Many oral cancers and pre-cancers are detected by dentists, doctors or dental hygienists during regular examinations or by self-exam. White patches (leukoplakia) are the most common early sign of cancer.
Early-stage oral cancers are easier to treat, with high survival rates. This is why it’s important to have routine oral cancer screenings.
What is an Oral Cancer Screening?
A regular oral cancer screening is an exam that examines the tissues inside your mouth for signs of precancerous and cancerous conditions. The exam is usually performed by a dentist and can be done during your regular dental visit. This is an important part of your overall health care routine and can reduce your chances of serious problems down the road.
When caught early, most types of mouth cancer are easier to treat. But less than one-third of all mouth cancers are found in this stage, and most cases are diagnosed after they have spread to other parts of the head or neck. Early detection of oral cancer is the key to saving lives.
Oral cancer screening can be done using visual examination (VOE) by a trained healthcare professional, such as a dentist or oral surgeon. Studies have shown that a comprehensive visual examination can detect a significant proportion of oral cancer and precancerous lesions. These findings can be used to direct patients for expert examination and appropriate treatment.
However, some cancers never cause symptoms and don’t need treatment. It is also possible that some cancers or precancerous cells are missed by screening. Additionally, there is a risk that some people will receive a false-negative test result and delay seeking medical attention when they should. For this reason, it is important that you see your dentist or oral surgeon for a complete oral cancer screening at least once every year.
What are the Signs of Oral Cancer?
Unlike some other cancers, early oral cancer can be asymptomatic, meaning that the earliest signs may be painless or easily overlooked. For this reason, it is important to have any sore or change in the tissue inside the mouth checked by a healthcare provider, whether it is part of an oral cancer screening or not.
Oral cancer usually starts in the squamous cells that line the lips, cheeks, inner gums and tongue. These cells can become cancerous when they change DNA and grow quickly. They can also spread to other parts of the mouth and head and neck. If the cancer is found in its earliest stages, it can be treated with surgery or radiation. If left untreated, the cancer can spread and be fatal.
The primary way that oral cancer is diagnosed is through a visual and physical examination of the lips, tongue and soft tissues of the mouth. Sometimes a special device, such as the VELscope, is used to help identify precancerous and cancerous tissue that would be difficult to see with the naked eye.
During the exam, your dentist will remove any dentures or other removable appliances from your mouth, so that all of your tissue can be seen. They will also check your neck and jaw for any lumps or other abnormalities. If they find anything suspicious, they will take a sample of the tissue and send it to a laboratory to be tested for signs of cancer.
How Does an Oral Cancer Screening Work?
The majority of oral cancers are diagnosed in late stages when they are much more difficult to treat. It is therefore important to screen asymptomatic individuals using systematic visual oral examinations to detect and refer for expert evaluation any pre-malignant or malignant lesions. Screening asymptomatic adults using routine visual examination has been shown to be feasible and cost-effective. The US Preventive Services Task Force recommends screening those most at risk of developing mouth cancer (see the figure below).
Your dental professional will examine your lips, cheeks, gums, tongue, chin and neck for asymmetries, spots or bumps that may be abnormal in color or texture and enlarged lymph nodes. We also gently palpate the neck, jaw, outside cheeks and under the chin for firm nodules or odd lumps. Depending on the results of your physical exam, your dentist may recommend further testing.
If the test results are positive, a biopsy may be required to determine whether or not the area is in fact a malignant growth. We may also suggest imaging tests such as a CT scan or an MRI to get a better look at any suspicious tissue. We may even use an endoscope to examine hard-to-see areas like behind the nose and in the throat. If the test results come back as negative, your dentist will still give you advice about changing your lifestyle to reduce your risks of mouth cancer in the future.
What Happens After an Oral Cancer Screening?
If a dental professional detects a lump, bump or sore in the oral cavity, jaw, throat or neck, they will perform further tests to check for cancerous tissues. They will also check the lymph nodes in your neck for signs that the cancer has spread.
Your dentist will look inside your mouth using a mirror, lighted scope or gauze to check the hard and soft tissue for changes. They will look for any asymmetries, enlarged or unusual bumps or patches of color. The dental professional may also use their fingers to feel (palpate) the neck, face, lips, cheeks and jaw for any unusual areas that could be lumps or nodules.
Some healthcare professionals may also use special tools to identify pre-cancerous or cancerous tissue, such as a blue dye (toluidine blue) or a special screening light that makes healthy tissues look dark and abnormal ones glow. They may ask you to swish the dye around your mouth for several seconds, then spit it out so they can see which tissues absorb the color.
If any abnormal tissue is found, the dentist will often perform a biopsy to confirm whether it is cancerous or not. This involves taking a small amount of cells from the suspicious area and sending them away for analysis. Alternatively, they may order imaging tests like a CT scan or MRI to get a better look at the tissue.