Oral Cancer Diagnosis

Since early diagnosis dramatically improves your chances for successful treatment, it’s important for oral cancers and precancerous 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.

If you have signs or symptoms of oral 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.

Biopsy

During a biopsy, a small tissue sample is removed and examined under a microscope for the presence of cancer cells. Depending on tumor location, some biopsies can be done on an outpatient basis with only local anesthesia. Other times patients must undergo a surgical biopsy under general anesthesia.

A biopsy is the only way to definitively diagnose oral cancer. There are different biopsy procedures for oral cancer. These include:

Incisional biopsy: This is the traditional, most frequently used type of biopsy. The doctor or dentist surgically removes part or, in rare cases, all the suspected cancer tissue. 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.

Brush biopsy (exfoliative cytology): This 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, doctors will recommend an incisional biopsy.

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 Then cells are withdrawn and examined under a microscope.

Imaging tests

The folloing imaging exams may be used to diagnose oral cancer:

CT or CAT (computed axial tomography) scans.
PET (positron emission tomography) scans.
MRI (magnetic resonance imaging) scans.
Ultrasound, which 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.
Endoscopy

Learn more about imaging exams.

Specialized oral cancer tests

There are several tests that are unique to oral cancer. If these tests come back positive, a biopsy will be performed. These tests include:

Autofluorescence imaging: A special device emitting a blue light is shined in the mouth. Healthy, normal tissue will essentially light up in response. Tissue that looks dark or does not light up may be cancerous or pre-cancerous. Benign (not-cancerous) inflammation can also look dark in these exams.

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: Patients rinse their mouth with a mild acid solution. A special light is used to highlight suspicious areas. Healthy cells usually do not reflect the light; cancerous cells usually do.

Oral cancer staging

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.

Oral cancer stages

(Source: National Cancer Institute)

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. The tumor is two centimeters or smaller and the deepest point of tumor invasion is five millimeters or less.

Stage II

In stage II, the tumor:

is two centimeters or smaller and the deepest point of tumor invasion is greater than five millimeters; or
is larger than two centimeters but not larger than four centimeters and the deepest point of tumor invasion is 10 millimeters or less.

Stage III

In stage III, the tumor:

is larger than two centimeters but not larger than four centimeters and the deepest point of tumor invasion is greater than 10 millimeters; or
is larger than four centimeters and the deepest point of tumor invasion is 10 millimeters or less; or
has spread to one lymph node that is three centimeters or smaller, on the same side of the neck as the primary tumor.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC.

In stage IVA, the tumor:

is larger than four centimeters and the deepest point of tumor invasion is greater than 10 millimeters; or cancer has spread to the outer surface of the upper or lower jawbone, into the maxillary sinus, or to the skin of the face. The cancer may have spread to one lymph node that is three centimeters or smaller, on the same side of the neck as the primary tumor; or
is any size or cancer has spread to the outer surface of the upper or lower jawbone, into the maxillary sinus, or to the skin of the face. Cancer has spread:
- to one lymph node that is three centimeters or smaller, on the same side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
- to one lymph node that is larger than three centimeters but not larger than six centimeters, on the same side of the neck as the primary tumor; or
- to multiple lymph nodes that are not larger than six centimeters, on the same side of the neck as the primary tumor; or
- to multiple lymph nodes that are not larger than six centimeters, on the opposite side of the neck as the primary tumor or on both sides of the neck.

In stage IVB, the tumor:

has spread to one lymph node that is larger than six centimeters; or
has spread to one lymph node that is larger than three centimeters, on the same side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
has spread to one lymph node of any size on the opposite side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
has spread to multiple lymph nodes anywhere in the neck, and cancer has spread through the outside covering of any lymph node into nearby connective tissue; or
has spread further into the muscles or bones needed for chewing, or to the part of the sphenoid bone behind the upper jaw, and/or to the carotid artery near the base of the skull. Cancer may have also spread to one or more lymph nodes of any size, anywhere in the neck.

In stage IVC, the tumor has spread beyond the lip or oral cavity to other parts of the body, such as the lung, liver, or bone.

Oral Cancer Diagnosis

Biopsy

Imaging tests

Specialized oral cancer tests

Oral cancer staging

Oral cancer stages

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