Identifying Pre-Cancer in the Mouth: A Guide to Early Detection

Oral cancer is a major health concern, especially in India, but early detection of lesions, before they turn to cancer (precancer), can significantly help avoid conversion to cancer. Recognizing premalignant lesions and conditions plays a crucial role in improving outcomes. By understanding these warning signs, individuals can seek timely medical advice, increasing the chances of prevention and early intervention advice and reducing the risk of progression to malignancy.

What Are Precancerous Lesions and Conditions?

Oral potentially malignant disorders (OPMD) refer to abnormalities that have the potential to turn into cancer over time. The World Health Organization (WHO) has defined it as :

“Any oral mucosal abnormality that is associated with a statistically increased risk of developing oral cancer.”

Some Common OPMD’s

1. Leukoplakia

Leukoplakia presents as white patches or plaques that cannot be wiped off. It is often linked to tobacco use, alcohol consumption, and chronic irritation. Although many cases are benign, some may show dysplastic (precancerous) changes.

2. Erythroplakia

Erythroplakia appears as a red, velvety patch that may have a slightly raised surface. It is more concerning than leukoplakia because it has a higher likelihood of progressing to oral cancer.

3. Oral Submucous Fibrosis (OSMF)

A chronic, progressive disorder linked to areca nut (betel nut) chewing, OSMF leads to stiffness and reduced mouth opening. Over time, it can undergo malignant transformation.

4. Lichen Planus

Oral lichen planus manifests as white, lacy patches, ulcers, or red areas in the mouth. It is an autoimmune disorder, and while not all cases become malignant, some forms (especially erosive lichen planus) carry a small risk of cancer.

5. Actinic Cheilitis

This condition affects the lips due to prolonged sun exposure, leading to dryness, cracking, and white or red patches. It is considered a precancerous condition, particularly in fair-skinned individuals with significant sun exposure.

6. Palatal lesion in reverse smokers (Smoker's palate)

In reverse smoking, the burning end of a cigarette is held inside the mouth. One may see a whitish or black, thickened, or roughened area on the roof of the mouth (palate). Numerous small red dots scattered across the white area. The surface may look dry and slightly leathery due to chronic exposure to heat from smoking.

There are many more types of premalignant disorders but what is most important is to learn to identify them by simple self-examination.

How to Identify Premalignant Changes

Here are some signs to watch for:

• White, red, or mixed red-and-white patches that persist for more than two weeks

• Non-healing ulcers or sores in the mouth

• Persistent pain, burning, or irritation

• Thickened, rough or leathery areas in the mouth

• Difficulty in chewing, swallowing, or speaking as well as restriction in mouth opening over a few months or years.

• Unexplained loosening of teeth or bleeding gums

Where in the mouth can they occur?

Oral precancer can develop anywhere in the mouth except the teeth. Common sites include the inner cheeks, the surface and underside of the tongue, the floor of the mouth (below the tongue), the gums, the roof of the mouth, the upper or lower lip, etc. Therefore, it is essential to examine the entire mouth under good lighting.

What to Do If You Notice Symptoms?

If you observe any of the above symptoms, consult an oral medicine specialist or an oral and maxillofacial surgeon as soon as possible. A thorough examination generally gives good information, sometimes a biopsy or imaging may be required to assess the risk of malignancy.

Prevention and Risk Reduction

Preventive measures include:

• Tobacco and Alcohol Cessation: Both smoking and alcohol significantly increase the risk of oral cancer.

• Avoiding Areca Nut and Betel Quid: Reducing consumption of these substances can lower the risk of conditions like Oral submucous fibrosis

• Good Oral Hygiene: Regular brushing, flossing, and dental check-ups help in maintaining oral health.

• Sun Protection: Using lip balms with SPF can help prevent actinic cheilitis.

• Healthy Diet: A diet rich in fruits and vegetables can provide protective antioxidants.

"Recognizing premalignant disorders of the mouth is vital for early intervention and the prevention of oral cancer. By adopting healthy lifestyle habits, performing regular self-examinations, and prioritizing routine dental visits, we can significantly reduce the risk of malignancy. Awareness and timely action not only safeguard our health but also spare us from the physical, emotional, and financial burdens of extensive treatments like major surgeries, radiation, or chemotherapy. As the saying goes, 'An ounce of prevention is worth a pound of cure.' – Benjamin Franklin."