Diagnosis of Oral Cancer
Any suspicious lesion within the oral cavity needs to be evaluated very thorough with a history and physical exam. Careful examination of the neck by palpation is performed because often the first indication of spread of the cancer is to lymph nodes
within the neck (neck metastases).
The oral and maxillofacial surgeon will establish a diagnosis by taking a biopsy (tissue sample) of the suspected area.Generally, a biopsy can be performed safely under local anesthesia, in the surgeon’s office.
When performing an oral cancer
self-examination, look for the following:
- a white or red patch on the gums, tongue, tonsil, or lining of the mouth
- red and white patches — erythroleukoplakia
- a sore that fails to heal within two weeks and bleeds easily
- an abnormal lump or thickening of the tissues of the mouth or cheek
- chronic sore throat or hoarseness
- difficulty in chewing or swallowing
- difficulty moving the jaw or tongue.
- numbness of the tongue or other area of the mouth.
- swelling of the jaw that causes dentures to fit poorly or become uncomfortable
- a lump in the neck
The biopsy is sent to the pathologist for microscopic diagnosis. Once a diagnosis of oral cancer has been confirmed, the patient will usually be referred to a specialist in the management of this disease, such an oral and maxillofacial oncologic surgeon or ENT oncologic surgeon. Further evaluation will include a thorough clinical exam and various forms of advanced imaging of the head and neck, such as CT scan and MRI.
In cancer, a CT scan may be used to help detect abnormal growths; to help diagnose tumors; to provide information about the extent, or stage of disease; to help in guiding biopsy procedures or in planning treatment; to determine whether a cancer is responding to treatment and to monitor for recurrence.
Positron emission Tomography (PET scan) may also be utilized to look for cancer spread within the lymph nodes and other structures of the body such as the lungs. Not everyone needs each test. Your doctor determines which tests are appropriate based on your condition. A second cancer within the head and neck can be found in up to 15% of patients diagnosed with an oral cancer
. The oncologic surgeon may elect to perform an endoscopy ( use of a camera to evaluate other structures within the head and neck) to help identify the size of the oral cancer
or to look for a second cancer within the head and neck, such as tongue base or larynx (voice box).The endoscopy may be performed in the office or operating room environment.
Staging describes the severity of a person’s cancer based on the size and/or extent (reach) of the original (primary) tumor and whether or not cancer has spread in the body. Staging is important for several reasons:
- Staging helps the doctor plan the appropriate treatment.
- Cancer stage can be used in estimating a patient’s prognosis.
- Knowing the stage of cancer is important in identifying clinical trials that may be a suitable treatment option for a patient.
- Staging helps health care providers and researchers exchange information about patients; it also gives them a common terminology for evaluating the results of clinical trials and comparing the results of different trials.
Staging is based on knowledge of the way cancer progresses. Cancer cells grow and divide without control or order, and they do not die when they should. As a result, they often form a mass of tissue called a tumor. As a tumor grows, it can invade nearby tissues and organs. Cancer cells can also break away from a tumor and enter the bloodstream or the lymphatic system. By moving through the bloodstream or lymphatic system, cancer cells can spread from the primary site to lymph nodes or to other organs, where they may form new tumors. The spread of cancer is called metastasis.
Physical exams, imaging procedures, laboratory tests, pathology reports, and surgical reports provide information to determine the stage of a cancer
Once all the clinical and radiographic information is collected, the tumor can be accurately staged based upon the American Joint Committee on Cancer (AJCC) TNM staging system. The TNM system is based upon three categories: T (tumor size), N (lymph node involvement) and M (distant metastases, ie, spread to other parts of the body). Staging places the patient into a specific risk stratification category, which helps to predict their long-term prognosis and response to various treatment options.
Stage I and II are considered early disease in which tumor size is small (< 4 cm) and there is no cancer spread to any neck lymph nodes. Advanced stage tumors ( Stage III and IV) include those cancers with larger size (>4cm) that have also spread to the lymph nodes within the neck or body.
The five year survival rate for advanced stage disease (Stage III and IV) is only 35%-45%
Treatment of oral cancer – Part 3