Oral cancer cases rise in Israel as HPV, smoking, alcohol consumption take effect

The rates of oral cancer have continued to rise in Israel, despite numerous public health campaigns, thanks to a number of lifestyle choices related to sexual health, smoking, and the consumption of alcohol.

Prof. Samer Srouji, an oral and maxillofacial specialist at Assuta Medical Centers, head of the Galilee College for Dental Sciences, and director of the Oral and Maxillofacial Surgery Department at the Galilee Medical Center, noted that the area is highly sensitive due to its dense network of blood vessels and lymph nodes. The anatomical density accelerates the involvement of additional systems, sometimes at relatively early stages.

Oral cancer is more frequently diagnosed in men, but recent years show a rise among women as well, due to behavioral changes and prolonged exposure to smoking and alcohol.

Tumors linked to human papillomavirus are more common among younger individuals, a trend currently being studied by health agencies. Prof. Srouji stressed that the disease does not receive the public attention given to other cancers, resulting in many patients being unaware of early warning signs.

Smoking is the most prominent risk factor, alongside heavy alcohol use, HPV infection, chronic sun exposure, and a diet low in fruits and vegetables.

Prof. Srouji noted that the combination of smoking and alcohol significantly increases tissue damage. HPV vaccination reduces the risk of certain tumors, but vaccination rates remain low in some populations. Poor dental and gum health may cause chronic irritation that can accelerate precancerous changes.

The tumor typically forms after cumulative damage to epithelial cells. Chronic injury from smoking or alcohol, or HPV infection, leads to genetic changes that impair the cell’s ability to repair errors and regulate division. A tumor then begins spreading to muscles, jawbones, and the lymphatic system.

Prof. Srouji explained that the relatively rapid spread is linked to the dense structure of the oral cavity, where even small changes affect essential functions such as swallowing, chewing, and speech.

Early signs are not always clear. A sore that does not heal for two weeks, a white or reddish patch on the oral mucosa, persistent pain, a lump in the cheek or tongue, difficulty swallowing, prolonged hoarseness, unexplained bleeding, or persistent bad breath all warrant medical evaluation. Neck swelling may indicate lymph node involvement.

Prof. Srouji noted that many patients assume mouth sores are temporary irritation and seek diagnosis only after the disease progresses.

Diagnosis begins with a clinical examination by an oral and maxillofacial surgeon or an oral medicine specialist. If suspicion arises, a biopsy of the affected tissue is performed to provide a definitive diagnosis. Imaging tests such as CT, MRI, or PET-CT evaluate the stage of the disease and possible lymph node involvement.

According to Prof. Srouji, light-based technologies are increasingly used to detect early tissue changes, but the biopsy remains the determining tool. Routine dental checkups can sometimes identify lesions much earlier, before they spread extensively.

Treatment depends on tumor size, location, depth of invasion, and lymph node involvement. Surgery is often the first line of treatment. Tumor removal and reconstruction are performed with advanced techniques, including tissue transfers from other parts of the body. In some cases, the surgical area can be closed primarily without complex reconstruction.

Certain procedures are performed using robotic techniques, which allow greater precision and better preservation of surrounding tissue. Prof. Srouji notes that reconstructive surgery is particularly important because functional impairment can be significant.

Postoperative radiation is sometimes required, depending on tumor characteristics. New radiation methods allow highly precise targeting and reduce damage to healthy tissue. Some patients receive chemotherapy alongside radiation.

Immunotherapy has become a leading treatment for malignant oral cavity tumors in recent years. It activates the immune system against cancer cells and is particularly effective for advanced tumors or recurrent disease. Targeted biological therapies are available for some patients depending on the tumor’s molecular profile. According to Prof. Srouji, combined treatment now provides outcomes that were not possible a decade ago.

Prognosis depends largely on the stage at diagnosis. Early detection is associated with high recovery rates, while lymph node involvement or deep bone invasion lowers survival rates. Tumors related to HPV generally respond better to treatment.

Prof. Srouji emphasized the significant difference between early and late detection and underscored the need to raise public awareness.

Rehabilitation addresses both function and appearance. Oral rehabilitation specialists create tailored solutions, including implants and customized prosthetics. In some cases, skull structures must be rebuilt using implants or tissue transferred from another part of the body.

Advanced computer-based planning now enables the design of personalized implants that offer greater precision and improved reconstructive outcomes. Patients are also referred to complementary therapies such as physiotherapy and speech therapy to improve swallowing and speech.

Prof. Srouji noted that rehabilitation is a long process that requires multidisciplinary support, but modern reconstructive methods yield much better results than in the past.

“Oral cavity cancer is almost absent from public discourse despite the significant risk it poses,” concluded Prof. Srouji. “Unlike other cancers, many people are unaware of the early signs and risk factors. Raising awareness about smoking, alcohol, and HPV, along with routine checkups, especially dental checkups that can identify early lesions before symptoms appear, can help reduce the number of patients.”