As with any cancer, an early diagnosis will help ensure that treatment is as effective as possible. A biopsy with histology will give a definitive oral cancer diagnosis and should be conducted before treatment begins.
Often, an oral cancer diagnosis is based on multiple medical examinations and tests such as:
This includes an assessment of avoidable risk factors, such as tobacco and alcohol use, that increase the chances of developing cancer. The medical history also covers immunosuppression and family history of cancer. Oral cancer survivors have a high risk of developing a new cancer, especially if they continue to use tobacco or drink excessive levels of alcohol.
Oral Exam (Examination of the Mouth)
Since all intra-oral soft tissues are capable of developing lesions, the oral examination involves a detailed viewing of the entire mucosa or skin lining of the inside of mouth and the back of the throat. We may use adjunctive techniques, such as different light sources to better visualize subtle changes or special dyes that will preferentially stain precancerous lesions. Detection of a suspicious lesion (precancer) should be taken seriously, and may require a biopsy.
Head and Neck Exam
This is a detailed assessment of the head and neck. The exam involves inspection of the skin, looking for obvious asymmetry of the head and neck structures, and palpation of the area. It can also include indirect pharyngoscopy and laryngoscopy, procedures using mirrors to examine the throat, base of the tongue or larynx, areas which are otherwise not easily viewed.
A biopsy is the removal of a sample of tissue or cells so they can be examined by a pathologist. The types of biopsies commonly used for oral cancer include:
A small piece of tissue is cut from the abnormal-looking area. This is the most traditional type of biopsy used for diagnosing oral cancers. A punch biopsy is a variation of the incisional biopsy.
Fine needle aspiration (FNA):
A very thin needle attached to a syringe is used to extract (aspirate) cells from a tumor or mass such as an enlarged lymph node.
At the NYU Oral Cancer Center we are investigating the use of brush biopsies to collect cells and DNA which may be used to predict and tailor treatment. Currently, this approach is in the research stage.
The tissue or cells removed by a biopsy are prepared and examined under a light microscope and/or electron microscope. The histological exam leads to the diagnosis and is also used for grading the cancer to determine its level of advancement.
Magnetic resonance imaging (MRI):
Commonly used to evaluate the size and infiltration of an oral cancer and to assess the lymph nodes in the neck.
Computed tomography (CT) scan, Co-axial tomography (CAT) scan:
These scans provide information about the size, shape and exact position of the tumor and may identify enlarged lymph nodes containing cancer cells.
Positron emission tomography (PET) scan:
Used to display the body's metabolism. Since cancer cells divide rapidly, any increased activity identified on a PET scan can indicate primary and metastatic tumors. PET scans are only used for the evaluation of oral cancer patients under certain circumstances.
Radiographs (commonly known as x-rays):
May determine cancer spread to the jaws or lungs.
A less frequently used imaging test for oral cancer detection.