Oral Cancer

Diagnosis

Diagnosis of oral cancer can be made through the following techniques:

• Medical history and physical examination: Dentists or primary care providers detect some cases of oral cancers during a routine check-up. However, in many cases, oral cancer is diagnosed when the patients experience oral cancer symptoms and visit the hospital for further evaluation. The patients are enquired about the occurrence and progression of symptoms. Lifestyles, such as smoking and chewing tobacco, are also asked to determine the risk of oral cancer. Cancer specialists also ask about family history or oral or any other type of cancer. The patients are also checked for any lump or abnormal growth and lesions inside the mouth.
• Comprehensive head and neck examination: If the patient is suspected of having oral cancer, he is referred to the ENT doctor for further examination. These doctors evaluate the head and neck to detect any swollen lymph nodes. The patients may also undergo direct or indirect laryngoscopy to determine if cancer has spread to the pharynx.
• Panendoscopy: This procedure diagnoses the spread of oral cancer into the pharynx, larynx, esophagus, trachea, and bronchi. The technique involves laryngoscopy, pharyngoscopy, esophagoscopy, and bronchoscopy. The procedure is performed under general anesthesia to avoid discomfort to the patients. In addition, the procedure helps in determining the presence, size, and location of the tumor.
• Exfoliative cytology: Once the area of concern is detected, the abnormal cells are scraped and collected on the glass slide. The cells are then stained and evaluated. If there is a presence of abnormal cells, the patient is recommended to undergo a biopsy. The benefit of exfoliative cytology is reduced pain and discomfort to the patients. It also assists in early cancer diagnosis, which may improve survival outcomes. However, the disadvantages of this technique include not showing all types of cancer and not effectively differentiating the normal and abnormal cells.
• Biopsy: Biopsy involves obtaining a tissue sample from the abnormal area and testing it in the laboratory for cancer cells. There are various types of biopsies:
  Fine needle aspiration biopsy: In this technique, a very thin needle is used to obtain certain cells from the lump or tumor. This technique is not usually used to obtain mouth or oral cavity samples. Instead, it is used for sampling a lump in the neck, which is seen through a CT scan.
  Incisional biopsy: It is the most common biopsy procedure performed to diagnose abnormal cells in the oral cavity. This technique involves cutting the tissues from the abnormal area. The sample obtained through biopsy is checked for variation in the cellular characteristics and presence of human papillomavirus infection.
• CT scan: CT scan provides detailed information about the presence and location of the tumor in the oral cavity, nearby organs or lymph nodes, or distant organs, such as the lungs. CT scan is also used to guide the instruments for taking the samples during the biopsy, a procedure known as CT-guided biopsy.
• MRI: MRI scans use strong magnets and radio waves to create high-quality images of the oral cavity. This imaging modality is preferred over a CT scan in patients with significant dental fillings as they may distort the images of the CT scan. MRI scan also allows the oncologists to evaluate the spread of cancer to the bone marrow.
• Barium Swallow: This test involves the administration of barium solution that lines the upper digestive tract. The test is used to determine if cancer has spread to the esophagus.
• Chest x-ray: If it is strongly suspected that cancer has spread to the lungs (based on the pulmonary symptoms), the oncologists may advise the patients to undergo chest x-rays.
• Bone scan: Bone scan uses radiopharmaceutical substances. It helps in detecting the spread of oral cancer to bones.
• Ultrasound: The patients may undergo a neck ultrasound to evaluate the health of the lymph nodes. Ultrasound also finds its application during biopsy (ultrasound-guided biopsy).