Oral Cancer: The Silent Killer of Speech

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Have you ever wondered if the diminutive mouth sore on your lips was a worrisome sign of something more lethal?

Oral cancer is a concealed yet omnipresent disease within society today. New cases of mouth cancer in the UK have now reached 8,337 a year. This has increased by 64% in the last decade and by 171% compared with 20 years ago1. The vindictive malady of oral cancer is commonly omitted within the plethora of cancer diseases, however, it forms a huge part in dentistry and acts as a bridge towards the diagnosis of other cancers within medicine as a whole.

What is oral cancer?

Oral cancer can be described as a cryptic mystery, because (as you may have guessed already) it greatly affects our mouths, however, it has many more implications on our craniofacial region altogether. Oral cancer primarily appears as a growth or sore in our mouth that does not diminish after a prolonged period of time. However, it can protrude towards other areas, including the lips, tongue, cheeks, floor of the mouth, the hard and soft palate, sinuses, and pharynx (throat). The main problem that surrounds the current inflated incidence of oral cancer is its ability to develop into something much more pernicious if not recognised and treated in early stages2 (hence why I refer to it in the title as the “silent killer”).

What are the risk factors of oral cancer?

The predominant causes of mouth cancer are alcohol and tobacco, which both act as carcinogens. Apart from this, there are many other societal and environmental factors that can lead to the development of this disease. A distinctive example is the consumption of betel nuts- a seed that is used widely in Asian communities. Betel nuts have a stimulant effect similar to coffee and can have huge carcinogenic effects on our whole body. As a result of these Asian cultures and traditions, confirmed cases of mouth cancer are usually higher amongst people from Bangladeshi, Sri Lankan, Indian and Pakistani communities.

The greatest advancing risk factor of oral cancer is HPV. Human Papillomavirus (HPV) is a group of viruses that can affect our skin, as well as membranes specifically within our throat. The virus is caused by sexual contact with an infected person, and it is the same virus that causes cervical cancer in women. There has been extensive evidence that suggests that types of HPV can cause abnormal tissue growth inside our mouths, leading to the unfortunate diagnosis of mouth cancer in a vast number of people3.

Other risk factors include vitamin and mineral deficient diets, excessive UV exposure, as well as being more common in older men, or people who have previously had cancers in the head and neck region4.

What are the symptoms of oral cancer?

Before I discuss the symptoms of oral cancer, it is important to be aware of how oral cancer can spread, which affects the way that our body physically responds to abnormal malignancy.

There are 2 ways mouth cancer can spread

  • directly spreading to surrounding skin or to the back of the jaw
  • through the lymphatic system3

Once we are aware of where oral cancer spreads, it can be easier for us to identify signs and symptoms in our mouth, head, and neck region. For example, the main signs that occur within our tongue palate are commonly known as the “patch of trouble”. These patches are the development of squamous cell carcinoma from the squamous cells that line the surfaces of our mouth, tongues, and lips. Examples of these are listed below.

  1. Mixed red and white patches- Erythroleukoplakia
  2. Red patches- Erythroplakia
  3. White patches- Leukoplakia
Leukoplakia: Symptoms, causes, and prevention
An example of Leukoplakia 8

Some other symptoms include speech problems, persistent ulcers or sores, and lumps in the neck5.

So, how does oral cancer act as a threat to our speech?

As mentioned above, one of the symptoms of oral cancer is having difficulty speaking, however, oral cancer can subsequently affect our speech, and in worse cases can lead to the perpetuating loss of this form of communication. Speech impairment usually arises after treatment and surgery- treatments such as radiotherapy can affect our larynx. Some people may develop a huskier, quieter voice with slurring words. Some people lose their voice. This can be temporary and get better, once swelling from surgery has gone down. In the worst cases, these changes can be permanent. However, with the aid of speech and language therapy for several months after treatment, it is possible to manage the long term effects6

The effects discussed above are supported by a study where 24 (12 preoperative and 12 postoperative patients) patients who had buccal and tongue cancer completed medical screening. The results showed that the speech outcome was worse in postoperative patients when compared to preoperative patients, which in turn highlights the extensive effect that oral cancer and it’s treatment can have on one’s voicing and enunciation7.

Conclusively, it is clear that oral cancer is a disease that can lead to a huge loss of life and individuality. After reading this article, hopefully, you have become more aware of the symptoms, risk factors, and the detrimental effects that oral cancer can cause. Moving forward, I hope that due to future innovative technologies, there will be a widely available treatment for oral cancer patients that avoids subsequent speech deprivation, and as a society, the ubiquity of oral cancer will hopefully be lessened due to increased education and collaborative awareness.


References

  1. “The State of Mouth Cancer UK Report 2019/2020” (2020) [online] https://www.dentalhealth.org/thestateofmouthcancer [ Last Accessed 27 July 2020]
  2. “An Overview of Oral Cancer” (2019) [online] https://www.webmd.com/oral-health/guide/oral-cancer#1 [Last Accessed 27 July 2020]
  3. “Causes-Mouth Cancer” (2019) [online] https://www.nhs.uk/conditions/mouth-cancer/causes/ [Last Accessed 27 July 2020]
  4. “Oral Cancer” (2020) [online] https://www.royalmarsden.nhs.uk/your-care/cancer-types/head-and-neck/oral-cancer [Last Accessed 27 July 2020]
  5. Treacy Colbert “5 Pictures of Mouth Cancer” (2019) [online] https://www.healthline.com/health/what-does-mouth-cancer-look#canker-sores [Last Accessed 27 July 2020]
  6. “Changes in your speech” (2018) [online] https://www.cancerresearchuk.org/about-cancer/mouth-cancer/living-with/changes-speech [Last Accessed 27 July 2020]
  7. Indian J Palliat Care. “Speech Outcome in Oral Cancer Patients – Pre- and Post-operative Evaluation: A Cross-sectional Study” (2016) [online]  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072244/ [Last Accessed 27 July 2020]
  8. Featured Image: Jennifer Huizen “What to know about leukoplakia” (2019) [online] https://images.app.goo.gl/v8a1gyN4iHqLhqys5 [Last Accessed 27 July 2020]

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