Oral Cancer – Part 3
5.10.16 in General
So, we have discussed the incidence and significance of oral cancer. We have identified common locations that oral cancer occur, and reviewed the TNM classification system of cancers. But what do they look like? How would you or your dentist recognize an oral cancer lesion? Let me break that answer down to its components, in order to make it clear.
The first part of recognition of something that is abnormal, is knowing what “normal” looks like. And so, we definitely know some normal appearances about the head and neck.
For the most part, the neck, face, mouth and head are roughly symmetric. When something stands out on one side and does not exist on the contra lateral side; that demands explanation. Color and pigmentation of our skin, lips, and mucosa inside the mouth are for the most part “homogenous” or uniform. This does not mean that any variances in pigment are abnormal; however, they should catch our eye, and again demand explanation. Any “spots” noticed should be described by the examiner. By that I mean, the examiner should actually say aloud what they are seeing. A small white spot may be present, but full description of, “a 2mm white, crusted, non-tender ulceration on the left lateral border of the tongue,” should even sound more suspicious to the examiner, than just “a white spot.” One can actually self-examine much of the head, neck and mouth, and use the same advice. You may not be aware of the significance of all findings, but if it sounds abnormal to you when you describe it compared to another area of your mouth, get it checked out, and describe it to your dentist or physician. Remember that most “lesions”, no matter what shape, color or texture, are NOT cancer. For instance, the most common cause of a white spot in the mouth, is probably food debris, adhering to the tissue. This almost always wipes off. Ulcerations of the mucosa are most commonly associated with either trauma, or the common canker sore. The first guess shouldn’t be cancer. Noticing a difference in one area should warrant monitoring for full healing though.
The typical profile of malignant lesions is that they are changing, in shape, size or color, non-tender, and non-healing. When a lesion is noticed, full description, ideally by photography, should occur. If some logical explanation exists for its presence, allow some time (1-2 weeks) for healing and disappearance of the lesion. Re-examine the lesion later and if still present, or worsened, then a definitive explanation should be pursued.
Normal findings of skin color are that the skin is uniform in color & texture. Normal findings for our lips reveal uniform color and texture. There is a “wet/dry” border of the lip, and the mucosa of the inside of the mouth is normally pink in color, with some injections of red blood vessels that are visible. Gums, palate, and cheeks are normally light pink in color. The tongue is pink to reddish in color, and has a texture like that of “plush carpet.” Throat and tonsils are also pink in a healthy state. In good health we do not have bulges or swollen or tender glands in our head and neck, and so presences of this should raise suspicions. We should not see drainage or pus, nor white, red nor blue spots present, and if we do notice new colored lesions, we should have those examined and explained.
The take home is this. Most changes we experience will not be malignancy; however, since we know one of the biggest problems with the incidence and survival from oral cancer is late diagnosis, it is prudent for you to see a professional about anything that you think appears or feels abnormal. Also, be sure to ask your physician and dentist to perform a head and neck cancer screening examination for you on a regular basis. Next blog we are going to discuss what to do to prevent and treat oral cancer, So, stay tuned in and keep smiling. Dr W.