kills more people each year, oral or cervical cancer? Which is
deadlier, oral cancer or melanoma? If you think these are trick
questions, you're right.
cervical cancer and melanoma take a lion's share of the media's
attention, oral cancer is in fact more deadly, largely due to
its low profile. "Women go to their physicians and ask for a PAP
test, which can identify early, presymptomatic cervical cancers.
People check their own bodies for unusual skin lesions and show
these to their dermatologists," says Arnold Rosenheck, DMD, associate
dean at UMDNJ-New Jersey Dental School (NJDS).
how many individuals ask their dentists to check their mouths
for cancer or go to their dentists if they have a mouth sore that
doesn't heal right away?" he asks. About 8 percent of these white
lesions in the mouth - called leukoplakias - are pre-malignant.
are more than 30,000 cases of oral cancer diagnosed annually in
the U.S., and 8,000 deaths caused by this malignancy each year.
"The number is so high," says Rosenheck, "because the early cancers
are not being caught. If you find the oral lesion before it metastasizes,
the cancer can be cured." Cure is directly related to the stage
of the lesion at the time it is diagnosed: Stage 1 has a cure rate
of 80 percent, stage 4, less than 18 percent.
statistics have not improved over the last couple of decades, but
that is changing," he states. Surgery for advanced oral cancer is
beginning to get some long-overdue attention. Although the specialization
is very new, New Jersey has one oral/maxillofacial surgeon - there
are just a handful in the country - trained to surgically treat
malignant disease in the mouth. He is Randall Wilk, MD, DDS, PhD,
assistant professor and vice chairman of the Department of Oral
and Maxillofacial Surgery at NJDS.
says that if a lesion is pre-malignant, localized, or at an early
stage, then cutting it out is usually the answer. But when a malignancy
is large, at an advanced stage, or is in certain critical locations,
then the course of action is not as clear-cut and will usually require
multiple therapies. "How we proceed will be based on many factors,"
explains Wilk. "The primary ones are location and stage of the cancer."
radiation, chemotherapy, or various combinations of the three may
be used in a variety of sequences. "Our mainstays for oral cancer
are surgery and radiotherapy," he says. "Chemotherapy, although
potentially promising, has yet to show any benefit to long-term
survival, especially as a single therapy."
genetic and molecular events involved with oral cancer may offer
better odds and better treatment for those with advanced disease,as
well as all other stages of disease. A brand-new piece of equipment
at NJDS - called a laser capture microdissector (LCM) - will allow
specialists and researchers such as Wilk to use lasers to isolate
and probe pre-malignant or malignant cells at the molecular level,
and then to identify what's wrong at the gene level.
is a state-of-the-art, basic science instrument," says Rosenheck.
"It will help us to determine which pre-malignant cells do and don't
turn cancerous, and why certain cells become malignant. It will
help us find cures for oral cancer based on basic biology."
says the future looks more positive for this disease. First, specialized
surgeons such as Wilk are far better equipped to treat advanced
cancers with surgery and other available therapies. Second, major
oral cancer awareness and screening campaigns - such as the one
currently being promoted in this area by NJDS and five other health
centers in the New York metropolitan area - will teach consumers
that finding early lesions and pre-malignancies is crucial to licking
this cancer; and that a new tool - called a brush biopsy - provides
a non-invasive means for obtaining a highly accurate biopsy sample.
research using new technology holds out great promise of a better
understanding of the basic biology of this disease. And with this
understanding, says Rosenheck, there is a greater chance of actually
finding a cure for this often-deadly cancer.