Screening is the process of testing for cancer despite the absence of symptoms. Cancers that are more prevalent in the United States like breast and prostate have standard screening protocols that are advised to the general population when they reach a certain age. There is no such protocol for mouth and throat cancer. However, signs and symptoms can usually be found by dentists and doctors during routine dental health exams. And there are tests available that can help diagnose these cancers and plan for treatment immediately.
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A method that dentists use is toluidine dye application. It is a blue dye that is spread to abnormal areas in the throat and mouth that will turn the areas around them a deep blue, making irregularities easier to spot. Fluorescent light can also be used to examine the areas since light reflects differently in normal vs abnormal tissues. If an abnormal area is found, and cancer is suspected, a process called exfoliative cytology is applied. This involves scraping an abnormal area with a stiff brush (brush biopsy) to collect samples which will later be analyzed in the laboratory.
If your general care physician suspects you may have mouth and throat cancer, you will be referred to a specialist called an Ear, Nose, and Throat (ENT) specialist or an otolaryngologist. A complete head and neck exam will usually be done.
Since the throat is deep inside the neck and may not be fully visible, a doctor will need to use tools like thin fiber-optic scopes to look at these areas. This procedure usually begins with spraying numbing medicine on the throat to prevent gag reflexes from kicking in.
Since tobacco and alcohol use are risk factors for cancers of the oral cavity, oropharynx, esophagus, and lung, there is a chance (up to 10%) of finding more than one cancer simultaneously. A panendoscopy may be performed to ensure that there are no cancers in the esophagus or lungs. This procedure is also helpful if the origin of the cancer is unclear or if the lymph nodes in the lower neck appear abnormal.
A panendoscopy is usually performed under general anesthesia in an operating room. The doctor uses different types of endoscopes passed through the mouth or nose to thoroughly examine the oral cavity, oropharynx, larynx, esophagus, trachea, and bronchi. The doctor looks for tumors, assesses their size, and determines the extent of their spread to nearby areas. Small tissue samples (biopsies) from tumors or abnormal areas may be taken using special tools through the scopes to determine if they contain cancer.
A biopsy involves collecting tissue samples and examining them under a microscope. They are also examined with chemical tests in the laboratory to ascertain the presence of cancer and possibly determine at which stage the cancer is currently. Since the cancer cells look distinct from normal cells, a doctor will be able to make a more accurate diagnosis. The following biopsy methods may be used:
Exfoliative cytology is a simple and relatively painless procedure where the doctor scrapes the affected area and smears the collected tissue onto a glass slide. The sample is then stained with a dye to make the cells more visible. If any cells appear abnormal, a biopsy can be performed. While this method is easy and can lead to early diagnosis and successful treatment, it may not detect all cancers. Moreover,it can be difficult to distinguish between cancerous and abnormal non-cancerous cells (such as dysplasia).
An incisional biopsy involves removing a small piece of tissue from the abnormal-looking area. This is the most common type of biopsy used to examine changes in the mouth or throat. The procedure can be performed in the doctor's office, with local anesthesia for easily accessible tumors. It can also be done in the operating room under general anesthesia for deep tumors inside the mouth or throat.
Fine needle aspiration (FNA) biopsy uses a thin, hollow needle attached to a syringe to extract cells from a tumor or lump. The collected cells are then examined in the lab to determine the presence of cancer. While FNA is not used to sample abnormal areas in the mouth or throat, it can help investigate neck lumps. FNA can identify benign causes, such as infections or cysts, or determine the type of cancer present. Additionally, FNA can be used to assess the spread of diagnosed oral or oropharyngeal cancer to neck lymph nodes. Additionally, it also helps guide treatment decisions and check for cancer recurrence after treatment.
Biopsy samples are sent to a laboratory for a thorough examination by a pathologist. This is a doctor specializing in diagnosing cancer from biopsy samples. The pathologist can usually distinguish cancer cells from normal cells and determine the type of cancer-based on the cells’ appearance. In some cases, special stains may be used to help identify the specific type of cancer.
For throat cancers, biopsy samples are often tested for the presence of the p16 protein, which indicates HPV infection. This information is crucial for staging (determining the extent of cancer spread) and making treatment decisions for oropharyngeal cancer. Additionally, the presence of HPV can help the doctor predict the likely course of the cancer. It’s worth noting that patients with HPV-linked cancers tend to have better outcomes compared to those with cancers not associated with HPV.
Imaging tests are not used for diagnosis in mouth and throat cancer cases. But they can be used before or after a diagnosis to look for suspicious areas that might be cancer, determine the extent of the cancer spread, monitor the treatment response, and look for signs of cancer coming back. The following imaging tests may be used before or after mouth and throat cancer diagnosis:
If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your mouth and throat cancer or from negligence during your treatment that caused you more harm, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are. In many ways, our results speak for themselves, and we will stand ready to help you and your family in your time of greatest need.
