Oral Cancer Screening

Overview:

Oral cancer screening is the process of identifying cancers and precancer development in the mouth. It is an examination done in the mouth by dentists who look for the development of any signs or symptoms of cancers and precancers. This is done during a routine dental examination by the dentist.

Screening:

Screening is the process of identification for any abnormalities that may have developed. This is done by using a test to identify people who do not have any symptoms and differentiate them from those who do not have any abnormalities. Oral cancer screening is the process of looking for any abnormalities developed in the oral cavity before developing any signs or symptoms as noticed by the individual.

Oral cavity Anatomy:

The oral cavity consists of the mouth and other parts. These include the lips, teeth, cheek tissue (buccal mucosa), gums, tongue, floor of the mouth, and roof of the mouth (palate). It also includes the retromolar area which is an area behind the wisdom teeth. The palate consists of the hard palate which is the bony, hard area in the front part of the roof of the mouth, and the soft palate which includes the smooth, muscular area in the back part of the roof of the mouth. Apart from these visible structures oral cavity has many muscles that help in mastication, and the salivary glands that secrete the saliva. It also includes parts of the pharynx called the oropharynx, nasopharynx, and hypopharynx.

Oral cancer:

Oral cancer is the development of any abnormal tissue in the oral cavity. The abnormal tissue includes growths, ulcers, lumps, or any changes in the normal anatomy. The development of any white or red patches in the oral cavity can also lead to oral cancer. These patches are generally non-scrapable. Oral cancers can also be in the form of white, raised proliferations with a verruciform appearance.

Causes of oral cancer:

Oral cancer is caused due to many reasons. These mainly include habits, trauma, infections, and family history.

Habits: Habits like smoking cigarettes, cigars, chuttas, beedis, and hookah can lead to cancer development. Smokeless tobacco in the form of chewing tobacco products by keeping them in the mouth like supari, pan, and others like dip, and snuff can also cause oral cancer. Alcohol consumption can also lead to oral cancer. A habit of smoking along with alcohol consumption can have additive effects leading to oral cancer development.
Trauma: continuous trauma to the tongue or cheeks due to a sharp object leads to the development of an ulcer which if not treated may lead to oral cancer development.
Infections: Viral infections like the papillomavirus can also cause oral cancer.
Family history: Having a family history of oral cancer also increases the chance of having oral cancer.

Importance of Oral cancer screening:

Screening for oral cancer helps to identify the cancer even before any symptoms. Because by the time symptoms are developed the cancer might have spread to other areas. Hence, screening for oral cancer decreases the chance of spread by early identification and increases the chance of early treatment. This has the advantage of increasing the chance of survival and quality of life as the 5-year survival rate in oral cancer is low.

Indications:

Oral cancer is one of the most common cancers of the head and neck areas. Oral cancer screening is indicated in individuals with any long-standing, suspicious growths in the oral cavity. It is also indicated in individuals with a history of habits like smoking and alcohol intake, family history, and prolonged exposure to harmful ultraviolet rays of the sun. It is also indicated in high-risk individuals who are at risk of developing cancers and also those with a previous history of oral cancer.

Before screening:

Before oral cancer screening an individual should give a complete history of the habits. History regarding the duration and number of packs of cigarettes, quantity, and type of alcohol, habit of smokeless tobacco, previous viral infections in any other parts of the body, and any recent sun exposure are taken.

During screening and types:

Oral cancer screening is done by a dentist. The patient is made to sit comfortably in a dental chair. Using a mouth mirror dentist visually inspects the entire oral cavity for any abnormalities. Later using a gloved hand the dentist examines the oral cavity by touching the various parts for any abnormalities. If any suspicious lesion is found the dentist further examines it using certain screening dyes and screening lights.

Screening dyes: These include the toluidine blue dyes. These are dyes that the dentist asks to rinse the mouth with. After rinsing the oral cavity, any areas with dye uptakes are looked for. Abnormal cells take up the dye but normal cells do not.
Screening lights: These include using special screening lights to detect abnormalities. Devices like the vizilite, velscope, and Droroscope are used to check the fluorescence capability of the tissues. Healthy tissues and abnormal tissues differ in their fluorescence capability and are identified.
Brush biopsy: Further screening in the form of brush biopsy is done where are few cells from the oral cavity are collected and sent for microscopic examination.

After screening:

One can return to normal activities after the screening. They may advise for further examination in case of any suspicion or a recall visit to monitor the lesion. Further examinations include a biopsy of the suspicious lesion.

Risks and complications:

Certain risks associated with the screening process include false-positive and false-negative results. Oral cancer screening cannot diagnose or confirm the cancer but can be used to identify the presence of cancers.

Conclusion:

Oral cancer screening helps to identify the cancers and precancers in the mouth by screening. It is a vital tool that can help in early intervention of any suspicious lesions or growths. This helps to increase the chance of survival and quality of life.

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