Oral Cancer Diagnosis & Detection

The team of cancer doctors at Cancer Treatment Centers of America (CTCA) uses sophisticated imaging technology and tools to conduct a complete evaluation of your disease status.

During your first visit to a CTCA hospital, you’ll undergo a comprehensive exam to precisely evaluate your oral cancer and determine if it has spread to any other part of your body. This helps your team formulate an individualized treatment plan that is appropriate for you.

Throughout your oral cancer treatment, we will use diagnostic imaging and laboratory tests to monitor your progress. If the disease is resisting treatment, we will modify your treatment or recommend using a different therapy. Our turnaround time goal from the time of imaging scans to delivery of results is four hours, so that treatment planning can occur as quickly as possible.

Discover a Treatment Plan Tailored to Your Needs

The following tests are often the first step in making an oral cancer diagnosis:

• Medical history and physical exam: The first step in diagnosing oral cancer is usually a general physical. Your doctor will ask you about your symptoms, whether you have any of the known risk factors, and about any other medical conditions. During a physical exam, your doctor may find signs of an oral cavity or oropharyngeal cancer, or a precancerous condition. These signs may include bumps or other abnormalities on your head, face, or neck, or problems with the nerves of the face and/or mouth. Your doctor will also check inside your mouth for any signs of oral cancer.

  If your doctor is concerned that you may have cancer, he or she will refer you to a specialist for additional tests. This specialist will likely be either an oral and maxillofacial surgeon or a head and neck surgeon, typically referred to as an ear, nose, and throat doctor or an otolaryngologist.

• Complete head and neck exam: The specialist will carefully examine the entire area of your head and neck, including the lymph nodes of the neck, to check for any signs of cancer.

  This exam may include the use of mirrors so that your doctor can see areas inside the neck that are not easily viewed. Other procedures that may aid in oral cancer detection include:

  • Indirect pharyngoscopy and laryngoscopy: Your doctor may place small mirrors at the back of your mouth in order to clearly examine your throat, the base of your tongue, and part of your larynx (voice box).
  • Endoscopy: A fiber optic scope that uses a flexible, lighted, narrow tube may be inserted into the mouth or nose so that your doctor can examine hard-to-see areas such as the larynx and behind the nose.
• Panendoscopy: If your doctor suspects the presence of oral cancer, a more thorough examination of the head and neck will likely be done. In this exam, an individual is given general anesthesia in an operating room so that the entire region of the body can be closely inspected for cancer. Endoscopes are used to look at the throat, larynx, esophagus, and possible the windpipe (trachea) and bronchi. If any tumors are found, your doctor will remove samples that can be looked at under a microscope.
• Exfoliative cytology: With this approach, a suspicious area is gently scraped to collect a sample of cells. These cells are placed on a glass slide and stained with dye, so that they can be easily viewed under a microscope. If any cells appear abnormal, a deeper biopsy will be done. This technique is very easy to do, allowing even minimally abnormal areas to be examined, which can help with early diagnosis. However, oral cancer detection using exfoliative cytology can be challenging and some cancers may be missed, or may be confused with abnormal but non-cancerous cells, and so a biopsy will be needed to make a definitive diagnosis.
• Biopsy: 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.

Imaging Tests

If an oral cancer diagnosis is made, various kinds of imaging tests can help determine the extent of the disease. If questions remain after a biopsy, then an imaging test may also be used to help determine whether cancer is present. The types of imaging tests that are commonly used for oral and oropharyngeal cancer include:

• Chest x-ray: An x-ray of the chest may be taken to check if the cancer has spread to the lungs. Cancer will not be present in the lungs unless it is in an advanced stage. An x-ray is usually an outpatient procedure, meaning that you do not have to be admitted to a hospital for the test. If the result is abnormal, further tests will be done.
• Computed tomography (CT) scan: A CT scan can provide information about the size, shape, and position of any tumors, and may also help identify enlarged lymph nodes that may contain cancer cells.
• Magnetic resonance imaging (MRI): Rarely, an MRI scan may be used to examine oral cavity or oropharyngeal cancer.
• Positron emission tomography (PET) scan: For patients diagnosed with oral cancer, a PET scan may be useful for seeing if cancer has spread to the lymph nodes, for determining the originating site of cancer when it is found in the lymph nodes first, or for checking the entire body for any spreading of cancer cells.
• Barium swallow: Also known as an “upper GI series,” a barium swallow involves drinking a chalky drink made of a barium-based solution, which allows cancer cells in the esophagus and upper part of the digestive system to be seen with an x-ray. This imaging technique can also show if oral cancer is interfering with swallowing.

Other Tests

• Blood test: Blood tests are not used when making an oral cancer diagnosis, but can help evaluate your overall health and provide your doctor with useful information about your care before treatment begins.
• Dental exam: If radiation is part of the treatment plan for oral cancer, a dental exam beforehand is usually recommended. A dentist can help with preventive care to minimize damage to the oral cavity. When teeth or other structures in the oral cavity need to be removed, a specialist known as a prosthodontist can make prosthetic replacements to help restore appearance, comfort, and function after treatment.

Next Topic: Oral Cancer Staging