Anyone can get oral cancer. If diagnosed with oral cancer, the five-year survival rate is 52%, which has not changed in 25 years.
The major reason for such a poor survival rate is that oral cancer is often not diagnosed until a significant, persistent lesion prompts a patient to ask his or her dentist or doctor about it. Unfortunately, because of the aggressive nature of oral cancers, the lesion may already have spread to the lymph system by the time it is noticed. However, when cancer is recognized early, the five-year survival rate increases to 82%. Therefore, early diagnosis saves lives!
Many dentists and dental hygienists perform physical oral cancer examinations routinely. The exam takes only a few minutes to perform and is often done routinely at dental check-ups. The clinician inspects the inside and outside of the mouth for unusual lumps, bumps, red spots, white spots, and ulcers. The cheeks and lips are usually rolled and palpated for masses. A very critical part of the oral cancer exam is an inspection of the tongue. Usually, the tip of the tongue is grasped with a piece of gauze and stretched forward while the clinician looks at the sides, top, and bottom of the tongue for anything suspicious. This exam has been considered to be the standard of care for many years.
Over the past decade or so, several technologies have been introduced for dentists to use to aid in early detection of oral cancer. For example, one of the early tools required the patient to swish with a vinegar solution followed by the dentist inspecting the mouth with a glow-stick, similar to a test used by some gynecologists. This test, although beneficial, was relatively costly and unpleasant for routine use; it worked well to highlight suspicious white lesions, but it did not work as well on red lesions. Incidentally, red lesions tend to have the highest likelihood of becoming cancer in the mouth. Another technology that has been improved by the FDA for early cancer screening is called direct tissue fluorescence visualization. Essentially, a special light that uses wavelengths within the visible light spectrum is used to inspect the soft tissues of the mouth. No rinse or dye is needed. It works on the principle that rapidly reproducing cells, such as cancer cells, do not allow the light to penetrate down to the collagen level of the skin. Healthy tissue reflects the light and “lights up” through a viewing filter or special glasses, depending on the design of the product used. Suspicious lesions appear as black spots in a field of color. This is a much more useful tool for helping to decide the risk level of a lesion because rapidly reproducing cells, such as those in dysplasia or cancer, lose the ability to fluoresce. In fact, this technology can even be used during surgical procedures to guide the surgeon in identifying the margin, and it has been used to identify dead bone from healthy bone when used for surgical removal of osteonecrosis after the patient has been on a course of tetracycline because the antibiotic, which is highly fluorescent, diffuses through healthy bone but not dead bone.
Once a lesion is discovered, either through visual inspection, by chemical fluorescence, or by direct tissue fluorescence visualization, further tests are necessary to reach a diagnosis. A secondary screening test, similar to a PAP smear, can be performed for early lesions, which tells if further studies are necessary or not. If further studies are needed and to get a definitive diagnosis of the lesion, then a scalpel biopsy is performed. In a surgical biopsy, part or all of the lesion is removed surgically and viewed by a pathologist under a microscope. Obtaining a diagnosis is essential for determining the appropriate treatment. Fortunately, a simple excisional biopsy or even no treatment is all that is needed for very early oral lesions.
If you have not received an oral cancer screening, we strongly recommend you schedule an appointment to get tested.