Every year, worldwide, more than 500,000 patients receive the diagnosis of squamous cell carcinoma (SCC) of the head and neck. Squamous carcinoma develops in the outer layers of the skin. Due to the various oral sites at which it may develop, the symptoms can include sore throat (pharyngitis), difficulty swallowing (dysphagia), painful swallowing (odynophagia), and hoarseness. These symptoms are especially significant if they do not resolve completely within ten to fourteen days, and should be evaluated by a dentist or physician. Sometimes early lesions may not be accompanied by any symptoms at all.
Other clinical findings include a report of continuous enlargement of the lesion. SCC is more common in males in the United States. Females from Asia/ India have a higher incidence of leukoplakia (white lesions) developing into SCC. When present, pain can be localized or referred, often to the ear. A tingling sensation or numbness (paresthesia) in the lower lip may also be present. Bleeding may occur, and a fissure may develop, which does not heal. This is especially true on the lips.
Early diagnosis is essential!
Early diagnosis is essential for a positive outcome. Due to the nature of oral mucosa, benign and malignant tissues can be difficult to tell apart until later stages. Because of this dilemma, 50% of patients have evidence of lymph node metastasis at the time of diagnosis—greatly worsening the prognosis. Early detection has improved in recent years through the use of various tests that can improve a dentist’s ability to visualize abnormal tissues.
Risk factors for oral cancer include tobacco (historically, about 75% of oral cancer patients have been tobacco users); alcohol, solar radiation, genetic predisposition, nutritional deficiency (iron-deficiency anemia in Plummer Vinson syndrome), immunosuppresion and infections (candidal leukoplakia and human papillomavirus infections HPV-16/18). Combined use of alcohol and tobacco significantly increases the risk of oral cancers. In recent years, the number of patients who develop oral cancers in the absence of common risk factors has been on the rise, particularly in young men. This is believed to be related to the increased incidence of human papillomavirus.
How does the dentist diagnose Oral Cancer?
Note: ToothIQ.com contains general information. Only a dentist can properly diagnose your specific condition.
A cytologic smear or brush biopsy can be performed from the ulcerated surface or intact, but suspicious appearing mucosa. This means cells are harvested from the lesion and transferred to a microscope slide, where they are stained and prepared for microscopic evaluation. Tissue biopsy and microscopic examination is necessary to confirm the diagnosis, although clinical impression (how the lesion appears visually and behaves over time) is also very important.
Scientists are searching for biomarkers in saliva, an easy to obtain body fluid, for noninvasive detection of oral cancer and possibly other forms of cancer. A tissue sample may also be harvested traditionally, either in part (incisional biopsy) or or via complete removal of the lesion (excisional biopsy). This is typically done with a scalpel.
Visual examination often uncovers the presence of oral cancer. The visual cues upon examination are: deep seated ulcerated mass (extending into adjacent tissues), fungating ulcerated mass (extending away from the adjacent tissues), the ulcerated margins are commonly elevated, adjacent tissues may be indurated (hardened or thickened), may have residual leukoplakia and/or erythroplakia, and SCC most often occurs on the posterior lateral tongue, oropharynx and floor of the mouth—an area known as Waldeyer’s Ring.
Oral cancer screening tests are now available to assist the doctor at early detection of cancers that may otherwise be difficult to identify through visual examination.
How is Oral Cancer treated?
Common treatment options for squamous cell carcinoma of the oral cavity and oropharynx may include a combination of surgery, radiation, and chemotherapy where indicated. Scheduled periodic re-evaluation is essential due to possible recurrence. Smoking cessation, if applicable, is also critically important to recovery and achieving the best possible prognosis.
WARNING: Graphic image of basil cell carcinoma on the ear
WARNING: Graphic image of advanced oral cancer of the head and neck
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Additional author: William A. Brachvogel DDS, FAGD
Photographs courtesy Victor Raposo, DMD