As lay people we really do not always know what the doctor is doing, looking at, or thinking as they examine our mouths. Are they going to recognize the early signs of cancer? Are they looking where it routinely occurs? Are they using all the tools available to them when they are examining our mouths? Most of us would never know. But there are some things that will indicate to you whether your professional is doing a thorough job or not. Clearly we all wish to just feel comfortable trusting our medical and dental professionals to do things well and correctly. In the real world that is not always possible or the case. Understanding the process helps you evaluate if you are in good hands; ones worthy of trusting your life to. Sounds severe, even harsh? You bet. But being informed is the first step in taking good care of yourself, choosing competent care, and recognizing potential problems early enough to have them caught at a survivable state. When it comes to a medical or dental professional who may save your life by catching dangerous diseases at the earliest possible time, you need to be concerned with more than a great personality and chairside manner. So here is what to expect. Remember that any one of the signs and symptoms we mention here by itself could be something benign and non related to oral cancer.
Preparing for the exam: If you have dentures (plates) or partials, you will be asked to remove them. No one can see all the soft tissue areas of the mouth with any appliances in place.
Part of a comprehensive exam is asking a patient important questions. These reveal things to the examiner that may augment their decision making after the physical exam, or direct them to explore a particular area in greater detail. Obviously the first thing they want to know is if YOU have experienced any problems or have noticed any changes yourself. Be candid. This verbal history taking part of the process is very important. With some of the new causes of oral and oropharyngeal cancers the signs and symptoms are VERY subtle. In disease caused by the HPV virus, the oral environment may be completely normal in appearance and the oral history is crucial. Questions you should expect to hear are; (1) Have you noticed any changes in swallowing? Do things seem to stick or catch in your throat when you swallow? This sensation usually is not painful, but something that subtly gets more noticeable over time. Most people, men in particular, have a tendency to ignore things like this, especially if they are not painful. But this one question can be a red flag for the development of a base of tongue oral cancer caused by the virus. (2) Have you had any chronic hoarseness? Here a condition that has lasted for over two weeks is what is important. Less than that and it could be any transient infection. Persistence over a protracted period of time is the indicator of something more dangerous. (3) Have you noticed/felt any small lumps when feeling the side of your neck putting on makeup or shaving? They are interested in things which are painless. Again something that people will ignore, these can be the metastasis of an oropharyngeal cancer away from the inside of your mouth out into the lymph nodes of your neck. Painful swollen nodes are usually a sign of an infection not cancer. The painless ones are the red flags. (4) Have you had any ear aches that seem to persist, particularly unilateral (only on one side)? (5) Have you or any of your friends noticed a change in your voice? Again, similar to hoarseness which not only will you feel, but others can hear, there may be changes in how your tongue moves and helps you form certain sounds when you speak. Oral cancers that impact the nerves that control the movement of your tongue can be painless, and alter your speech in very subtle ways or even your ability to stick it straight out of your mouth without it consistently veering to one side when you try to. All these questions help your professional examiner come to good conclusions about your health, and potential need for examinations beyond the simple screening that you are there to receive on that day.
Your healthcare provider will inspect your face, neck, lips, and mouth to look for any signs of cancer. Clearly a sore on your lip will be obvious to everyone, even you. But some of what they are looking for is more subtle. Is there a nice symmetry to your features, or does part of your external mouth not move well, or possibly droop? Some doctors are looking at these things when you first approach and sit in the chair, and it may not be apparent to you that their observations are actually taking place. But a good practitioner is sensitive to these small give-aways… a slur in your speech, a corner of the mouth that does not seem to move well in concert with everything else, a subtle swelling on one side of your face causing asymmetry. By themselves, these are not areas of specific oral cancer concern, but they are all part of putting together the puzzle of different signs, which may indicate you are worthy of referral to a specialist, or to have further diagnostic procedures.
In the old days before the common use of rubber gloves, a manual palpation of the oral cavity was called a “wet finger” exam. Manual palpation is a very important part of the examination. If you are approached with two wooden tongue blades, or with only a mouth mirror to do the screening, the examiner is missing valuable opportunities to detect important things. With both hands, he or she will feel the external area under your jaw and the outside of your neck, checking for lumps (enlarged lymph nodes) that may suggest inflammation or more. Many times if these nodes are painless but hard and enlarged, and feel like they are fixated in position, it can be a sign of cancer.
When feeling the floor of your mouth (bi-manually palpating it), a finger is placed under your tongue and the fingers of the other hand placed under your chin. Rolling the soft tissues of the floor of your mouth between the two, they can detect enlarged nodes or other hard spots called indurations that may be an area of concern. Anyone not using their fingers to examine you, and only looking with a mirror, or worse using just a pair of wooden tongue blades, is going to miss things. Touch is important.
He or she will then look at and feel the insides of your lips and cheeks to check for possible signs of cancer, or pre-cancerous tissue changes, such as red and/or white patches, or thickened areas.
Your provider will have you stick out your tongue so it can be checked for swelling or abnormal color or texture. They will be watching to see if as you extend it, it deviates to one side or the other, a possible sign that something