1. Oral Cancer Screening
People’s lives can be saved through early detection of oral, head and neck cancers.
Adriana Clark, DDS

2. Agenda Introduction Oral Cancer Facts
Oral Cancer Screening. Mucosa lesion assessment.
- Patient History
- Visual Screening Examination
Extraoral and Intraoral (Inspection-Palpation)

3. Agenda Red Flags Documentation Optional Screening Aids
The Dawn of New Era
Demo Extra- Intraoral Exam
Glossary

5. Oral 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 cancer
cases 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.

6. Facts (Continued) Approximately 90% of oral cancers are classified as
squamous cell carcinoma.
In general, lesions that require monitoring include:
nonhealing ulcerations
white 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

7. Facts (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.

8. Red patch
White patch

9. APPROACH Oral cancer screening and mucosal lesion assessment

10. Patient History
The 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 allergies
Oral habits and lifestyle, with particular reference to quantity, frequency and duration of tobacco use and alcohol consumption
HPV + test
Symptoms of oral pain or discomfort

11. Visual Screening Examination
Explain to the patient the protocol for the exam.
EXTRAORAL
INSPECTION
Head
Neck
Supraclavicular regions for lymph nodes

12. Palpation Submandibular Neck
Supraclavicular regions for lymph nodes (size, number, tenderness and mobility)
Lips and perioral tissues.

13. Extaoral Palpation

14. Intraoral

15. Tools
Good source of light
Basic tray
2x2
Tongue blade

16. Inspection - Palpation
(Important to ask the patient to remove all dental
appliances and piercing jewelry).
All oral soft tissue
Particular attention to the high risk sites such as:
Lateral and ventral aspects of the tongue
Floor of mouth
Soft palate

17. Intraoral - Examination

18. Examination of Mucosa
Recommendation to dry surface with 2x2 or air syringe
Look for:
Color changes
Textures
Red and white lesions

19. Lesions

20. Red Flags
TOBACCO- 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.

21. Examination of the Tongue
One of the most common sites of oral cancer is on the
lateral 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.

22. Lesion Inspection Evaluate the specific characteristics of lesion:
Location
Size
Color
Texture
Attention to white, red and white, ulcerated and/or indurated lesions.

23. Lesion Inspection

24. Documentation If possible, take a photos of any suspicious lesions
Record all findings and description of the lesion in medical and dental file
Report to the Physician

25. Optional 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)

26. Visualization Adjuncts
Vizilite Plus with Tblue
Microlux DL
Orascoptic DK system
The VELscope – Tissue Fluorescence. (Differentiate between normal and abnormal tissues).

27. VELscope showing severe displasia.

28. VELscope showing normal tissue.

29. Cytopathology Use the OralCDxBrush for:
Common, harmless appearing small white and red spots.
Chronic ulcerations.
Lesions with unusual surface such as a granular appearance
Evaluation 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.

30. Dysplastic lesion TBlue 630 Test
Leukoplakia

31. Vizilite Plus
VELscope

32. The Dawn of a New Era
Salivary biomarker technology in oral cancer research and diagnosis is an exciting emerging field.

34. Biopsy
It 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.

35. Demo Extra-Intraoral Exam
Video available for viewing.

36. Glossary
Erythema: 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.

37. Glossary
Leukoplakia: 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.