The incidence of mouth cancer is on the rise. Data just published in 2016 in the journal Cancer Research from a UK-wide prevalence study show a large increase in cases in recent years.1
The association of oral cancer with HPV is now proven and the possible link with oral sex has hit the tabloids - this doubtless accounts for some of the problem. Although the number of oral cancer cases diagnosed within the UK from 2002-2011 more than doubled, the research has suggested that the proportion of HPV+ cases actually remained static at about 50%.
November is Mouth Cancer Action Month. Read this short article to refresh your knowledge of the red flags for referral of oral cancer. For more information visit the RCGP-accredited Oral Cancer Toolkit to gain CPD points.
This article has been funded by Cancer Research UK for GP Connect
Rather worryingly, this would mean there is a growing problem with cases related to HPV, but also, at the same time, in those cases caused by smoking and alcohol. This reinforces the need for HPV vaccination, smoking cessation and alcohol moderation in addressing the oral cancer ‘epidemic’.
Red flag symptoms
The good news is that with early treatment, oral cancer, irrespective of its cause, has excellent survival.
The signs of oral cancer are usually a persisting lump or ulcer in the mouth, or a painless neck lump and in some cases mucosal changes may also be present. If caught early and referred promptly, simple treatment with minor surgery or radiotherapy is usually curative.
On the other hand, advanced tumours have very complex treatments with higher morbidity, involving radiotherapy and chemotherapy often needing complex reconstructive surgery. Alas the outcomes, despite these major therapies, are disappointingly poor survival (approximately 35%) and extremely disabling effects on appearance, chewing, swallowing and speech.
As is often the case, prevention and early diagnosis is much the better option.
What can GPs do?
Both GPs and dentists have a key role in early diagnosis of oral cancer. The ‘red flag’ signs and symptoms can be easily elucidated and the two-week referrals to head and neck cancer diagnostic clinics couldn’t be easier.
Understanding that GPs are often not as confident as dentists in spotting high-risk lesions, Cancer Research UK has created a user-friendly, RCGP-accredited CPD tool to simplify things - the ‘Oral Cancer Toolkit’ includes:
- An overview of risk factors
- A head neck and oral examination video
- An image library showing normal, borderline and suspicious lesions
- Case studies
- Referral guide
- CPD-accredited quiz
Professor Richard Shaw is professor of head and neck surgery at The University of Liverpool Cancer Research Centre; associate director & national specialty lead for surgical oncology, NIHR Clinical Research Network - Cancer; and honorary consultant in oral & maxillofacial/ head and neck surgery, Aintree University Hospitals NHS Foundation Trust
1. Schache AG, et al. HPV-related oropharyngeal cancer in the United Kingdom: an evolution in understanding of disease etiology. Cancer Res 2016 Aug 28. pii: canres.0633.2016