There 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.

    "Our 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.

    Wilk 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."

    Surgery, 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."

    Understanding 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.

    "This 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."

    Rosenheck 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.

    Third, 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.