The process of finding out the cause of a health problem is diagnosis. Diagnosing oral cancer begins with a visit to your dentist or family doctor. Your dentist or doctor will ask you about any symptoms you have and do a dental or oral exam. Based on this information, your dentist or doctor will refer you to a specialist, such as a head and neck oncosurgeon.
The following tests are usually used to rule out or diagnose oral cancer.
Health history and physical exam
Health history is a record of one’s symptoms, risk factors and all the medical events and problems one had in the past. Doctor will ask questions about history :
• symptoms that suggest oral cancer
• tobacco use
• alcohol use
• sun and ultraviolet (UV) exposure
• human papillomavirus (HPV) infection
• previous cancer
• weight loss
• other medical conditions
Doctor may also ask about a family history:
• head and neck cancers
• other cancers
A physical exam allows doctor to look for any signs of oral cancer. During a physical exam, doctor may:
• assess facial symmetry, speech, swallowing, breathing and hearing
• carefully look at the mouth
• feel for lumps or swelling on the inside of the mouth, including the cheeks and lips
• feel the floor of the mouth, tongue and roof of the mouth
• check tongue movements
• feel the neck for any lumps or swelling
• check the salivary glands
• look at the throat using an endoscope
Different Tests done include of:
Exfoliative cytology-A test used to look for abnormal or cancerous cells. The doctor or dentist using a cotton swab, brush or small wooden stick scrape small sample of cells from an area and place them on a glass slide. They stain the sample with dye and examine it under a microscope. This test can detect cell changes and may show that further tests are needed. If an abnormality is found, doctors may do a biopsy.
Biopsy- The doctor removes tissues or cells from the body in order to test them in a lab. Types of biopsy done are:
Fine needle aspiration (FNA)
Endoscopy- Types of endoscopy used to find small tumours or to see if cancer has spread beyond the mouth or head & neck.
Nutritional assessment- People diagnosed with oral cancer usually have serious nutrition problems. A dietitian will do a nutritional assessment when one is diagnosed of oral cancer and during its treatment by looking at body mass index (BMI), diet and any weight changes. A feeding tube may be placed so that one’s nutrition can be good enough to support treatment.
Speech, swallowing and dental assessments- People diagnosed with oral cancer must have a complete dental exam before treatment such as radiation therapy. A speech therapist (speech-language pathologist) is needed at the time of diagnosis and throughout treatment to help manage any speech problems.
Following tests be done if is having any problems with swallowing:
Fibre optic endoscopic evaluation of swallowing (FEES)
Video fluoroscopic swallow study (VFSS)
X-ray- Chest x-ray & Panoramic x-ray of the mouth (also called a panorex) is done to assess the teeth and see if cancer has spread to the jaw.
Ultrasound- uses high-frequency sound waves to check if cancer has spread to the lymph nodes in the neck (called cervical lymph nodes) or to major blood vessels.
CT scan- A computed tomography (CT) scan records 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A CT scan is used to provide information about the size, shape and location of a tumour. Surgeons routinely perform a CT scan of the neck and the chest before surgery. Sometimes a contrast medium is used with a CT scan to help show better detail. It is usually injected into a vein in the hand or arm.
MRI- Magnetic resonance imaging (MRI) using powerful magnetic forces records cross-sectional images of organs, tissues, bones and blood vessels. It is used to provide information about the size, shape and location of a tumour. It is often used after a CT scan to get additional information.
PET Scan- Used to see the spread of cancer to lymph nodes or other parts of the body. It may be combined with a CT scan (called a PET-CT scan). PET Scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues.
Heart and Lung Function Tests-to check the functioning of heart and lungs and make sure that one is healthy to recover from surgery or anesthesia.