Crucial Facts on the Diagnoses and Treatment of Oral Cancer

It’s obvious that oral cancer is a serious matter. But that’s why you need be educated on the symptoms, risks, and diagnoses process of this disease.

 

photo by US Army Africa via Flickr.

No type of cancer is easy to talk about.

Still, it’s important to be educated on this disease in order to catch it in it’s earliest stages. With oral cancer, it’s no different. This year alone, it’s predicted that over 48,000 people will be diagnosed with oral or pharyngeal cancer. To protect yourself, here is everything you need to know about the symptoms, diagnoses, and treatment of oral cancer.

Early Detection and Symptoms

You play the biggest role in diagnosing cancer in its earliest stages. Some ways to be on guard against oral cancer are getting screened annually, keeping up with regular dental examinations, taking note of changes in your mouth that could be signs of oral cancer. The Oral Cancer Foundation advises that you contact your doctor or dentist immediately if you notice any of the following symptoms:

  • An unusual lump or thickening in the cheek
  • A lesion or mouth sore that bleeds easily and does not heal within 2 weeks
  • A sore throat or feeling that something is in the back of the throat
  • A white and/or red patch found on the lining of the mouth, gums, or tongue
  • Difficulty swallowing, chewing, or moving jaw or tongue
  • Numbness around the mouth or tongue
  • Chronic hoarseness
  • Swelling of the jaw

Although the symptoms listed above may be caused by less serious problems, it doesn’t hurt to be too careful when facing the possibility of cancer. Be especially aware of these symptoms if you use tobacco, drink excessive amounts of alcohol, or have been diagnosed with HPV, as these put you at greater risk of developing oral cancer.

Diagnoses

Examinations

Only a medical professional will be able to properly diagnose the presence of oral cancer definitively. Dentists are trained to give simple, quick screenings where they will examine the teeth and oral cavity as a whole to check for concerning signs of cancer. Besides a visual examination of your mouth, a doctor will provide a physical examination. To search your mouth for abnormalities and swelling, your doctor will feel the back of your throat, your lymph nodes, inside of cheeks and lips, and the floor of your mouth. An indirect examination of the nasopharynx and larynx will take place through an oral screening. Your doctor will look for signs such as ulcerations, lumps and bumps, red or white sores, and loose teeth.

Seeing a Specialist

When your doctor or dentist is unable to find the cause of your symptoms, they may refer you to a specialist. Doctors who specialize in dealing with the ear, nose, or throat may need to examine the state and severity of your symptoms. If an abnormal area is found, the next step is a biopsy.

Biopsy

A biopsy is the only way to be sure that the abnormal area in your mouth is cancerous. There are a few kinds of biopsies that may be performed during diagnosis of oral cancer.

  • Brush Biopsy - A brush biopsy is at a dental office where a sampling of cells is collected for preliminary examination. This is done by aggressively rubbing a brush against the concerning area. If the cells show a positive sign of cancer, then a conventional incisional biopsy must be performed.
  • Incisional Biopsy - During an incisional biopsy, a doctor will remove a small piece of tissue to look for cancer cells. The sample is often taken from part or all of a lesion depending on the size. The sample is then sent to a pathologist who examines the tissue for abnormal or malignant cells under a microscope.
  • Fine needle biopsy (FNB) - A fine needle biopsy (or fine needle aspiration cytology) is often used when dealing with a significant mass, such as an enlarged lymph node. In this technique, a sample of suspect tissue is taken using a syringe. A doctor may draw out cells from several locations on the mass to ensure that a thorough sample has been taken.
  • Punch Biopsy - In this type of incisional biopsy, a very small circular blade is pressed down to cut a round border on the suspect area. Then, the doctor pulls on the center of the area, snipping the surrounding tissue free with a scalpel or small tissue scissors. Thus, a perfect plug of cells is removed from the sample area. 

Questions to ask about Biopsy

Before you get a biopsy, the National Cancer Institute recommends that you ask your doctor or dentist the following questions:

  • Why do I need a biopsy?
  • How much tissue will be removed?
  • How long will the process take? 
  • Will I be awake during the procedure? 
  • Will I feel any pain during the biopsy?
  • How soon will I know the results?
  • Are there any risks? What are the chances of infection or bleeding after the biopsy?
  • How should I care for the biopsy site afterward? How long will it take to heal?
  • Will I be able to eat and drink normally after the biopsy?
  • If I do have cancer, who will talk with me about treatment? When?

Staging

If you have been diagnosed with oral cancer, your doctor will then need to learn the extent of the disease. Learning the stage of the cancer will help you and your doctor choose the best type of treatment.

Your doctor may order that you undergo one or more of the following procedures:

  • CT Scan - A CT scan is used to find tumors in your mouth, throat, neck, lungs, or elsewhere in the body. You may receive an injection of dye so that the x-ray machine linked to a computer can take a series of detailed pictures of the suspect areas.
  • MRI - An MRI test can show if the oral cancer has spread to other parts of your body. It uses a powerful magnet linked to a computer to take detailed pictures of your body for doctors to examine.
  • X-rays - An x-ray may be taken of your mouth to determine if the cancer has spread to the jaw. Images of your chest and lungs may also be taken to see if the cancer has spread to those areas.
  • PET Scan - During a PET scan, you’ll receive a small amount of radioactive sugar that gives off signals for the scanner to pick up. The PET scanner then uses those signals to make a picture of the area where the sugar is being taken up. The cancer cells will show up brighter because they take in sugar faster than normal cells. It will also show if the cancer has spread throughout the body.
  • Endoscopy - During this test, the doctor will use a thin, lighted tube to check your windpipe, lungs, and throat. Local anesthesia, general anesthesia, or a mild sedative will be given to prevent discomfort during the procedure. This examination can be done in a doctor’s office, outpatient clinic, or hospital.

Determining the Stage of Cancer

Determining the stage of oral cancer is crucial for choosing the most effective treatment. To describe the stage of cancer, doctors consider the size of the tumor(s) and if/how the cancer has spread to other tissue. 

According to the American Society of Clinical Oncology, cancer is defined by stages 0 through 4.

  • Stage 0 - Stage 0 cancers are often highly curable, and tumors can usually be removed with surgery. In this case, the cancer is still in its original location and has not spread to nearby tissue.
  • Stage I - This is an early stage cancer that has not spread to the lymph nodes or other tissues. The small cancer or tumor has not grown deeply into the nearby tissue.
  • Stages II and III - This stage often indicates a deeper growth of larger cancers or tumors into nearby tissue. Though the cancer hasn’t spread to other parts of the body, it may have spread to the lymph nodes.
  • Stage IV - This is an advanced stage of cancer. This means that cancer has spread to organs and other parts of the body.

Prognostic Factors

Your doctor may use other information to determine the best available treatment and chance of recovery on top of the staging system.

  • Grade - The grade is a description of how much the cancer cells look like healthy, cancerous cells under a microscope. Low-grade cancer cells look more like healthy cells, whereas high-grade cells look more or less like healthy cells. 
  • Tumor Genetics - The genes in cancer cells can sometimes help predict how the cancer will spread and what treatments will help.
  • Tumor Markers - Tumor markers are substances found in significantly high levels in the blood, urine, or body tissues of people with cancer. This helps to determine the best treatment based on the tumor markers that indicate the type of cancer at hand.

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