Oral Cancer Exams and Biopsies

Cancer is a group of diseases that occur when cells become abnormal and divide without control or order. Cells doing this can form too much tissue, called a tumor. These can be benign, which do not spread to other parts of the body, and therefore are not a threat to life. Tumors can also be malignant, which invade other parts of the body, and can spread through the lymphatic system and form secondary tumors called metastases.

At every initial and recall examination, an oral cancer screening is performed. It is always best to have an early diagnosis when oral cancer is involved. If sores or lesions in the mouth are noted that do not heal within two weeks, it is important to contact us for an appointment as soon as possible.

Symptoms to Watch For:

• A lump or thickening in the cheek
• A white or red patch on the gums, tongue, tonsils, or lining of the mouth
• A sore throat or a feeling that something is caught in the throat
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Numbness of the tongue or other area of the mouth
• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable
• A sore on the lip or in the mouth that does not heal
• Unusual bleeding or pain in the mouth
• A change in the voice
• Pain in the ear

These symptoms may be caused by other, less serious problems, but they also indicate the possible presence of oral cancer. After the physical examination of your mouth, if we find any areas that are suspicious, we may recommend a biopsy. In this procedure, we simply take a small portion of the suspicious tissue and send it to an oral pathologist for examination under a microscope.

Types of Biopsies

Incisional

The most traditional type of biopsy is incisional. In an incisional biopsy, we remove part of or the entire lesion, depending upon its size and extent. The sample of tissue is then sent to a pathologist who examines the tissue under a microscope to check for abnormal or malignant cells.

Fine Needle Biopsy

When dealing with an area of significant mass, such as an enlarged lymph node, fine needle aspiration cytology (fine needle biopsy or FNB) is reliable and relatively inexpensive. A small needle attached to a syringe is inserted into the questionable mass, and cells are aspirated, or pulled out into the syringe.

Punch Biopsy

In this case, a very small circular blade is pressed down into the suspicious area to cut a round border, allowing us to remove a perfect plug of cells from the sampled area. The area where the plug was removed is small, will not bleed much, and heals normally without the need for stitches.

OralCDx

A new way to test for oral cancer is a system called OralCDx. Using a special, hand-held brush, we take a small sample of tissue from the suspicious lesion. The sample is put on a slide and sent to the CDx Laboratories. At the lab, computers use advanced robotics and scanning and imaging techniques to accurately examine the thousands of cells on the sample. The computer is able to look at every cell, compare them to libraries of normal and abnormal cells, and determine which cells are potentially problematic. A summary report is returned to us for our files or for further discussion with you. If the OralCDx test is positive or atypical, we will then confirm it with a standard incisional biopsy. If the OralCDx test turns out to be negative, but the lesion persists, will will schedule a follow-up evaluation.

Treatment

If a diagnosis of oral cancer is made, surgery may need to be performed to remove the tumor in the mouth and possibly the lymph nodes in the neck. If the disease has spread to muscles and other tissues in the neck, the operation may be more extensive.
Radiation therapy is the use of high energy rays to damage cancer cells and stop them from growing. Radiation therapy is sometimes used instead of surgery for small tumors in the mouth. Sometimes radiation is given before surgery to shrink the tumor so that it can more easily be destroyed.
Chemotherapy is the use of drugs to kill cancer cells. These can be used by themselves, or in combinations with other therapies to destroy the tumor and prevent the disease from spreading.