Oral Cancer Screening

Oral cancer screening is important for catching mouth and throat cancer (and pre-cancer) at an early stage when it’s easier to treat. Getting regular dental checkups, which include an oral exam, is one of the best ways to get screened.

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Your dentist will check your face, neck, lips and tongue for signs of abnormal sores or color changes. If they find something, they may order further tests to look at the tissue more closely.

Oral Cancer Risk Factors

Oral cancer is a disease that arises from malignant changes in cells that grow uncontrollably. It is a highly preventable disease and if caught early, the 5-year survival rate is very high. Screening is the key to prevention and early detection. The best time to screen for oral cancer is before it manifests as a noticeable lesion or sore in the mouth.

The conventional test applied in most screening studies and programs involves a systematic visual examination of the entire oral cavity (including the cheeks, lips, tongue, jaws, and neck) under a bright light source. The examiner looks for asymmetries, swellings, bumps, patches of color, and ulcerations, among other things. The examiner also checks for enlarged lymph nodes in the neck that indicate regional metastasis.

Despite its preventable nature, oral cancer is often asymptomatic and mimics benign conditions such as canker sores and gingivitis. This, along with the high monetary costs and emotional toll of diagnosis and treatment, make a compelling case for routine screening of individuals at increased risk for developing OC.

In low and middle income countries where the dental workforce is limited, several opportunistic screening studies have been undertaken using PHCWs. In general, these workers have been shown to be able to perform visual screening for oral cancer and OPMDs with good accuracy comparable to trained dental professionals.

Oral Cancer Symptoms

A person with oral cancer may experience a range of symptoms, including painful or tender areas in the mouth or neck, sores that won’t heal, red and white patches inside the mouth, numbness in the mouth or throat, difficulty chewing or swallowing and a hoarse or dry voice. People with these symptoms should see a doctor or dentist for an exam.

During an oral cancer exam, the healthcare professional will check the face, neck, lips, tongue, gums, teeth and back of the throat for signs of oral or mouth cancer or pre-cancer. They may shine a special light in the mouth to look for abnormal tissue that glows or reflects differently under the light than normal tissue. A newer device, called a VELscope, uses fluorescent light to help find early cancerous tissue.

Other tests may be done to check for oral cancer or pre-cancer, such as a blood test, biopsy or exfoliative cytology. With a sample of cells removed from the lip or mouth, the healthcare professional can look for cancerous cells under a microscope.

Currently, the most effective method of diagnosing oral cancer is by surgery. Depending on the stage of the cancer at diagnosis, survival rates improve with earlier detection and treatment. The five-year survival rate for people with stage 1 or 2 oral cancer is about 70 to 90 percent.

Oral Cancer Diagnosis

Typically, an oral cancer diagnosis begins with a thorough dental exam. Your dentist will look for asymmetries, lumps or discolorations in your mouth, throat and jaw areas. In addition, he or she will observe the back of your head and neck for enlarged lymph nodes, which are signs that cancer may have spread to other parts of the body.

Your dentist may also perform a biopsy, which is the removal of some cells from a suspicious area for further testing. If he or she suspects that your cancer is advanced, you will most likely be referred to an oncologist for further evaluation and treatment.

If your cancer is at a very early stage, your doctors can usually treat it successfully with surgery and/or radiation. If your cancer is in a more advanced stage, they will likely recommend chemotherapy and/or other types of treatments.

The standard test applied in most screening studies and programs is a systematic visual examination (VOE) of the oral cavity under bright light to identify abnormal oral findings that raise an index of suspicion for oral cancer or OPMDs and evaluation of neck for enlarged lymph nodes suggestive of regional metastasis. In spite of this, the US Preventive Services Task Force (USPSTF) has concluded that current evidence is insufficient to assess the balance of benefits and harms of VOE for oral cancer/OPMD screening in asymptomatic adults.

Oral Cancer Treatment

Oral cancer and pre-cancers are best treated in the early stages when they are small. Screening can help find these abnormalities.

The best way to detect an oral cancer or pre-cancer is through regular dental check-ups. Your dentist will examine your mouth to look for any unusual areas or growths. They may use a special rinse or a light that shines on the tissue to make healthy tissue look dark and abnormal tissues look lighter.

If they find something, the doctor will usually perform a brush biopsy or a tissue biopsy to see if the cells are normal or cancerous. Then they will send the cells to a lab for a more definitive diagnosis. If the cells are cancerous, the doctor will usually treat them with surgery, radiation therapy or chemotherapy. If the cancer is more advanced, treatment may include a combination of these treatments or other types of care like immunotherapy.

It is important to note that some cancers found through screening never cause symptoms or become life-threatening. This is known as overdiagnosis. However, it is also true that some people get treated for cancers that would have naturally progressed and died without screening. These patients live longer with their disease and have less chance of dying from it later. Fortunately, studies of VOE programs have generally shown that the benefits outweigh the harms from overdiagnosis.