A new epidemic- Oral cancer due to HPV

We have seen a dramatic rise in our department of patients presenting with oral cancer. This change is in a younger group of patients with P16 positive (Human Papilloma virus) tumours. This is a world-wide phenomenon.

In Sweden the age-standardized incidence of tonsillar cancer increased from 1.3 to 3.6 (2.8-fold) per 100,000 between 1970 and 2002 in the Stockholm area . In men, the increase was 2.6-fold (1.077–2.81 per 100,000), while in women the increase was 3.5-fold (0.232–0.829 per 100,000) 

To learn more about HPV and oral cancer, check out the following infographic from the Mount Sinai Medical Center, USA

Causes, incidence, and risk factors

Oral cancer most commonly involves the tonsils or the tongue. It may also occur on the:

• lips
• Cheek lining
• Floor of the mouth
• Gums (gingiva)
• Roof of the mouth (palate)

Most oral cancers are a type called squamous cell carcinomas. These tend to spread quickly.

Smoking and other tobacco used to cause most cases of oral cancer with Heavy alcohol use also increasing your risk for oral cancer. But now Human papilloma virus (HPV) infection is the commonest cause 

Other factors that may increase the risk for oral cancer include:

• Chronic irritation (such as from rough teeth, dentures, or fillings)
• Taking medications that weaken the immune system (immunosuppressants)
• Poor dental and oral hygiene

Some oral cancers begin as a white plaque (leukoplakia) or as a mouth ulcer.

Men get oral cancer twice as often as women do, particularly men older than 40.

Symptoms

Sore, lump, or ulcer in the mouth:

• Enlarged tonsil with earache
• A lump in the neck often painless
• May be a deep, hard-edged crack in the tissue
• Ulcer on the tongue, lip, or other area of the mouth
• Usually painless at first (may develop a burning sensation or pain when the tumor is advanced)

Other symptoms that may occur with oral cancer include:

• Chewing problems
• Mouth sores
• Pain with swallowing
• Speech difficulties
• Swallowing difficulty
• Swollen lymph nodes in the neck
• Tongue problems
• Weight loss

investigations

• biopsy of the lesion
• FNA of neck node
•  CT scans will be done to determine if the cancer has spread.

Treatment

Surgery to remove the tumor is usually recommended if the tumor is small enough. Surgery may be used together with radiation therapy and chemotherapy for larger tumors. Surgery is not commonly done if the cancer has spread to lymph nodes in the neck.

Other treatments may include speech therapy or other therapy to improve movement, chewing, swallowing, and speech.

Expectations (prognosis)

Approximately half of people with oral cancer will live more than 5 years after they are diagnosed and treated. If the cancer is found early, before it has spread to other tissues, the cure rate is nearly 90%. However, more than half of oral cancers have already spread when the cancer is detected. Most have spread to the throat or neck.

About 1 in 4 persons with oral cancer die because of delayed diagnosis and treatment.

Complications

• Complications of radiation therapy, including dry mouth and difficulty swallowing
• Disfigurement of the face, head, and neck after surgery
• Other spread (metastasis) of the cancer