5Oral Cancer Facts Oral cancer is a common cancer of global concern. The five – year survival rate is approximately 50 per cent.Early detection has the potential to significantly reduce oral cancer death and morbidity.Known risk factors include tobacco and alcohol consumption, which together are responsible for about 75 per cent of oral cancers.There is an alarming increase in oropharyngeal cancercases seen in the age group. (Types HPV).More than 25% of oral cancers do occur in people without risk factors of tobacco or excessive alcohol consumption.
6Facts (Continued) Approximately 90% of oral cancers are classified as squamous cell carcinoma.In general, lesions that require monitoring include:nonhealing ulcerationswhite patches that do not rub off (leukoplakia)red patches that do no rub off (erythroplakia)High-risk sites:Lateral tongue, floor of mouth, and tonsillar pillars
7Facts (Continued)Most oral premalignant lesions and cancers should be detectable at the time of a Comprehensive Oral Examination.These lesions often present as a white patch, or less frequently a red patch.Progression from premalignant lesions to cancer usually occurs over years.
9APPROACH Oral cancer screening and mucosal lesion assessment
10Patient HistoryThe first step in screening for oral cancer is the completion of a patient history which should include review of:General health history with a list of current medications and medication allergiesOral habits and lifestyle, with particular reference to quantity, frequency and duration of tobacco use and alcohol consumptionHPV + testSymptoms of oral pain or discomfort
11Visual Screening Examination Explain to the patient the protocol for the exam.EXTRAORALINSPECTIONHeadNeckSupraclavicular regions for lymph nodes
12Palpation Submandibular Neck Supraclavicular regions for lymph nodes (size, number, tenderness and mobility)Lips and perioral tissues.
15ToolsGood source of lightBasic tray2x2Tongue blade
16Inspection - Palpation (Important to ask the patient to remove all dentalappliances and piercing jewelry).All oral soft tissueParticular attention to the high risk sites such as:Lateral and ventral aspects of the tongueFloor of mouthSoft palate
20Red FlagsTOBACCO- ALCOHOL lesions tend to favor anterior tongue and mouth, and HPV (+) posterior oral cavity.Patients with habit of cheek biting - follow patient for any changes in color, size, or texture.Betel nut users. (Asia). Oral squamous cell carcinoma is common in long-term betel quid users.The carcinogenicity of the known risk factors for oral cancer is dose-dependent and magnified by multiple exposures.
21Examination of the Tongue One of the most common sites of oral cancer is on thelateral aspect of the tongue.With a 2x2 pull the tongue out and roll it from side to side while retracting the cheek with a tongue blade.Palpation of the dorsum and lateral margins of the tongue is important.Ask the patient to touch the roof of their mouth with the tip of their tongue.
22Lesion Inspection Evaluate the specific characteristics of lesion: LocationSizeColorTextureAttention to white, red and white, ulcerated and/or indurated lesions.
24Documentation If possible, take a photos of any suspicious lesions Record all findings and description of the lesion in medical and dental fileReport to the Physician
25Optional Screening Aids Techniques that are promoted to improve earlier detection and diagnosis of oral malignancy include:VITAL TISSUE STAINING: (TB). Tolonium Chloride. Has been used for more than 40 years. Staining of abnormal tissue in contrast to adjacent normal mucosa. (Mouth rinse or topical swab w/different concentrations)
26Visualization Adjuncts Vizilite Plus with TblueMicrolux DLOrascoptic DK systemThe VELscope – Tissue Fluorescence. (Differentiate between normal and abnormal tissues).
29Cytopathology Use the OralCDxBrush for: Common, harmless appearing small white and red spots.Chronic ulcerations.Lesions with unusual surface such as a granular appearanceEvaluation of mucocutaneous disorders (e.g., lichen planus) unresponsiveness to treatment.Follow-up of a persistent lesion despite a benign diagnosis from a previous brush or scalpel biopsy.All oral CDx atypical /(+) must be confirmed by incisional biopsy and histology.
34BiopsyIt is the gold–standard diagnostic test for oral mucosal lesions that are suggestive of pre-malignancy or malignancy.Persistent lesion after removal of identified local irritants such as trauma, infection or inflammation.
35Demo Extra-Intraoral Exam Video available for viewing.
36GlossaryErythema: Redness that suggest epithelial inflammation, thinness and irregularity.Erithroplakia: A well defined red, velvet or granular lesion of the oral mucosa.Homogenous: A descriptive term for a mucosal lesion that is uniform in appearance.Indurated: An abnormal firm or hard portion of tissue with respect to the surrounding similar tissue.
37GlossaryLeukoplakia: A white patch that cannot be rubbed off and cannot be characterized clinically or histologically as any other lesion.Nodular: Referring to a granular surface texture.Speckled: A mucosal lesion that has red and white components to it.Ulceration: The result of loss of epithelial integrity involving all layers of epithelium with resultant exposure of the underlying connective tissue.Verrucous: Referring to an irregular mucosal surface or “wart-like” white surface projection.