Diagnosis of oral cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer often means first ruling out other health conditions that share similar symptoms with cancer. It can be a very worrying time for you and your loved ones. Sometimes this process is quick. Sometimes it can feel long and frustrating. But it’s important for doctors to get all the information they need before making a diagnosis of cancer.

Diagnosing oral cancer usually begins with a visit to your dentist or family doctor. They 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 or order tests to check for oral cancer or other health problems.

The following tests are usually used to rule out or diagnose oral cancer. Many of the tests that are used to diagnose cancer are also used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment.

Your health history is a record of your symptoms, risks and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest oral cancer
• tobacco use
• alcohol use
• sun and ultraviolet (UV) exposure
• human papillomavirus (HPV) infection
• other cancer
• weight loss
• other medical conditions

Your doctor may also ask about a family history of:

• head and neck cancers
• other cancers

A physical exam allows your doctor to look for any signs of oral cancer. During a physical exam, your doctor may:

• check speech, swallowing, breathing and hearing
• look at the mouth
• feel for lumps or swelling on the inside of the mouth, including the cheeks and lips
• feel for lumps or swelling on the face, including the upper and lower jawbone
• 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

Find out more about physical exams.

Exfoliative cytology (brush biopsy) is a test used to look for abnormal cells. The doctor or dentist uses a brush or a small wooden stick to scrape a small sample of cells from the area being looked at. The cells are placed on a glass slide, stained with dye and then examined under a microscope. The dye helps the abnormal cells stand out.

If there is an abnormality, you will need further tests, such as a punch or incisional biopsy.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample. Doctors sometimes apply dye to an abnormal area in the mouth (such as an area of leukoplakia or erythroplakia) to help them see the biopsy site more clearly.

A punch biopsy removes a round area of tissue using a sharp tool called a punch. It is the most common type of biopsy used to sample the inner lining of the mouth (the oral mucosa).

An incisional biopsy removes a small piece of tissue from the abnormal area using a scalpel (knife).

A fine needle aspiration (FNA) uses a very thin needle to collect a sample of cells, tissue or fluid from an abnormal area or lump. An FNA may be used to biopsy lumps or lymph nodes in the neck. An ultrasound or a CT scan may be used to guide the needle for an FNA.

Find out more about biopsies.

An endoscopy allows a doctor to look inside the body using a tube with a light and camera on the end. This tool is called an endoscope. An endoscopy is done when diagnosing and staging oral cancer.

Different types of endoscopy may be used to find small tumours or to see if cancer has spread beyond the mouth or if there are other tumours anywhere in the head or neck.

A nasopharyngoscopy looks inside the nose and throat (pharynx).

A laryngoscopy looks at the voice box (the larynx).

A panendoscopy looks at the pharynx, larynx, esophagus, windpipe (trachea) and bronchi.

Find out more about an endoscopy.

A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to give information about the size, shape and location of a tumour. It can also be used to see if cancer has spread to the lower jawbone (mandible) or lymph nodes in the neck and chest.

A contrast medium may be used with a CT scan to show organs and structures more clearly.

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3D pictures.

An MRI is used to give information about the size, shape and location of a tumour. It is used to measure how deep a tumour has grown into a structure in the mouth or to see if the cancer has spread to a nerve. It is also used to see if cancer has spread to the bones of the skull or lymph nodes in the neck.

Find out more about MRIs.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to check if cancer has spread to the lymph nodes in the neck. Ultrasound may also be used to guide an FNA.

Find out more about ultrasounds.

A positron emission tomography (PET) scan uses radioactive materials called radiopharmaceuticals to look for changes in the metabolic activity of body tissues. A computer analyzes the radioactive patterns and makes 3D colour images of the area being scanned.

A PET scan is used to see if the cancer has spread to lymph nodes or other parts of the body. It may be combined with a CT scan (called a PET-CT scan).

Find out more about PET scans.

An x-ray uses small doses of radiation to make an image of parts of the body on film.

A panoramic x-ray of the mouth (also called a panorex) may be done to assess the health of your teeth before radiation therapy. This x-ray takes pictures of the upper and lower jawbones and surrounding areas.

Find out more about x-rays.

A nutrition assessment includes looking at your body mass index (BMI), what you are eating and any weight changes.

Oral cancer can make it difficult to eat. This can cause serious problems with your body getting the nutrients it needs to function well. Having a nutrition assessment by a dietitian when you are diagnosed and during your treatment helps make sure you are healthy enough to have and recover from treatment.

You may need to have a feeding tube to make sure you get enough nutrition to support your treatment. Find out more about tube feeding.

Oral cancer and its treatment can cause problems with speech or swallowing.

A speech-language pathologist (also called a speech therapist) will help manage any speech or swallowing problems you have as a result of oral cancer or its treatment.

You may also have one of the following tests to see if you are having any problems with swallowing.

Fibre optic endoscopic evaluation of swallowing (FEES) uses an endoscope with a fibre optic camera to look at the pharynx and larynx while the person swallows.

Modified barium swallow (MBS) uses x-ray and a contrast medium (called barium) to record swallowing movements.

Oral cancer can often cause dental problems. If you're diagnosed with oral cancer, it's important to have a dental exam so that any necessary dental work can be done before treatment such as radiation therapy or surgery. You will need regular dental exams and may need to have more dental work done after treatment.

Heart and lung function tests are a group of tests that measure how well the heart and lungs are working.

You may have these tests to see if you are healthy enough to have and recover from surgery. An electrocardiogram (ECG) measures the electrical activity in the heart. An echocardiogram (echo) uses ultrasound to look at the structure and motion of the heart.

Lung function tests (also called pulmonary function tests) measure how much air the lungs can hold and how well a person can let air out of the lungs.

Find out more about ECG, echo and lung function tests.

Find out more about a diagnosis. To make the decisions that are right for you, ask your healthcare team questions about diagnosis.