more similar to skin cancers, with a survival rate of more than 90 percent. This article reviews the methods of assessing oral cancer and the controversy surrounding screening programs. Oral cancers account for approximately 3 percent of all cases of cancer in the United States. An estimated 30,000 people will be diagnosed with oral cancer this year, and about one half of them will eventually die of the disease. The most common type of oral cancer is squamous cell carcinoma. Sixty percent of oral cancers are well advanced by the time they are detected, even though physicians and dentists frequently examine the oral cavity. The two most important risk factors for oral cancer are tobacco use and heavy alcohol consumption. The keys to reducing mortality are prevention and control. The earlier any intraoral or extraoral abnormalities or lesions are detected and biopsied, the more lives can be saved. Controversy exists whether screening programs effectively reduce the mortality rate. Specific step-by-step guidelines should be followed to perform an adequate examination of the head and neck. (Am Fam Physician 2002;65:1379-84,1385-6. Copyright© 2002 American Academy of Family Physicians.)