Selected Podcast
Oral Cancer and the OMS
More than 53,000 Americans will be diagnosed with oral or oropharyngeal cancer this year. Dr. Deepak Kademani discusses how the mortality rate for oral cancer is particularly high – not because it is hard to detect, diagnose or treat, but because the cancer often is discovered late in its development and why routine self-exams and routine dental/medical checkups are so important.
Featured Speaker:
Learn more about Deepak Kademani
Deepak Kademani, DMD, MD, FACS
Dr. Kademani is a member of numerous professional societies, including the American College of Surgeons and the American Head and Neck Society. In addition to authoring or co-authoring over one hundred books, abstracts, chapters, monographs, and publications, he has authored two textbook’s ‘Atlas of Oral and Maxillofacial Surgery’ and ‘Improving Outcomes in Oral Cancer’ He has delivered over 300 invited lectures nationally and internationally on a variety of topics, predominantly in head and neck pathology, oral cancer and reconstructive head and neck surgery. He has served as President of the Minnesota Society of Oral and Maxillofacial Surgeons. He has served as on the Examination Committee for the American Board of Oral and Maxillofacial Surgery and was recently elected as Director. He has a number of roles associated with the American Association of Oral and Maxillofacial Surgery, including being appointed as Chair of Committee of Continuing Education and Professional Development, Research Committee and the Committee on Oral/Head and Neck Oncologic and Reconstructive Surgery. With the American Dental Association Dr Kademani serves on the Clinical and Scientific Affairs Committee. His practice is dedicated to the care of head and neck cancer, oral cancer, salivary gland tumors, thyroid, skull base surgery and reconstructive head and neck surgery, orthognathic, TMJ, sleep apnea and dentoalveolar surgery. He prides himself on delivering the highest quality and compassionate surgical care to his patients.Learn more about Deepak Kademani
Transcription:
Oral Cancer and the OMS
Bill Klaproth (host): This is OMS Voices, an AAOMS podcast. I'm Bill Klaproth and with me is Dr. Deepak Kademani who is here to discuss oral cancer and the OMS. Dr. Kademani, thank you for being here.
Dr. Deepak Kademani: Hi Bill. It's nice to meet you.
Bill Klaproth (host): You as well. So, this is going to be an interesting topic. So, let's start with this. What are the types of oral head and neck cancer?
Dr. Deepak Kademani: There are approximately 53,000 actual cases of oral and oropharyngeal cancer diagnosed in North America every year. This also accounts for approximately 10,000 deaths that we see. And if you extrapolate that on a timeframe, this accounts for about one patient dying every hour here in the United States from oral and oropharyngeal cancer. So, this is a significant problem that we have and I appreciate the opportunity to discuss.
Bill Klaproth (host): Yeah, I think it's important to discuss this because we might not know of these stats. And now that you say that it's pretty sobering and it's probably more common than we think.
Dr. Deepak Kademani: Yes. That's exactly right. It's much more common than we think.
Bill Klaproth (host): Yeah. So what are the different types of cancers? that you deal with as an OMS?
Dr. Deepak Kademani: So I think the way to think about it is that they can be divided based on their anatomic location. So, we think about the oral cavity, which is the mouth and the associated structures. The oropharynx is really the base of the tongue and the tonsils and the posterior part of the pharynx. There's also an area known as the hypopharynx, which includes the larynx and the voice box. And there's The nasopharynx which involves the nasal cavity and the paranasal sinuses and then we also, we'll deal frequently with salivary gland and thyroid cancers as well, along with skin cancers that occur in the head and neck as well.
Bill Klaproth (host): So the OMS covers all of these areas?
Dr. Deepak Kademani: Yes, that's correct. So, our specialty when we think about the management of head and neck cancer, really really focuses not only on the oral cavity, but really extends from an area called the skull base down to the clavicles.
Bill Klaproth (host): Wow. This is really interesting. I think some people probably think of OMS, 'Oh, teeth and gums' but it's certainly more than that.
Dr. Deepak Kademani: Yes. That's correct.
Bill Klaproth (host): Yeah. So, when we think about oral cancer, what are the signs and symptoms we should be looking for?
Dr. Deepak Kademani: Well, some of the signs and symptoms of oral cancer can be very insidious. And many of these things can be mistaken for other types of complaints. What we often see is things like lumps and bumps that can occur inside the mouth or in the neck. We can see persistent red or white lesions. We can see also the presence of ulceration that does not heal the presence of bleeding, the presence of loose teeth. We also get concerned about numbness or the new onset of numbness. And also ear pain and any conditions such as difficulty swallowing or any changes with our ability to speak and swallow.
Bill Klaproth (host): Yeah. So, as you talk about those things, it's easy to understand how the signs and symptoms of oral cancer could be signs and symptoms of other things as well. So, it really takes an expert to diagnose these things properly. Is that right?
Dr. Deepak Kademani: Yes. And in general, what we'd like to try to convey to patients is that any lesion or abnormal sensation, or if they don't feel that things are right for more than about 14 days, they should really be seen by either their primary care physician, their general dentist, or a specialist.
Bill Klaproth (host): Okay. That's excellent that you said that I was going to ask, when is it time to see the doctor or dentist or OMS? So, thank you for saying that. So, when we talk about oral cancer, are there categories of oral cancer we should know about what are those?
Dr. Deepak Kademani: The most common type of cancer we see in the head and neck is something called squamous cell carcinoma. About 90% of the malignancies we see in the head and neck are this type of cancer. It's a tumor that can affect the mouth. It can also affect the deepest structures in the throat and the voice box. I think there's one important thing to understand: is that traditionally the risk factors associated with oral cavity cancer are the use of tobacco and alcohol.
However, in the last 20 years or so, we are seeing a lot more patients being diagnosed. younger that don't have the traditional risk factors associated with oral cavity cancer. Many of these patients have a human papilloma virus induced cancer. And this is biologically a slightly different than the traditional type of oral cancer that we see.
Bill Klaproth (host): Okay. That's interesting to hear. So, when we see the commercials on TV for get vaccinated for this HPV. This is part of the outcome of that. This is one of the cancers that can manifest because of that.
Dr. Deepak Kademani: Yes, that's correct. We know the papilloma virus not only causes oropharyngeal cancers but can also cause genital cancers and cervical cancer as well.
Bill Klaproth (host): So, the big one is oral squamous cell carcinoma. You said 90% and people who are more at risk for that are people who smoke and drink. Is that right? Excessively, drink excessively?
Dr. Deepak Kademani: Yes, that's correct.
Bill Klaproth (host): Wow. That's interesting. So, how important is an examination for detecting oral cancer then?
Dr. Deepak Kademani: No. We're very fortunate that in the head and neck and particularly the oral cavity who we are able to perform examinations without a lot of need of technology. It's a relatively non-invasive, it's a very accessible site. So, it's certainly an area of the body that can be examined and needs to be examined at least annually in the majority of patients.
Bill Klaproth (host): So visually you can see if there's a lesion or you mentioned earlier, some of the signs and symptoms, those are easy to see visually or a lump or a bump, if a patient is complaining or that have that, it's easy for you to kind of get in there and look and go, okay, could be an issue here?
Dr. Deepak Kademani: Yeah, That's correct. I mean, The components of an examination on not only visual inspection, but they're also palpation and our ability, to feel those structures and make sure that we can get a sense of what looks normal versus abnormal.
Bill Klaproth (host): Right. And you said, you know, some of the symptoms before you said difficulty swallowing, things like that. Mouth pain, mouth sores, those types of things. Those are clues to you as well.
Dr. Deepak Kademani: Yes, that's correct.
Bill Klaproth (host): Right. Okay. Does everyone need to perform like a cancer self-exam as we were just talking about or some level of self-exam?
Dr. Deepak Kademani: I think in general, what we tell patients and what we recommend is that people should have a comprehensive head-neck cancer screening examination, usually annually above the age of 40. They can certainly self-examine but in general, a comprehensive head and neck exam per performed by their dentist or a specialist or primary care physicians completely appropriate at least once a year.
Bill Klaproth (host): So when you go into the dentist for your annual checkup or cleaning, or every six months, they will look and you know, obviously, I've been there and it's stick your tongue out. They look under to the side, they look inside there we go, everything looks good. So that's kind of that visual inspection. And of course, you know, are you feeling anything? Anything? Nope. Okay. Everything. at that point, looks good. But that type of, at least once a year kind of inspection is important?
Dr. Deepak Kademani: Yes. that's correct.
Bill Klaproth (host): Right. And then of course, know your body, know you're feeling, what you're sensing, those types of things. 'Hey, I've got a lump here, Doc, you may want to check that what is this?' Happens normally, sometimes you bite or a sharp chip or something, 'Hey, what is this?' And right.
Dr. Deepak Kademani: Yeah. That's correct. So, in general, we like to tell patients that if something doesn't feel right for more than about 14 days, they should really get it evaluated.
Bill Klaproth (host): Yeah, absolutely. So early detection is really a key component to all of this. That helps you with your job.
Dr. Deepak Kademani: Yes, that's correct. It's also important to note that unfortunately about 50% of the cancers that we see in the neck are diagnosed with an advanced stage and the more that we can do as a profession and also with public education, like what we're doing here to really alert the general public to the signs and symptoms of head and neck cancer will go a long way to being able to de-escalate that stage. So, we can diagnose patients with much earlier disease.
The early diagnosis of these patients makes treatment much less complicated. It takes away some of the morbidity. associated with the typical types of treatments that we give. And if we're able to Diagnose patients with early-stage cancers, they can also very often avoid radiation and chemotherapy.
Bill Klaproth (host): Which is important and really nobody wants to go through. So that's why early detection is so important. So, Dr. Kademani, let me ask you this. Is there any way to minimize our risk through brushing and flossing?
Dr. Deepak Kademani: Oral hygiene is a very important component of overall health. And if you look at the literature, there really hasn't been a strong correlation between oral hygiene and the development of. However, it's good for a general practice for people to maintain the best oral health that they can.
Bill Klaproth (host): Absolutely. And then does family history play into this too as well?
Dr. Deepak Kademani: You know, that's again a great question. There are certain sub-sites of people that have genetic conditions that makes them immunosuppressed, that makes them more susceptible to the development of oral cancer but in general, there's not a lot of other conditions that will play into this type of diagnosis.
Bill Klaproth (host): Right. All right. Well, Dr. Kademani, thank you so much for your time. Anything else you want to add when we're talking about oral cancer in the OMS?
Dr. Deepak Kademani: I would just like to thank you for the opportunity of doing this. And I think if I can leave our consumers with the message of: early diagnosis is important and if they feel that there's anything wrong that they should certainly go and see their dentist or oral and maxillofacial surgeon for a comprehensive examination. I want to thank you the opportunity.
Bill Klaproth (host): Absolutely. Well, thank you for your time. And that's a great message. If you feel there's anything wrong, don't delay better, safe than sorry. Go get it checked out.
Dr. Deepak Kademani: Yeah, that's correct.
Bill Klaproth (host): For sure. Dr. Kademani, thank you so much for your time. We appreciate this. And for more information on the full podcast library, please visit MyOMS.org. And if you found this podcast interesting, please share it on your social media and don't forget to subscribe. Thanks for listening.
Oral Cancer and the OMS
Bill Klaproth (host): This is OMS Voices, an AAOMS podcast. I'm Bill Klaproth and with me is Dr. Deepak Kademani who is here to discuss oral cancer and the OMS. Dr. Kademani, thank you for being here.
Dr. Deepak Kademani: Hi Bill. It's nice to meet you.
Bill Klaproth (host): You as well. So, this is going to be an interesting topic. So, let's start with this. What are the types of oral head and neck cancer?
Dr. Deepak Kademani: There are approximately 53,000 actual cases of oral and oropharyngeal cancer diagnosed in North America every year. This also accounts for approximately 10,000 deaths that we see. And if you extrapolate that on a timeframe, this accounts for about one patient dying every hour here in the United States from oral and oropharyngeal cancer. So, this is a significant problem that we have and I appreciate the opportunity to discuss.
Bill Klaproth (host): Yeah, I think it's important to discuss this because we might not know of these stats. And now that you say that it's pretty sobering and it's probably more common than we think.
Dr. Deepak Kademani: Yes. That's exactly right. It's much more common than we think.
Bill Klaproth (host): Yeah. So what are the different types of cancers? that you deal with as an OMS?
Dr. Deepak Kademani: So I think the way to think about it is that they can be divided based on their anatomic location. So, we think about the oral cavity, which is the mouth and the associated structures. The oropharynx is really the base of the tongue and the tonsils and the posterior part of the pharynx. There's also an area known as the hypopharynx, which includes the larynx and the voice box. And there's The nasopharynx which involves the nasal cavity and the paranasal sinuses and then we also, we'll deal frequently with salivary gland and thyroid cancers as well, along with skin cancers that occur in the head and neck as well.
Bill Klaproth (host): So the OMS covers all of these areas?
Dr. Deepak Kademani: Yes, that's correct. So, our specialty when we think about the management of head and neck cancer, really really focuses not only on the oral cavity, but really extends from an area called the skull base down to the clavicles.
Bill Klaproth (host): Wow. This is really interesting. I think some people probably think of OMS, 'Oh, teeth and gums' but it's certainly more than that.
Dr. Deepak Kademani: Yes. That's correct.
Bill Klaproth (host): Yeah. So, when we think about oral cancer, what are the signs and symptoms we should be looking for?
Dr. Deepak Kademani: Well, some of the signs and symptoms of oral cancer can be very insidious. And many of these things can be mistaken for other types of complaints. What we often see is things like lumps and bumps that can occur inside the mouth or in the neck. We can see persistent red or white lesions. We can see also the presence of ulceration that does not heal the presence of bleeding, the presence of loose teeth. We also get concerned about numbness or the new onset of numbness. And also ear pain and any conditions such as difficulty swallowing or any changes with our ability to speak and swallow.
Bill Klaproth (host): Yeah. So, as you talk about those things, it's easy to understand how the signs and symptoms of oral cancer could be signs and symptoms of other things as well. So, it really takes an expert to diagnose these things properly. Is that right?
Dr. Deepak Kademani: Yes. And in general, what we'd like to try to convey to patients is that any lesion or abnormal sensation, or if they don't feel that things are right for more than about 14 days, they should really be seen by either their primary care physician, their general dentist, or a specialist.
Bill Klaproth (host): Okay. That's excellent that you said that I was going to ask, when is it time to see the doctor or dentist or OMS? So, thank you for saying that. So, when we talk about oral cancer, are there categories of oral cancer we should know about what are those?
Dr. Deepak Kademani: The most common type of cancer we see in the head and neck is something called squamous cell carcinoma. About 90% of the malignancies we see in the head and neck are this type of cancer. It's a tumor that can affect the mouth. It can also affect the deepest structures in the throat and the voice box. I think there's one important thing to understand: is that traditionally the risk factors associated with oral cavity cancer are the use of tobacco and alcohol.
However, in the last 20 years or so, we are seeing a lot more patients being diagnosed. younger that don't have the traditional risk factors associated with oral cavity cancer. Many of these patients have a human papilloma virus induced cancer. And this is biologically a slightly different than the traditional type of oral cancer that we see.
Bill Klaproth (host): Okay. That's interesting to hear. So, when we see the commercials on TV for get vaccinated for this HPV. This is part of the outcome of that. This is one of the cancers that can manifest because of that.
Dr. Deepak Kademani: Yes, that's correct. We know the papilloma virus not only causes oropharyngeal cancers but can also cause genital cancers and cervical cancer as well.
Bill Klaproth (host): So, the big one is oral squamous cell carcinoma. You said 90% and people who are more at risk for that are people who smoke and drink. Is that right? Excessively, drink excessively?
Dr. Deepak Kademani: Yes, that's correct.
Bill Klaproth (host): Wow. That's interesting. So, how important is an examination for detecting oral cancer then?
Dr. Deepak Kademani: No. We're very fortunate that in the head and neck and particularly the oral cavity who we are able to perform examinations without a lot of need of technology. It's a relatively non-invasive, it's a very accessible site. So, it's certainly an area of the body that can be examined and needs to be examined at least annually in the majority of patients.
Bill Klaproth (host): So visually you can see if there's a lesion or you mentioned earlier, some of the signs and symptoms, those are easy to see visually or a lump or a bump, if a patient is complaining or that have that, it's easy for you to kind of get in there and look and go, okay, could be an issue here?
Dr. Deepak Kademani: Yeah, That's correct. I mean, The components of an examination on not only visual inspection, but they're also palpation and our ability, to feel those structures and make sure that we can get a sense of what looks normal versus abnormal.
Bill Klaproth (host): Right. And you said, you know, some of the symptoms before you said difficulty swallowing, things like that. Mouth pain, mouth sores, those types of things. Those are clues to you as well.
Dr. Deepak Kademani: Yes, that's correct.
Bill Klaproth (host): Right. Okay. Does everyone need to perform like a cancer self-exam as we were just talking about or some level of self-exam?
Dr. Deepak Kademani: I think in general, what we tell patients and what we recommend is that people should have a comprehensive head-neck cancer screening examination, usually annually above the age of 40. They can certainly self-examine but in general, a comprehensive head and neck exam per performed by their dentist or a specialist or primary care physicians completely appropriate at least once a year.
Bill Klaproth (host): So when you go into the dentist for your annual checkup or cleaning, or every six months, they will look and you know, obviously, I've been there and it's stick your tongue out. They look under to the side, they look inside there we go, everything looks good. So that's kind of that visual inspection. And of course, you know, are you feeling anything? Anything? Nope. Okay. Everything. at that point, looks good. But that type of, at least once a year kind of inspection is important?
Dr. Deepak Kademani: Yes. that's correct.
Bill Klaproth (host): Right. And then of course, know your body, know you're feeling, what you're sensing, those types of things. 'Hey, I've got a lump here, Doc, you may want to check that what is this?' Happens normally, sometimes you bite or a sharp chip or something, 'Hey, what is this?' And right.
Dr. Deepak Kademani: Yeah. That's correct. So, in general, we like to tell patients that if something doesn't feel right for more than about 14 days, they should really get it evaluated.
Bill Klaproth (host): Yeah, absolutely. So early detection is really a key component to all of this. That helps you with your job.
Dr. Deepak Kademani: Yes, that's correct. It's also important to note that unfortunately about 50% of the cancers that we see in the neck are diagnosed with an advanced stage and the more that we can do as a profession and also with public education, like what we're doing here to really alert the general public to the signs and symptoms of head and neck cancer will go a long way to being able to de-escalate that stage. So, we can diagnose patients with much earlier disease.
The early diagnosis of these patients makes treatment much less complicated. It takes away some of the morbidity. associated with the typical types of treatments that we give. And if we're able to Diagnose patients with early-stage cancers, they can also very often avoid radiation and chemotherapy.
Bill Klaproth (host): Which is important and really nobody wants to go through. So that's why early detection is so important. So, Dr. Kademani, let me ask you this. Is there any way to minimize our risk through brushing and flossing?
Dr. Deepak Kademani: Oral hygiene is a very important component of overall health. And if you look at the literature, there really hasn't been a strong correlation between oral hygiene and the development of. However, it's good for a general practice for people to maintain the best oral health that they can.
Bill Klaproth (host): Absolutely. And then does family history play into this too as well?
Dr. Deepak Kademani: You know, that's again a great question. There are certain sub-sites of people that have genetic conditions that makes them immunosuppressed, that makes them more susceptible to the development of oral cancer but in general, there's not a lot of other conditions that will play into this type of diagnosis.
Bill Klaproth (host): Right. All right. Well, Dr. Kademani, thank you so much for your time. Anything else you want to add when we're talking about oral cancer in the OMS?
Dr. Deepak Kademani: I would just like to thank you for the opportunity of doing this. And I think if I can leave our consumers with the message of: early diagnosis is important and if they feel that there's anything wrong that they should certainly go and see their dentist or oral and maxillofacial surgeon for a comprehensive examination. I want to thank you the opportunity.
Bill Klaproth (host): Absolutely. Well, thank you for your time. And that's a great message. If you feel there's anything wrong, don't delay better, safe than sorry. Go get it checked out.
Dr. Deepak Kademani: Yeah, that's correct.
Bill Klaproth (host): For sure. Dr. Kademani, thank you so much for your time. We appreciate this. And for more information on the full podcast library, please visit MyOMS.org. And if you found this podcast interesting, please share it on your social media and don't forget to subscribe. Thanks for listening.