Early detection and diagnosis is crucial to successful treatment of oral, head and neck cancers. When detected at stages I and II, the survival rate is over 80%; however, the majority of cases are found much later. At more advanced stages, survival rates are lower, treatments are more invasive, and the side effects of treatment are much more significant. The fact that oral cancer occurs in an area of the body that lends itself to easy examination allows for detection early in development in many cases. Prevention is a combination of the simple act of observing plus healthy lifestyle choices.
Once a month, open your mouth wide and take a quick look in the mirror. Look at the roof and floor of the mouth, inside the cheeks, all around the tongue, the gums and inside surface of the lips. The early signs of precancer are white, red or mixed white/red patches that cannot be wiped off the surface.
At each six-monthly dental check up, the dentist should perform an inspection not only of the teeth and gums but also of the soft tissues in and around the mouth. This includes the inside and outside of the lips, the cheeks, the sides and undersurface of the tongue, the floor and roof of the mouth, the gums, and the back of the mouth/top of the throat (oropharynx). Make sure your dentist performs this examination as part of a routine dental visit. Any suspicious tissue should be examined by an oral cancer specialist. This early detection of tissue changes is the best means of preventing oral cancer.
Education, counseling and dependency treatment can prevent oral cancer in the typical high-risk individual, who is male, over 40 years of age and uses tobacco and/or alcohol heavily. Although often requiring dramatic changes to lifestyle and habits, the benefit of a healthy lifestyle is a decreased likelihood of developing the disease as well as improved general health. There is evidence suggesting that a healthy diet high in fruits and vegetables is associated with a reduced risk of oral cancer and may be protective.
Smoking cessation programs have reduced the number of smokers and consequently reduced the number of oral cancers seen in males aged 40 or older. After quitting smoking, many precancerous lesions improve and in some cases may even disappear. Today, the fastest growing segment of the oral cancer population is non-smokers under the age of 50. Patients diagnosed with a precancerous lesion or oral cancer will be offered smoking cessation counsel and guidance on limiting alcohol consumption.
Lip cancer, which is also a lifestyle cancer primarily due to prolonged sun exposure, shows a decline in numbers over the last decade. Once again public education campaigns – touting the damaging effects of excessive sun and UV light and advocating sunscreen protection – are most likely responsible for these reduced numbers.
Self Exam Guide
Check to see that both sides of the face and neck look symmetrical and there is no swelling. Feel both sides of your neck, under the jawline, along the muscle that runs down each side of your neck, and the hollow above the collarbone. Using fingertips, use a circular motion or rolling stroke to check the lymph nodes from the corner of your jaw all the way forward to under your chin. Hard, painless, swollen ones merit further professional attention.
Use fingertips on the muscle that runs down each side of the neck, from the jaw to the collarbone. Turn the head one way then the other to feel the deeper nodes along this muscle. It is not unusual to feel a number of different lymph nodes in this area. Healthy ones are soft and move about easily when you push against them. Next check the lymph nodes above the collarbone. To do this, raise the shoulders and round them forward to feel inside the hollow area above your collarbone. If you find a hard lump like a small stone, first compare it to the other side. If it feels different from the other side, doesn’t move around, is not tender/sore, and persists for more than two weeks, it is a concern.
Now it’s time to look inside the mouth. The examination of the mouth should include the lips, gums, the inside of the cheeks, tongue, floor and roof of the mouth, and back of the throat including your tonsils. It is best to follow a system each month when checking the mouth, so no area is overlooked. Here’s what you’ll need; a tongue depressor, light source, mirror, and a piece of gauze.
Your lips should have a defined border and be uniform in color and texture. Lip cancers are caused by solar radiation and common in people that work outdoors. Most are found early as they are a very visible sore that is easily seen. But some occur within the lip or on the inner surface. To detect them early, you must feel for their signs by placing one finger inside and another finger outside the mouth, compressing the lips and tissue to feel that it is consistently soft. If there is a persistent thickened area or a lump, it needs further evaluation.
The gums should be pale pink closest to your teeth. Make sure to lift your upper and lower lip so the entire area right to the point where the gums meet the inside of the cheeks can be seen. This area may be deeper red in color and should feel uniform in texture. Check any discoloration, ulceration, tissue of a different surface texture, any sore which bleeds easily when touched, or any growth above the level of the rest of the tissue.
With a finger placed inside the mouth and another on the outside, compress the tissue all the way from the corners of your mouth, up and down to the very back where the jaw ends. Check for any discoloration, ulceration, tissue of a different surface texture, or any growth above the level of the rest of the tissue. You may feel a line running along the inner cheek related to cheek biting or the way your teeth meet together trapping the tissue when you are sleeping. It is nothing more than a hardened area of tissue developing against the chronic abrasion taking place and is normal.
This is a very important area to examine closely as it is a high-risk area for oral cancer. Feel the top of the tongue, both sides, and the underside. There are small bumps of varying sizes on the tongue called papillae. They should be relatively consistent in color and texture. There are rows of larger, raised papillae towards the back of the tongue on the top surface. Stick out the tongue. It should move freely and evenly from side to side. With a piece of gauze around the tip of your tongue to get a good hold on it, pull it forward and move to the right and then to the left. There should be uniform appearance and consistent color and texture.
After the visual exam, feel both sides of your tongue from the back of the tongue to the tip of the tongue. They should feel relatively the same. Check the tip of the tongue under the gauze as well. What you are feeling for are any pea-size small hard areas. Cancers can begin within the tongue tissue and live there for a while before erupting into a visible sore. Touch the roof of your mouth with the tip of your tongue. Look at and feel the underside of the tongue. There are some deep blue veins which is normal but it should be free from any other discolorations like a white or red area, or any kind of sore or ulceration.
FLOOR OF MOUTH
With one finger inside and a corresponding finger outside, compress the tissue moving from as far back as possible and all the way around from one side to the other side. You should not feel any small hard areas, discolorations, or ulcerations. Look and feel the floor of the mouth underneath the tongue. There are blue veins in the floor of the mouth and a small band of tissue that attaches the tongue to the floor of the mouth (frenum) that is normal.
ROOF OF MOUTH
With Throat Scope in your hand, look across the entire roof of your mouth. This area should be uniform in color and free from any sores or ulcerations. Next feel the roof of the mouth. The palate is harder towards the front of the mouth and has a number of ridges on it. As you move towards the back it is softer, even in texture and uniform in color. Sometimes there can be a bony growth in the midline of the palate called a torus, which is normal.
THROAT & TONSILS
There are many variations of normal tonsils. Push down on the tongue to view the back of the throat. A swollen tender tonsil on one side is usually an infection, not cancer. One that is swollen, stays that way for three weeks or longer, and is not tender to the touch may need professional examination. The area behind the tonsil called the crypt, is also a common area for cancer to arise, It is problematic even for professionals to discover back of the mouth cancers as tissue folds can hide a problem. The first sign is often a painless swollen node in the neck, or a painless difficulty in swallowing, chronic sore throat, hoarseness, or a unilateral ear ache.