Scott Webb (Host): Early diagnosis of oral cancers is essential to limiting the physical and cosmetic effects from surgery to remove the cancers.

And I'm joined today by Dr. Mariangela Rivera. She's a Head and Neck Surgeon with PRISMA Health, and she's here today to share the causes and treatment options for oral cancers.

 This is Flourish, the podcast brought to you by PRISMA Health. I'm Scott Webb.

Doctor, it's nice to have you here today. We're going to talk about oral cancer and how to spot the signs, signs, symptoms, treatment options, and so forth. So great to have you here. Great to have your expertise. Just want to start off maybe the most basic ones. You know, how do you notice if you have oral cancer? What are the signs and symptoms?

Mariangela Rivera, MD: So the signs and symptoms of oral cancer can be anything from bleeding gums, a spot in your mouth that doesn't get better, or that's a sore spot, loose teeth and swelling can also be a sign of an oral cavity cancer. But generally speaking, you should be looking for discoloration, spots that are white or red, and areas that bleed or that don't heal.

Host: Okay. Yeah. And of course, you know, there's so many things, so many topics that I do when I host these is it could be one thing, oh, and it could also be some other things as well. So, you know, some things might just be sort of dental things, right? And some things maybe not. So if, if folks are concerned, they should just ask somebody, right?

Dentist, doctor, or otherwise. Yeah. Yeah. Cause I was going to ask you like, when should we be concerned about mouth sores? We've all had mouth sores or bitten our tongue or bitten our cheek or, you know, like things like that. Like, so how do we know when to be concerned?

Mariangela Rivera, MD: Oh my gosh, that's such a good question. If it's been more than six weeks, that's kind of the magic number. So if after six weeks things aren't getting better or if they're continuing to grow in size, that's when you really got to see somebody and get it checked out.

Host: Yeah. That makes sense. So when we think about the, how oral cancers, develop or you know, how exactly it works, like how long does it take for an oral cancer to develop to the stage where someone might notice it?

Mariangela Rivera, MD: What we know is that once we identify an oral cancer, and we can see it, that the amount of time that it's going to take for it to grow is usually on the order of weeks to months. Now some cancers are much faster and some are much slower. It's hard to predict, but generally speaking, you should get that wrapped up in no longer than a couple of months at most.

Host: Right. Of course, we always, especially with cancer, early diagnosis is key, but as you're saying, like, and until you notice it, you might not notice it. So maybe it would be good to focus on the risk factors. Like what are the risk factors for oral cancer? And I don't know if this falls under the myth category, but can mouthwash cause oral cancer?

Mariangela Rivera, MD: The biggest risk factors for oral cavity cancers are going to be preventable. So alcohol use, tobacco use, that includes using oral tobacco, like chewing tobacco or dip, obviously smoking cigarettes. These are all things that you can stop doing that'll prevent or decrease your risk of an oral cancer.

Now, the thing is there are mouthwashes that have alcohol in them. And so no amount of alcohol is safe. And, I'm hoping that, you know, the companies that make these products slowly start to pull alcohol out of them because mouthwash with alcohol in theory could cause it.

Host: Interesting. And again, this may be, we may do some more myth busting here, but, you know, I've often wondered, you know, it's all bad, of course, when we think about, you're talking about tobacco, right? So whether it's chews or dips, is somehow, are those worse than just smoking tobacco or smoking cigarettes, or is it all just bad and just stop doing all of it?

Mariangela Rivera, MD: It's all just bad. Please just stop. And some of the other like more uncommon in the United States is betel nut chewing, which also can cause cancer, and then rarely burns like severe injuries to the mouth can potentially increase your risk of cancers.

Host: You said betel nut? I'm in my 50s, I don't know what that is. There are folks that, that chew betel nuts in the world?

Mariangela Rivera, MD: Yes, betel nut is part of what's chewed, but it's actually, uh, like a, compound that's like a leaf and tobacco and the betel nut and it all gets kind of like shoved in your mouth and you chew on it and spit out just like you would chewing tobacco. It's very common in South Asia, , and in parts of Polynesia.

Host: It's really interesting. I, you know, you get to a certain age, you think you know everything, and then, and then I talk to you and I'm like, nope, that's definitely not something I've heard before. But one thing I have heard for sure, doctor, is that there's been an increase in HPV and its association with oral cancer. Maybe you can take us through that.

Mariangela Rivera, MD: Yeah, so it used to be that the most common cause of head and neck cancers that we see were things like alcohol and tobacco. Recently I say recently, and I mean like in the last 30 years, we've seen an increase in the incidence of p16 associated cancers of the tonsils. Now HPV associated cancers, there may be some in the mouth, but we don't really know what to do with that information from a prognostic standpoint, at least not yet.

There's a lot of science going into that now. But the HPV virus has been shown to cause cancers in the tonsils and in the tongue base that just behave a totally different way and the incidence is going up. Now, with the advent of Gardasil and a vaccine against HPV, hopefully we're actually starting to get to the peak of the incidence and we're going to start seeing those numbers come down as these younger generations are more consistently vaccinated.

Host: Right. And that would be a separate podcast encouraging folks to be vaccinated and all of that. But for today, we'll stay focused on oral cancer. And I'm wondering, how do we prevent oral cancer? And I want to frame this this way. You know, like I think about genetics and family history and behavior and lifestyle. Does, do all those things contribute to oral cancer? Or is it more just behavior and lifestyle?

Mariangela Rivera, MD: you know, my impression as a surgeon is that it is primarily lifestyle. Obviously, there's going to be some component of genetic risk where maybe one person's immune system is going to be more permissive. And it's going to allow cancers to sneak through versus maybe someone else's immune system might be less so, and will be more aggressive against those types of irritants that can cause cancer, but generally speaking, it's your exposure.

So it's smoking, it's using alcohol or using tobacco products in a way that's going to dry your mouth out and increase your risk.

Host: Yeah. And I want to ask you about screening for oral cancer. And I feel like, uh, and I don't think I'm inventing this. I don't think I've like imagined this. I feel like there was a time or two with my dentist over the years where he had some sort of mouthwash or something that he did. And I believe he told me he was sort of looking for oral cancer.

Again, I don't know if that's true or not, but generally speaking, or for everyone else who didn't go to my dentist, what's the screening for oral cancer and what does it involve?

Mariangela Rivera, MD: So it's really simple. It's really just having someone take a look around in your mouth with a mirror and with a flashlight. It's just like what your dentist is doing. And what we're looking for is that same stuff that we described at the beginning. So kind of spots and funky shapes, growths that maybe don't belong there.

And when you come in for a screening, if we see something that's weird, we'll recommend that we get a biopsy.

Host: Yeah. Let's just finish up then and just talk about diagnosis and most importantly, I think treatment. What are the treatment options for oral cancer?

Mariangela Rivera, MD: As a general rule, oral cancers are treated with surgery. So the sooner you catch it, the smaller the surgery. So little things, can usually be treated with just a small procedure to cut out the bad tissue or the cancerous tissue and close it up. But as things get more progressive and as they get bigger, it can be really disfiguring.

It can be surgery that involves removing part of your jaw or your whole tongue even. So, you know, as soon as you see something, and like I said, if it gets to be that five to six week mark and it's not getting better, go in and see somebody.

Host: Right, speak with your primary, be referred, whatever it takes, early diagnosis is key, and as you've sort of said here today, and I'll give you a chance here in your own words, but you know, most of it is lifestyle, it's mostly at least, within our control, right?

Mariangela Rivera, MD: That's right. The kids these days are using vapes, and I think that's going to be the next, source of exposures that really hurts people. So, I think avoiding vape. And then recently a paper came out saying that marijuana use, smoked, can also lead to an increased incidence of these kinds of cancers. So don't smoke anything, whether it be tobacco or otherwise.

Host: Don't smoke anything. Don't chew anything. Speak with your providers, be referred, look in your mouth, have others look in your mouth. I mean, it's all just great advice from an expert today. Thank you so much.

Mariangela Rivera, MD: Thank you for having me, Scott.

Host: For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish, a podcast brought to you by PRISMA Health. I'm Scott Webb. Stay well.