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| From OncoLog,
April 2004, Vol. 49, No. 4 |
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 Getting Screened for Oral Cancer
 With about 30,000 new cases diagnosed annually, oral cancer has become a significant health problem in the United States. The American Cancer Society estimates that the incidence of oral cancer is almost as high as that of leukemia and its mortality rate is about the same as that of melanoma. Dental examinations play an important role in screening for and diagnosing and treating oral cancer. While the prospect of dental examinations may be intimidating for some people, the vast majority of these examinations are quite painless and, in some instances, quickly performed.
Routine examinations/checkups
According to an American Dental Association survey, most respondents (61%) did not realize that dentists look for oral cancer as part of a routine dental examination; in fact, all dentists and dental hygienists have been trained to perform a visual head and neck examination, as well as an oral soft tissue examination. During the examination, the dental professional visually inspects all of the oral and gingival tissues, as well as high-risk areas, for the presence of cancer or premalignant changes. By obtaining a complete and thorough medical and dental history from the patient, the dental professional can learn of any oral cancer risk factors, such as tobacco and alcohol use.
Comprehensive oral cancer examination
When a dental professional examines a patient strictly for cancer detection, he or she often conducts a comprehensive oral examination, which only takes about 90 seconds. The dentist starts by examining the patient’s head, face, and neck and then systematically assesses and may palpate the patient’s lips, gums, tongue, and tissues inside the mouth, under the tongue, and on the roof of the mouth. If the dental professional suspects cancer, he or she will likely decide to remove some of the tissue for evaluation. The dentist may elect to do this but is more likely to make a referral to a specialist for this procedure. There are several ways that a suspicious lesion can be evaluated.
Scalpel and punch tissue biopsy
Biopsy remains the gold standard for diagnosing oral lesions. In a scalpel biopsy, also known as incisional biopsy, a scalpel is used to obtain a sample of the lesion. Another method is punch tissue biopsy, in which a punch tool resembling a small cookie cutter is used to remove a section of the tissue. With the use of a standard anesthetic injection, patients can undergo either of these procedures without experiencing any pain.
Brush biopsy
A brush biopsy technique is increasingly used for questionable lesions that are not obviously cancerous. In this procedure, a circular, stiff-bristled brush is rotated against the surface of the lesion until pinpoint bleeding occurs. Cells are then collected from the area of bleeding and transferred to a glass slide for analysis. Brush biopsy can be performed painlessly without the use of an anesthetic.
Mucosal staining
When a patient has oral surface abnormalities that are considered severe and that cover a large area of tissue, the area may be stained with blue dye called toluidine blue O. After the dye is applied and the patient rinses with an acetic acid solution, any blue-stained areas that remain indicate the need for further pathologic analysis of that area, most likely using a biopsy technique.
Chemiluminescent light
A new, cost-effective method of diagnosing oral lesions is the use of chemiluminescent light. In this procedure, the patient rinses with a mild acid solution to minimize oral secretions. A chemiluminescent light is inserted into the mouth. Precancerous cells will reflect the light, whereas healthy cells will not. Again, the atypical area would most likely be biopsied.
Summary
Regular dental checkups and examinations can lead to the detection of oral and head and neck cancers when they are at an earlier, more treatable stage. These examinations should be part of everyone’s routine dental care. Individuals who are not receiving an oral cancer examination from their dental professional should request the screening at least once a year. In addition, the dentist or dental hygienist can teach patients how to self-evaluate oral tissues.
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more information on this topic or for questions about M. D. Anderson’s treatments,
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