Oral Cancer Screening

Healthcare professionals can use a brush-like tool to scrape cells from the tongue or floor of the mouth and test them for signs of cancer. This is called a biopsy.

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Aggressive oral squamous cell carcinomas grow rapidly and have a short potential screening window, making them less likely to be detected during a routine screen. Less aggressive OSCCs may develop from OPMDs and grow more slowly.

Visual Examination

In the oral cancer screening process, a healthcare professional visually inspects your mouth and neck. The physical exam will include examining your lips, cheeks, gums, tongue, the floor of your mouth, throat and neck, and the inside of your nose. The healthcare professional will also look for asymmetries, swellings, lumps, and patches of color. They may also feel (palpate) for any rough areas or any hardened masses in your mouth and neck.

Several studies have shown that visual inspection is the best way to identify suspicious areas in the oral cavity. In addition, a number of clinical tools are used in screening including the toluidine blue dye test and fluorescent light inspection. These tools allow a healthcare professional to identify abnormal tissue and/or to monitor changes over time. In the case of toluidine blue dye, the abnormal cells are coated in the dye which makes them visible to the healthcare professional.

Several studies have reported on the effectiveness of these tools in increasing the stage at which cancers are detected without patients having to present with symptoms. These include the Cuban case finding program which reported favorable stage shifts in terms of detection of oral cancers (Fernandez Garrote et al., 1995; Santana et al, 1997). A risk prediction model that takes into account age, sex, race, education level, cigarette and alcohol use, lifetime history of oncogenic human papilloma virus (HPV) infection and family history of head and neck malignancies has been developed for future screening of the head and neck region, including the mouth and throat (Lee et al., 2020).

Tongue Examination

A good oral cancer examination takes eyes that know what to look for, and hands that are trained to feel particular areas of the mouth. If an examiner is using a mirror alone or worse yet, a pair of wooden tongue blades, they are missing important parts of the exam.

To properly palpate the tongue, ask your patient to open wide and relax. This will allow a full view of the oropharynx. Examine the dorsum of the tongue, lateral margins, and circumvallate papillae (the small bumps on the sides of the tongue). Look for ulceration, asymmetry, slurred speech, enlarged lymph nodes that may be firm and fixed in position, and other signs of pathology.

The examiner should also examine the base of the tongue. Often the base of the tongue is overlooked because of its location in the throat, but this area is very important for early detection of oral cancer. It is best to examine this area with the fingers of one hand under the tongue and the thumb of the other hand in the chin. This way the examiner can feel for the hard, swollen nodes called indurations that are sometimes associated with cancer of the tongue.

A proper exam should take no more than a few minutes and can be done while the patient is already in the office for other reasons. Some professionals use adjunctive devices like special lights, dyes, and tissue collection brushes to help them do a thorough exam, but these are not a substitute for a proper white light visual and tactile screening.

Floor of the Mouth Examination

During an examination of the oral cavity, doctors should inspect all the inside surfaces and borders of the mouth as well as the lips, cheeks and neck. It is also important to feel for lumps or swelling, and any other unusual or irregularity. A flashlight or penlight can be helpful for examining these areas. A tongue depressor can be used to move the tongue around and examine its surface as well. A small intraoral probe or a “hockey stick” probe can be used for a more detailed study of the tongues surface and to palpate the anterior belly, lateral sides and posterior tongue margin.

The floor of the mouth is a common location for oral cancers. It is a U-shaped space that extends from the inferior border of the tongue superiorly to the mylohyoid muscle sling and the geniohyoid bone inferiorly. It is important to palpate this area as it contains mucosa, glands, and the geniohyoid and mylohyoid muscles.

Some lesions in the floor of the mouth are premalignant or precancerous. These may transform into a malignant lesion or regress (turn into a noncancerous state). The transformation process is unpredictable and depends on many factors, including the patient’s lifestyle, age, risk factors, and other health problems. The PDQ cancer information summaries provide current information about oral cavity and oropharyngeal cancers, including prevention, early detection, and treatment.

Finger Palpation

Palpation is the use of a person’s fingers to physically feel something near the surface (superficial) or farther inside the body (deep). Taking a pulse on the wrist is an example of finger palpation.

People who smoke tobacco or drink heavily can develop pre-cancers and cancers in their mouth. A person who regularly sees a dentist or dental hygienist for oral cancer screening may be able to identify these abnormalities at an earlier stage.

These early abnormalities can be difficult to detect with only a visual examination. For this reason, healthcare professionals often use finger palpation to evaluate the mouth and jaws. The procedure involves feeling the jaw muscles for any clicks or irregularities. This helps to locate potential impacted wisdom teeth or temporomandibular joint (TMJ) problems.

In general, palpation should be done carefully and with appropriate draping techniques to optimize access while balancing patient modesty. For instance, the clinician should wash their hands before touching the patient and should warm them up (e.g., by rubbing them together). In addition, it is important to communicate with the patient to understand if they are experiencing any discomfort during the palpation process. The pressure used also varies depending on the structure being evaluated (e.g., excessive pressure can occlude a pulse). If a person is not comfortable with the touch of the clinician’s hand, it might be necessary to ask them to extend their fingers or thumb against resistance.