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Biopsy for oral cancer

What is a biopsy?

During a biopsy, a doctor removes a sample of tissue or fluid from the body. A pathologist inspects the cells under a microscope to see if they are cancerous. If the cells are found to be cancerous, a biopsy can help determine whether the cancer began at the site of the biopsy, or if it started somewhere else in the body and spread to the biopsy site.

Some biopsies are performed under image guidance, such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI). This allows your doctor to collect cells from deeper inside the body. Depending on the type of biopsy performed, you will receive an anesthetic to minimize any pain.

Compared with other diagnostic tests for cancer, biopsies often provide a more definitive diagnosis. A biopsy can help determine whether the cancer began at the site of the biopsy sample, or if it started somewhere else in the body and spread to the site of the biopsy sample.

Some sites that are commonly biopsied include the breast, skin, bone marrow, GI tract, lung, liver, bladder, colon and lymph nodes. Our doctors determine the most appropriate method of biopsy based on several factors, such as the size, shape, location, and characteristics of the abnormality.

Biopsy medical animation

Video: Biopsy Medical Animation

Medical animation

Dr. Bradley Mons discusses oral cancer and human papillomavirus (HPV).

Oral cancers linked to HPV have increased three-fold over the past 20 years. By 2020, HPV is projected to cause more cases of oral cancer than cervical cancers in the United States.

Where do oral cancers associated with HPV typically occur?

HPV is mostly associated with throat cancer. The base of tongue, tonsils and adenoids are common locations for HPV-related cancers.

Are there screening tests to detect HPV infections in the throat, tongue, tonsils and adenoids?

There are no current routine laboratory tests to screen HPV in the head and neck. However, a thorough head and neck examination by a physician once a year can detect early changes. You also can ask your dentist for a screening exam during a routine visit.

What diagnostic tests are used to detect oral cancer?

Examination is the appropriate detection method. CT scans and MRIs may be used for staging but cannot actually detect the cancer. Any non-healing wound or neck mass that persists longer than a week should be evaluated for biopsy, which will allow for earlier detection. Determining if oral cancer is associated with HPV also requires a biopsy, which would be examined for the presence of HPV DNA. Check with your doctor because not all hospitals routinely screen for HPV.

How can people protect themselves from oral HPV infections and oral cancer?

The best protection against HPV is to abstain from sexual activity or practice safe sex, as HPV is the most common sexually transmitted infection. It is still too early to determine if the HPV vaccine will reduce HPV-related cancer in the head and neck. Another way to reduce the risk of oral cancer is to refrain from tobacco and alcohol use.

What message would you like to convey about HPV and oral cancer?

Early detection can help improve survival. If you have a spot on your tongue or throat, a sore throat or any other symptom that does not resolve within a week, please see your physician. Survival rates can be as high as 90 percent if cancer is treated in its early stage.

What changes have occurred in recent years to improve outcomes for oral cancer patients?

Greater awareness! More people know about the importance of screenings, as well as what causes oral cancers. This knowledge has helped people make better choices. In addition, advances in surgery, radiation therapy techniques and chemotherapy make treatment more tolerable.

Biopsy for oral cancer

Only a biopsy can give a definitive oral cancer diagnosis. A sample of tissue or cells is required for a biopsy, which must be conducted before treatment can begin. The types of biopsies typically used for diagnosing oral cancers are:

  • Incisional biopsy: A small piece of tissue is cut from an abnormal-looking area. If the abnormal region is easily accessed, the sample may be taken at your doctor’s office. If the tumor is deeper inside the mouth or throat, the biopsy may need to be done in an operating room, with general anesthesia administered to prevent any pain.
  • Fine needle aspiration (FNA): Here, a very thin needle attached to a syringe is used to extract (aspirate) cells from a tumor or lump. This approach can be particularly useful for several situations that can occur with oral cancer.
  • Finding the cause of a new mass: An FNA may reveal that a lump is benign and is the result of a treatable infection, not cancer. An FNA may find a non-cancerous, fluid-filled cyst that can be surgically removed. When this occurs in conjunction with cancer symptoms, an endoscopy will still be needed to make a definitive oral cancer diagnosis.
  • Determining the extent of a known cancer: When an FNA is done in patients who have already been received an oropharyngeal or oral cancer diagnosis, the biopsy can show if cancer has spread to the lymph nodes in the neck, information that will help guide treatment.
  • Checking for recurrence: An FNA may be done in patients whose cancer has already undergone surgery or radiation to check if a neck mass in a previously treated area is scar tissue or if it may be a recurrence of cancer.
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