Oral Pathology and Cancer Screening

The inside of the mouth is normally lined with a special type of skin called mucosa, which is smooth and pink in color. A change in appearance could be a warning sign for a pathological process, the most serious being oral cancer. The following can be warning signs of a pathological process or cancerous growth:

  • Reddish or whitish patches in the mouth
  • A sore that won’t heal and bleeds easily
  • A lump or thickening of the skin that lines the inside of the mouth
  • A chronic sore throat or hoarseness and/or difficulty in chewing or swallowing

These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology, and curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer.

Only a biopsy can give a definitive oral cancer diagnosis. A sample of tissue or cells is required for a biopsy, which must be conducted before treatment can begin. The types of biopsies typically used for diagnosing oral cancers are:

  • Incisional biopsy: A small piece of tissue is cut from an abnormal-looking area. If the abnormal region is easily accessed, the sample may be taken at your doctor’s office. If the tumor is deeper inside the mouth or throat, the biopsy may need to be done in an operating room, with general anesthesia administered to prevent any pain.
  • Fine needle aspiration (FNA): Here, a very thin needle attached to a syringe is used to extract (aspirate) cells from a tumor or lump. This approach can be particularly useful for several situations that can occur with oral cancer.
  • Finding the cause of a new mass: An FNA may reveal that a lump is benign and is the result of a treatable infection, not cancer. An FNA may find a non-cancerous, fluid-filled cyst that can be surgically removed. When this occurs in conjunction with cancer symptoms, an endoscopy will still be needed to make a definitive oral cancer diagnosis.
  • Determining the extent of a known cancer: When an FNA is done in patients who have already been received an oropharyngeal or oral cancer diagnosis, the biopsy can show if cancer has spread to the lymph nodes in the neck, information that will help guide treatment.
  • Checking for recurrence: An FNA may be done in patients whose cancer has already undergone surgery or radiation to check if a neck mass in a previously treated area is scar tissue or if it may be a recurrence of cancer.

A consultation appointment is necessary to have an oral examination and discussion of the recommended procedure prior to the biopsy. It is important that the patient understands what to expect and has all questions answered. Once the biopsy is performed, it typically takes about a week to get the report back from the lab to confirm a diagnosis. The lab where the biopsy specimen will be sent is dictated by the insurance plan. A follow up appointment will be made to go over these results and also to assess the site of the biopsy for healing after the procedure. Additional follow-up appointments may be recommended to watch an area of concern over time.