Since early diagnosis dramatically improves your chances for successful treatment, it’s important for oral cancers and pre-cancerous oral lesions to be found as soon as possible. MD Anderson uses the most advanced techniques and technology to determine if a tumor is benign (not cancer), pre-cancer or cancer. In addition, we are working on new less-invasive optical techniques to help detect oral cancers.
Oral Cancer Diagnostic Tests
If you have signs or symptoms of cancer, your dentist or doctor will examine the inside of your cheeks and lips, the floor and roof of the mouth, the tongue and the lymph nodes in your neck. He or she will ask questions about your health and past illnesses and dental problems. Be sure to tell your doctor or dentist if you use or have used tobacco in any form.
If your doctor suspects you may have oral cancer, one or more of the following tests may be used to find out if you have cancer and if it has spread.
If any abnormalities are discovered during the exam, a small tissue sample, or biopsy, usually is taken. This biopsy is important, as it is the only way to know if the abnormal area is cancer. A properly done biopsy does not cause the cancer to spread. A biopsy may be obtained by:
Brush biopsy (exfoliative cytology): This relatively new type of biopsy is painless and does not require anesthetic. The dentist or doctor rotates a small stiff-bristled brush on the area, causing abrasion or pinpoint bleeding. Cells from the area are collected and examined under a microscope by a pathologist. If results are inconclusive or show cancer, an incisional biopsy will be completed.
Incisional biopsy: This is the traditional, most frequently used type of biopsy. The doctor or dentist surgically removes part or, rarely, all of the tissue where cancer is suspected. Usually, this procedure is completed in the doctor's office or clinic using local anesthesia. Occasionally, a biopsy in the mouth may need to be done in an operating room with general anesthesia.
Fine-needle-aspiration biopsy (FNA): This type of biopsy often is used if a patient has a lump in the neck that can be felt. In this procedure, a thin needle is inserted into the area. Then cells are withdrawn and examined under a microscope.
Mucosal staining: A blue dye called toluidine blue is applied to the area where cancer is suspected. If any blue areas remain after rinsing, they probably will be investigated with a biopsy.
Chemiluminescent light: After you rinse your mouth with a mild acid solution, your mouth will be examined with a special light to highlight suspicious areas. Healthy cells usually do not reflect the light; cancerous cells usually do.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- PET (positron emission tomography) scans
- MRI (magnetic resonance imaging) scans
- Ultrasound is often used to examine and/or direct needle aspiration of suspicious lumps in the neck
- Chest and dental X-rays
- Barium swallow: Also called an upper GI (gastrointestinal) series, this set of X-rays of the esophagus and stomach may be used to look for other cancers and determine how well you swallow.
If you are diagnosed with oral (mouth) cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This information helps the doctor treat the cancer. Once the staging classification is determined, the stage stays the same even if treatment is successful or the cancer spreads.
Disease stage is determined by the size of the primary tumor, how much it has invaded the tissues and whether the cancer has spread to the lymph nodes.
(Source: National Cancer Institute)
Precancerous stage: Abnormal (dysplastic) cells are found on the surface (in situ) of the lining of the lips and/or oral cavity. These abnormal cells may invade deeper to become cancer.
Early Stage (1-2):
- Tumor is 4 centimeters (about 1 ½ inch) or smaller AND
- Tumor has not spread to lymph nodes or other parts of the body
Advanced Stage (3-4A):
- Tumor is larger than 4 centimeters (1½ inches), invading deep muscle or bone OR
- Tumor has spread to the lymph nodes or other parts of the body
Unresectable/Metastatic (4B-C): The cancer involves tissues that cannot be removed, such as the carotid artery, or has spread to other parts of the body
Recurrent: The oral cancer has reappeared after it was treated. It may reappear in the oral cavity or another part of the body.