Early Detection
Kinds of Early DetectionWhen detected early, oral cancer patients have an 80 to 90 percent survival rate. Unfortunately, 40% of those diagnosed with oral cancer will die within five years because the majority of these cases will be discovered as a late stage malignancy. (see stage description in Oral Cancer section)

Oral cancer is particularly dangerous because the patient may not notice it in its early stages. It can frequently develop without producing pain or symptoms. As a result, Oral Cancer often goes undetected until it has already metastasized to another location.

 

 

Is Early Detection Screening Mandatory?

Shockingly, there are no universal guidelines for oral cancer screening programs in the US, even though early detection of oral cancer can increase survival rate to 80-90%.

 

  • The ADA estimates that 60% of the US population visits a dentist every year, however less than 15% of those who visit the dentist regularly report having received an oral cancer screening.
Kinds of Early Detection

Oral cancer screening should be a routine part of every annual dental examination. These regular check-ups, including an examination of the entire mouth, are essential in the early detection of cancerous and pre-cancerous conditions. You may have a very small, but dangerous, oral spot or sore and not be aware of it. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread. If you do not believe your dentist has given you an oral exam, simply demand one.

You should also be aware of your own oral health. The mouth experiences many changes, which are harmless and no cause for alarm — a canker sore, a wound from biting the inside of your mouth when you chew, or poorly fitting dentures. However, a sore that does not go away in two weeks should be brought to the attention of your dentist, primary doctor or other specialist.

Screening
Screening
Sadly, there is no standard or routine screening test for oral cancer. There is, however, a fairly traditional exam for abnormalities in the mouth. Your dentist should carefully examine the inside of your mouth, tongue and throat. In some patients abnormalities such as a flat, painless, white or red spot or a small sore are detected. Most of these are harmless, however some are not. Harmful spots and sores often look identical to those that are harmless, but professional testing can tell them apart.

Early discovery is THE most important step in reducing the death rate from oral cancer.

Types of Screening:
1. Manual Exam –
Your dentist should give you a visual examination of the soft tissues of the mouth, including the manual extension or pulling of the tongue (often to the point of gagging) to examine the base, a manipulation of the floor of the mouth, an examination of the cheeks, gums, the area behind the teeth and the tongue’s borders. The dentist should also feel the lymph nodes of the neck and those surrounding the oral cavity (sometimes the first visible sign of oral cancer). The exam will include looking for lesions, including areas of leukoplakia (an abnormal white patch of cells) and erythroplakia (an abnormal red patch of cells). Leukoplakia and erythroplakia lesions on the mucous membranes may become cancerous.

2. Manual with Adjunctive Medical Devices Medical companies are aggressively marketing several new screening tests and devices that they claim will vastly improve early detection of oral cancer. These devices use rinses, dyes and different types of lights to detect abnormal cells. Some of these devices have more cutting-edge technology than others, and we believe can aid in the discovery process of oral cancer, but do not replace a good manual exam. These “adjunctive” devices are good only if used in concert with a traditional manual exam. In small studies, the devices have successfully detected potentially malignant lesions that experienced specialists missed with the naked eye. The screening tests can cost the patient $35 to $65, though some dentists do not charge extra for it. Some insurers are now beginning to cover the cost of these devices.

In Case of Abnormalities:
FURTHER TESTS & DIAGNOSIS

If a screening test result is abnormal, you may need to have more tests done to find out if there is cause for concern.

These tests may include:
1. Exfoliative cytology: A procedure to collect cells from the lip or mouth. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, mouth, or throat. The cells are viewed under a microscope to find out if they are abnormal.

2. Brush biopsy: The removal of cells using a brush that is designed to collect cells from all layers of a lesion. The cells are viewed under a microscope to find out if they are abnormal.

3. Saliva Test — Researchers are working on a fascinating new oral cancer screening: a test that can analyze saliva for early gene changes that could lead to the disease. We are following this development and will report any update here.

Who Should Get an Oral Cancer Screening?If precancerous cells (dysplasia) are found, the lesion can be surgically removed if necessary during a separate procedure. It’s important to know that all atypical and positive results from any test must be confirmed by incisional biopsy or punch biopsy and histology.

Incisional biopsy. Your doctor may cut out a small sample of tissue. If the suspicious area is easy to reach, your doctor can numb your mouth and do this in his office. If the area is deeper in the mouth or throat, this is done in the operating room.

Once the biopsy is completed, the pathologist examines the tissue samples in a lab. He or she looks at the tissue under a microscope to check for cancer cells. It usually takes several days for the results of your biopsy to come back. A biopsy is the only sure way to tell if you have cancer and what kind of cancer it is. Another test may include a fine-needle aspiration.

Fine-needle aspiration. Your doctor may have noticed a lump in your neck. If so, he or she uses a thin needle to remove a small sample of tissue. This can be done in a doctor’s office.



Who Should Get an Oral Cancer Screening?

  • Dentists
  • Periodontists
  • Hygienists
  • Primary Care Physicians
  • Oral Surgeons Otolaryngologists (ENTs)
  • Head and Neck Surgeons

 

Who Should Get an Oral Cancer Screening?According to the Centers of Disease Control (CDC), anyone over the age of 17 should get an annual screening for oral cancer. This is due to the spread of HPV (Human Papilomma Virus) 16 and 18, the same virus that causes cervical cancer.

 

Anyone with a history of oral cancer should have a screening every six months.


Clinical Images
Trimira’s Identafi 3000 Ultra 3 Modalities of Light
(A) White (conventional) light
(B) Fluorescent light (Note: Healthy tissue fluoresces, Non-healthy tissue does not)
(C) Green-Amber light (displaying increased and irregular patterns of circulation, usually associated with tumors)

(Note to reader: OrCA has not accepted any fees for inclusion of detection device information or clinical photos)

Images Courtesy of Trimira(TM)Norma Ventral Tongue
Moderate Dysplasia - Lateral Tongue

Carcinoma

Sqaumous Cell Carcinoma

Squamous Cell Carcinoma