Oral Cancer

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Questions to Ask Your Doctor About Your Cancer
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Signs and Symptoms

Symptoms of mouth cancer include the following:

• Bad breath
• Changes in voice
• Difficulty chewing and moving the jaw or tongue
• Irritation (in patients who wear dentures)
• Lumps in the neck or cheek
• Numbness and/or bleeding in the mouth
• Pain
• Persistent sores
• Sore throat and painful swallowing
• Weight loss

Unusual red- or white-colored patches in the mouth or on the lips (e.g., leukoplakia, erythroleukoplakia, erythroplakia) may also develop in patients who have oral cancer.

Leukoplakia, which are most common, are white and sometimes, but not always, malignant. Erythroleukoplakia are a combination of red and white and are more likely to become malignant. Erythroplakia are bright red patches that often become malignant.

Diagnosis

The first step in diagnosing oral and oropharyngeal cancers is evaluating the patient's medical history. Physicians consider risk factors, symptoms, and family history and perform a thorough physical examination. If the physician suspects mouth cancer, the targeted tissue is evaluated for cancer cells. In some cases, a disposable light (e.g., Vizilite™) can be used to help identify abnormal tissue.

Laboratory Tests
Doctors may use exfoliative cytology to detect oral cancer. This test involves scraping or brushing questionable cells from the tissue and smearing them on a slide for examination. Dye may be used to make cells easier to see under a microscope. This procedure is easy and helpful for early diagnosis, but abnormal cells detected may not be cancerous (malignant). A biopsy must be performed to confirm if they are.

A biopsy involves removing a small piece of tissue and examining it closely under a microscope. Prior to this procedure, the patient is given anesthesia, either local or general. Incisional biopsy involves surgically removing tissue for analysis and fine-needle aspiration (FNA) involves using a needle to remove the cells in question. This type of biopsy is often used to find out if cancer has spread (metastasized) or if it is recurring.

Other diagnostic tests may be used to provide a better look at hard-to-see regions. Fiberoptic scopes and mirrors can be used to see the pharynx, larynx, lymph nodes, and the base of the tongue. A panendoscopy, which is performed while the patient is under general anesthesia, can help the physician evaluate more of the oral cavity, oropharynx, esophagus, trachea (windpipe), and bronchi (tubes that lead to the lungs).

Imaging Tests
Imaging tests may be used to provide more information about cancer cells, their extent, and their location. A chest x-ray is often performed to determine if the disease has spread (metastasized) to the chest or lungs.

Computed tomography (CT scan) provides cross-sectional images of the body, allowing the physician to see more details of the tumor. Magnetic resonance imaging (MRI scan) provides a crosswise and lengthwise view of the area using radio waves and magnets.

Another imaging test used to evaluate oral and oropharyngeal cancers is positron emission tomography (PET scan). In this test, a radioactive substance is injected and a camera is used to detect cancer cells, which take in the substance. This test can be used to help determine where cancer cells have spread (metastasized).

Also, a barium swallow may be used to detect additional tumors in the digestive system and to determine how the cancer may affect the patient's ability to swallow.

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