ADA Federal Treasurer Dr Martin Webb on ABC Sunshine Coast GM

12 October 2022

ADA Treasurer and ADAQ Past President Dr Martin Webb joins ABC Drive host Annie Gaffney to discuss the detection and treatment of oral cancers following John Farnham's public diagnosis.

Listen to the interview here .

Transcript:

Speakers: 
Annie Gaffney (ABC Sunshine Coast Drive radio host)
Dr Martin Webb, ADA Federal Treasurer and ADAQ Past President 

Transcript auto-generated by Meltwater.

Gaffney: Several weeks ago, we all heard the terrible news that our very own voice, John Farnham, had been diagnosed with cancer of the mouth. Now we know that John's had extensive surgery and faces a long recovery process, but it wasn't until last weekend, I guess that we learnt how John had come to be diagnosed. His son shared some of the details on 60 minutes that his dad, who apparently likes to sleep on his side, had experienced some discomfort sleeping, had noticed a little bit of a lump there. His wife had checked it out and pushed him to go and see the dentist, who then discovered what looked like an ulcer. Now. Ultimately, this was diagnosed by specialists as an oral cancer, a cancer of the mouth. But how would you know if there was something inside your mouth that was an oral cancer or could become one? Dr Martin Webb is a Sunshine Coast-based dentist from Maleny. He's the Federal Treasurer of the Australian Dental Association and Past President of the ADAQ. Martin good to have you with us this afternoon. What kind of a check do dentist do to look for potential mouth cancers or oral cancers, as you call them?

Dr Webb: Thank you Annie, it's great to be able to speak to you and your listeners this afternoon. The examination of the soft tissues of the mouth is a standard part of a dental check-up and should be done for all patients all the time. Every time you go and see the dentist. You're (the dentist) looking at the inside of the mouth, you're looking at the lips, you're looking at the floor of the mouth and the tissues next to the tongue. Many times, you will actually pick up the tongue with a piece of gauze and pull it to the side to check in the back section of the tongue. And you're looking around the throat area for the main areas that cause problems with oral cancer. 

Gaffney: How do those cancers typically present?

Dr Webb: They look like something that's rough or swollen, and often it's a red or white lesion. You (the dentist) see something that just doesn't look normal. You normally see a light pink colour in the mouth and if you see something that's white or red or ulcerated, you start to think it could be something that could be nasty and many times an ulcer, a standard ulcer of the mouth should hear or by itself within a week or two, and many times we actually ask a patient to come back in a couple of weeks to check a lesion that looks a bit suspicious. If it's still there or it's grown, we'll send them off to an oral pathologist or to a hospital to have a check. 

Gaffney: Are those cancers typically limited to the mouth or can they present in the jaw or the neck? I mean, do you check that part of the anatomy as well as part of a check-up? 

Dr Webb: The main presentation for oral cancers are in the soft tissues of the lip's tongue, mouth, throat and salivary glands. So sometimes you would check on the side of the neck. There's often lymph glands on the side of the neck and you're feeling to see if you can feel any what's called lymphadenopathy, which is a swollen area where the limp clans sit on the side of the neck. 

Gaffney: You've been a dentist now for how long now Martin?

Dr Webb: About 32 years since it graduated

Gaffney: How often in that time have you seen an oral cancer? Are they common?

Dr Webb: So, I've seen many areas that look a bit suspicious and fortunately most of them have been fairly mild. I've seen three proven diagnosed oral cancers, including one that I diagnosed myself for my own patient. 

Gaffney: What happens typically for a patient who does get that diagnosis, you've got an oral cancer. How is that typically treated? We understand from the very little we know about John Farnham's case that he's had very extensive surgery.

Dr Webb: Sure so the main thing when you talk about cancer treatment in the mouth is trying to remove enough tissue to achieve a clear margin. So, in the mouth you'll be talking about approximately one to two centimetres of tissue all the way around where the lead is found. So, if it's on the side of the tongue, you have to remove part of the tongue and the floor of the mouth area next to the tongue to try and remove any tissue that might be close to it. If it's near the jaw many times the surgeons will actually take away part of the jaw and remove it and replace it with a part of bone from some other part of your body. Occasionally, as you hip, they take a small section out of your hip bone and reshape that back into an area that they can fabricate a new jaw for you, and sometimes they take a section out of one of the leg bones to actually make up a jaw for you g. The surgery would be very extensive. Then it can be quite disfiguring in many cases, and you can look quite different, particularly if the cancer has been near your lips. There's often a fair chunk of your lips and soft tissues that needs to be removed, and often you'll get skin grafting in other areas to try and fill in the tissue again, but there can be significant effects on speech, on being able to swallow, on being able to eat and the movement of your tongue and even speaking can be quite a long and slow process, depending on where the cancer is actually found.

Gaffney: What is the life expectancy of someone who has been diagnosed with an oral cancer and had the kinds of treatments that you're talking about? Is it good? 

Dr Webb: It's reasonable. There's the statistics on 2009 to 13, they said a relative survival rate for oral cancers of 74 % being alive still after five years, depending on the top of tumour and what part of the mouth and how advanced it is. So obviously like any other cancers, if they are diagnosed later and the tumour is quite large, you have often a very poor chance of survival, and if you catch it early enough and this is where regular dental check-ups is really important - for a dentist to be looking inside your mouth for any early signs of these conditions, if you're catching it early you've got a very good chance of still being alive. 

Gaffney: Martin, what are the typical reasons why someone might develop an oral cancer? 

Dr Webb: The main risk factors, like many cancers, are smoking and excessive alcohol consumption. I'm not talking about having a beer after work, I'm talking about half a bottle of whiskey after work each day. If you're a heavy smoker, you have a much higher chance of developing oral can. Throughout your life and if you're a heavy drinker you also have a higher incidence and if you do both, if you're a heavy smoke and a heavy drinker, the risk factor goes up even more.

Gaffney:  Can there be instances of oral cancers where people are neither they just develop that cancer, for you know for no particular lifestyle reason.

Dr Webb: Yes, there can be and there's a lot of cancers that are happening these days with human papillomavirus, the same virus that's indicated for other cancers around the body. There are incidents of HPV causing problems around the mouth and there are some tumours that are related to HPV infection that goes on to become oral cancers. There's some evidence that if you are having a vaccination to HPV, that you decrease your chance of developing an oral cancer for those types of risk factors.

Gaffney: What would you like to tell people listening this afternoon, about oral cancers generally in terms of their prevention and regular health checks?

Dr Webb: The main thing we say to patients, and we talk to our patients about this all time as dentists, is that if you want to reduce your chances of getting oral cancer, reduce or cut out smoking completely reduce or cut out alcohol consumption or try and have the lower concentration alcohols like beer rather than a strong whiskey. And exposure to the sun is one of the other big risk factors for cancers of the lip areas. So, if you are going to be outside, try and make sure you cover your face with a hat and wear sunscreen or zinc on your lips to try and prevent you from getting lip cancer.

Gaffney: How often would you see cancer of the mouth oral cancers where it spread to the jaw or spread to the neck? How often does that kind of diagnosis happen?

Dr Webb: I personally haven't seen that in my career of thirty-two years at this stage, but there are areas of the world where there's not many health practitioners around the place to look after patients and people do present with quite advanced or cancer where it's grown into quite a large one. I saw one on on the Internet recently where there was a very large, ulcerated area on the side of someone's tongue by that stage would have actually spread to all of the adjacent tissues near that, and the chance of being successfully treat that much more difficult when it's got to that size. So, any ulcer in your mouth, any lump or bump that doesn't get better by the delf, definitely go and show it to your dentist or your oral health practitioner, so you can actually get it checked and make sure it's not anything nasty.

Gaffney: Dr Martin Webb, good to speak with you. Thank you. Thank you. An important topic, one that you might have found a little confronting about a very good reason to head to your dentist and get a check-up.