Oral Cancer Screening

Screening for oral cancer can detect new, potentially malignant lesions that might otherwise remain undiagnosed. Several studies have shown that visual examination performed by PHCWs is feasible and cost-effective for detection of early stage OPMDs.

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A provider will rinse your mouth with a special dye that makes healthy tissue appear dark and abnormal tissues look white. Then, the provider will shine a light in your mouth to identify any areas that may need further testing.

What is an Oral Cancer Screening?

An oral cancer screening involves an examination of your mouth, neck and jaw by a healthcare professional. Healthcare professionals may use tools like toluidine blue dye and fluorescent light to help detect precancerous or cancerous cells.

These tools coat parts of your mouth with a blue dye, which makes the abnormal tissue stand out against the healthy tissue. Healthcare professionals can also shine a special light in your mouth during an exam, which makes healthy tissue look dark and abnormal tissue appear white.

Healthcare providers may also feel (palpate) the surface of your mouth, cheeks, lips and neck for lumps or bumps. They will especially feel around your chin and jaw, including the area below your tongue.

During a screening, healthcare professionals may take a sample of cells from suspicious areas in your mouth and send them to the lab for testing. They can also perform a biopsy, where they remove a small amount of tissue and send it for laboratory testing to determine if it is cancerous or precancerous. This procedure is usually performed by a dentist or doctor who specializes in oral cancer diagnosis and treatment.

Why is Oral Cancer Screening Important?

Although anyone can develop oral cancer, people with certain risk factors are more likely to have it. These include being over 50 years of age, a history of smoking or alcohol consumption and exposure to the HPV virus (human papillomavirus). People who have these risk factors are also more likely to develop pre-cancerous lesions that can develop into oral cancer.

These pre-cancerous lesions are often asymptomatic, and are only detected by dentists during routine exams or oral cancer screenings. Early detection can significantly reduce deaths and suffering from this disease.

In addition, patients who receive diagnosis and treatment of oral cancer at an early stage have a better prognosis and can avoid more serious complications, such as loss of the tongue, jaw movement problems and difficulty eating or swallowing. It is important that these cancers are diagnosed at an early stage to prevent them from progressing to more advanced stages, when they can be much harder to treat.

How Does an Oral Cancer Screening Work?

During a routine visit, the healthcare provider will examine your mouth for signs of oral cancer. This includes looking at the roof of your mouth, floor of your mouth, and the back of your throat. Your healthcare provider will also feel around your neck for enlarged lymph nodes.

Many studies of oral cancer screening indicate that it can be a cost-effective strategy when targeted to populations at risk and performed regularly. The traditional case-finding screening test employed in these studies involves a systematic visual inspection of the oral cavity and palpation of the neck to identify abnormal findings that raise an index of suspicion for OPMDs, referred for expert examination (VOE).

There are several commercially available adjunctive techniques designed to improve the accuracy of VOE. These include rinsing the mouth with a special blue dye before an examination and shining a light in the mouth, which makes healthy tissue appear dark and abnormal tissues appear white. The effectiveness of these methods has not been rigorously tested in oral cancer screening trials conducted in primary care settings.

What is a VELscope?

The VELscope is a device that helps doctors detect pre-cancerous and cancerous lesions in the mouth. It is a noninvasive, painless and quick test that takes only a few minutes to complete.

When the VELscope is shined on your mouth, normal tissue will show up as a bright apple green color while pre-cancerous or cancerous tissue appears dark. The test is very useful in finding these lesions as they are often invisible to the naked eye.

Robinson, who spent two years learning about oral pathology during dental school, said it is important to catch the signs of these diseases early because they can be fatal if not treated. She says that a patient should have a VELscope screening at least once a year, especially if they have risk factors for oral cancer such as tobacco use, heavy alcohol consumption and excessive unprotected sun exposure. The early detection of these disease can help patients avoid invasive treatment like surgery and radiation.

What is Exfoliative Cytology?

The main type of cancer that affects the mouth and throat is oral cavity and nasopharyngeal cancer, which form in the squamous cells (thin flat cells) lining the lips, cheeks, tongue and the floor of the mouth. Diagnosis is based on biopsy, which involves taking cells from the suspected tumour and examining them under a microscope. It is necessary to have a diagnosis before treatment can begin, so that the correct dose and type of chemotherapy or radiotherapy can be given.

Exfoliative cytology is a simple technique that involves scraping the surface of the lesion with a scalpel or curette, removing any crust and then spreading some of the material onto a slide where it can be stained and looked at under a microscope. It is less invasive than skin biopsy and may allow patients to be treated sooner with fewer side-effects, while also saving health services the cost of unnecessary biopsies.

The Cochrane database included nine studies of this technique and it was found to be accurate for the diagnosis of BCC, but not melanoma or cSCC. However, many of the studies were at high risk of bias and accuracy estimates could not be trusted.