Transcription:

Scott Webb (Host): April is Oral Cancer Awareness Month, and joining me today to discuss this important topic, including risk factors and treatment options, is Dr. Jonathan Bailey. He's a Board Certified and Fellowship Trained Oral and Maxillofacial Surgeon with Carle.

Dr. Bailey, thanks so much for joining me. We're going to talk about oral cancer today in the context of oral cancer awareness. So thanks for joining me.

Jonathan Bailey, DMD, MD: Yes, sir. Pleased to have the opportunity to try and talk about an important topic.

Host: Yeah, it is an important topic and I'm glad to have you here. So, as we just kind of get rolling, a little foundational thing for listeners, maybe you can discuss the oral cancer risk factors, who's at the highest risk?

Jonathan Bailey, DMD, MD: In the category of oral cancer, you have those cancers which involve the tongue, the floor of mouth, the cheeks, the roof of the mouth. Those cancers are most commonly caused by age. As we age, our immune system sort of diminishes and opportunities for these lesions to develop and grow, increases.

Then there are also behavioral issues like smoking and drinking. So older patients who smoke and drink are really the highest risk categories for oral cancer. Along with that, is what's called oral pharyngeal cancer, which occurs in the back of the mouth or the base of the tongue and the throat.

And that is actually a different entity than traditional oral cancer. Oral pharyngeal cancer is very commonly associated with HPV virus, and that's the one I think that we've seen an uptick in the incidence of that over the last 10, 15 years.

Host: Yeah. And I know with certain cancers, breast cancer, prostate cancer perhaps, colon cancer, things like that; that genetics and family history can play a big part in that. Wondering, does that also apply to oral cancer or is that really more just behavior and lifestyle?

Jonathan Bailey, DMD, MD: Yeah, not to the same degree as in those other disease processes you mentioned. Oral cancer really is primarily a behavioral etiology. You know, it's, it's not a genetic predisposition.

Host: Yeah. So if we're over 40, if we smoke, if we drink, we're certainly at higher risk. And, I've never spoken with somebody about cancer where they said that later is fine. No hurry on diagnosis. So when we think about oral cancer, why is early diagnosis so important?

Jonathan Bailey, DMD, MD: There's a significant survival advantage. Early stage cancers, stage one and two cancers, can often be treated quite successfully with a five year survival rate of, you know, 75% or greater. Later stage cancers, stage three and four, have a much lower five year survival rate.

Additionally, the morbidity or the cost to the patient physically, in treatment for early stage cancer is much lower than for patients who present with a later stage disease. The treatment can be much more aggressive in advanced stage disease and take a greater toll on the patient.

Host: Yeah, so knowing our risk factors, being checked out, checked up regularly and often would be good, especially if we're in a higher risk category. So let's talk about some of the basics of treatment. You know, what you do, how you do it, how you help patients' recovery, you know, all that good stuff.

Jonathan Bailey, DMD, MD: Dentists identify a lot of these lesions early on. So routine dental care is really important, and they should be doing oral cancer screenings as part of that. But when a patient is referred to me, you know, the first thing we have to do is stage the patient and we want to figure out is this early stage, stage one and two or is it more advanced stage, and that's based upon the size of the tumor as well as the progression of the disease.

So these cancers start and they grow, and when they reach a certain size, they can spread or metastasize, and they tend to spread to the lymph nodes in the neck first. After that, they can then spread to the chest. So when someone is initially diagnosed, we stage the cancer by, you know, measuring the size of the tumor. We obtain CT scans of the neck and chest to try to evaluate for any evidence of spread. And after that's done, we take that information and we'll very frequently present it to a head and neck tumor board, which is a group of physicians, radiation doctors, chemotherapy doctors, radiologists, pathologists, surgeons. And we review all that information and we determine what's the best treatment for each patient

In general terms, early stage cancers can be treated by surgery or radiation, fairly equivalently. Advanced stage cancers, on the other hand, usually require combination therapy, usually surgery up front, followed by radiation, and occasionally chemotherapy, depending upon the pathologic results of the treatment thus far.

Host: Yeah, and maybe we can stick with this. You know, we think about, all right, so if, as you say, outcomes may be similar or the same between surgery, radiation. So regardless of which option is the best one for a particular patient, what's involved for a patient in terms of preparation, surgical time, radiation therapies, recovery, you know, what can they expect ultimately afterwards?

Jonathan Bailey, DMD, MD: So what we, we like to do is if we can do surgery, that's usually our preferred treatment. The reason being, radiation affects not only the cancer cells, but it can affect the normal cells as well. So specifically with oral cancer, that means that the mandible, the jawbone can be affected by the radiation and cause its own problems on down the line.

So if we can do surgery, that's our preferred first step, and we want to try to minimize the morbidity and things. So if you have an early stage cancer, oftentimes that can be treated simply with excising that cancer. So that may mean removing a portion of the tongue. When it's involving the jawbone itself; that at times means you're going to have to remove a segment of the jaw, and those then raise issues of reconstruction, and that's where the complexity of the treatment begins to increase. Typically for early stage disease, if a patient has surgery, we hope that by about two to four weeks after surgery, depending upon the subtleties of the actual surgery itself, you know, we want those patients to be back mobilized, taking an oral diet and hopefully regaining some of their regular activities of daily living.

Host: Yeah.

Jonathan Bailey, DMD, MD: Yeah, With advanced stage cancers that require surgery followed by radiation, then you're looking at a three to four month treatment period and recovery before those patients are getting back to activities of daily living.

Host: Yeah, so obviously, if we're in that risk group, if we're over the age of 40 and we drink and smoke, you know, certainly cut back or discontinue both of those. But certainly knowing our risk factors, seeing our dentists regularly, being screened for oral cancer, you know, as you said here today, early diagnosis is so key as we wrap up here, Doctor, maybe you can just sort of discuss, just folks in general taking care of themselves, right? So knowing their risk factors, addressing them, seeing respective doctors, be they dentist or otherwise. Maybe just in your words, encourage them, especially as we're framing this as oral cancer awareness, why it's so important for us to see our doctors.

Jonathan Bailey, DMD, MD: Yeah, if you're over 40, most of us at that age have a regular dentist and a physician that we see. You know, you should be seeing somebody three or four times a year. And if you notice something, make sure you point it out. If your dentist is not doing an oral cancer screening, you need to ask them about it. Similarly, your primary care doctor, you want to talk to your doctor, make sure you know, they look everywhere else, and they're pretty aggressive about, evaluating for colon cancer, breast cancer, and things like that. They need to at least look in your mouth and if you have an issue that you don't feel like is getting addressed; keep pushing the issue and make sure you get in front of someone who has a background in this or has some familiarity with it. We can at least get you to someone who can get this evaluated and resolved.

Host: Yeah, that's perfect. Great advice from an expert today. Doctor, thanks so much for your time. You stay well.

Jonathan Bailey, DMD, MD: Thank you so much. Have a good day.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.