Introduction
Squamous cell carcinoma of the oral cavity and pharynx accounts for over 58,250 cases per year in the United States, with approximately 12,250 deaths per year(1,2). Unfortunately, the diagnosis continues to rely on patient presentation and physical examination with biopsy confirmation. This may delay diagnosis, accounting for the fact that most of these cancers are diagnosed at a late stage (1, 3-5). Studies confirm survival correlates with the stage, making early diagnosis and treatment optimal for this disease (1). Despite advances in surgical techniques, radiation therapy technology, and the addition of combined chemotherapy and radiation therapy to the treatment regimen, survival data has not shown appreciable change in decades (1,6,7). Five-year survival data reveal overall disease-specific survival rates of less than 60%. However, those who do survive often endure significant functional, cosmetic, and psychological burdens due to dysfunction of the ability to speak, swallow, breathe, and chew. Seventy-five percent of all head and neck cancers begin in the oral cavity. According to the National Cancer Institute’s Surveillance, Epidemiology, and Ends Results (SEER) program, 30 percent of oral cancers originate in the tongue, 17 percent in the lip, and 14 percent in the floor of the mouth (11). Many other studies support this finding that oral cancers appear most often on the tongue and floor of the mouth (12,13). New data related to the HPV16 virus may indicate that these trends are changing with the poster mouth, including the tonsils, tonsillar pillar and crypt, the base of the tongue, and the oropharynx, increasing rapidly in incidence rates. A thorough, systematic examination of the mouth and neck only takes a few minutes, and these cancers can be detected at an early and curable stage. Our goal is to discover oral, head, and neck cancers early before patients present complaining of pain, a mass, bleeding, otalgia, or dysphagia. Errors in diagnosis are most often ones of omission, and therefore, the importance of a systematic approach to the oral, head, and neck cancer examination cannot be overstated.
History
Although this report is based on examination technique, it is critical to remember that any person with a history of tobacco and alcohol use or prior head and neck malignancy has a significant risk of developing oral, head, and neck cancer. Historically, 75 percent of these cancers are related to alcohol and tobacco use (10). These individuals may deserve more frequent examinations as described to follow. Bear in mind that 1 out of 4 oral, head, and neck cancers, particularly in patients over the age of 50, are detected in patients who do not smoke or drink alcohol; all patients, regardless of their history, need to be screened at least once a year by their physician or dentist. Current research indicates that HPV-positive disease is rapidly changing these ratios and age groups. Younger, nonsmoking patients under the age of 50 are the fastest-growing segment of the oral cancer population. Unfortunately, this increase in the number of oral, head, and neck cancers found in men and women in their 20s and 30s is rapidly replacing those caused by tobacco since the use of tobacco products has declined in the US every year for more than a decade. During this same period, the incidence rate of OSCC has increased. This HPV 16-18 presence decides of at-risk populations much more complex, and opportunistic screening of ALL patients must become the norm if the death rate is to be reduced. As in many cancers, the symptoms and history will often lead the dentist/physician to not only the presence of a tumor but also the likely site of the lesion. Tobacco/alcohol lesions tend to favor the anterior tongue and mouth, and HPV-positive lesions tend to favor the posterior oral cavity.
Application
Dental and medical professionals have developed this examination protocol for use. The different environments of practice will dictate apparent differences in the equipment and manner in which the examination is conducted. However, all aspects of this thorough examination apply to both types of practitioners to ensure that a complete patient assessment has been accomplished.
Instruments Used For Oral, Head, and Neck Cancer Examination
Clinicians need specific instruments and supplies to conduct a thorough and time-efficient examination. Suggested tools for the oral, head, and neck cancer exam include an adequate light source, mirrors (laryngeal and nasopharyngeal), gloves, tongue blades, 2×2 gauze pads, anesthetic nasal spray, flexible nasopharyngolaryngoscope, otoscope, and nasal speculum.
General Examination
A thorough oral, head, and neck cancer examination can easily be completed in less than 5 minutes. It primarily consists of inspection and palpation. Once the patient has established good rapport, the clinician is ready to begin the exam. It is essential to explain precisely what you are doing to the patient before doing it. Not only will this help put the patient at ease, but it also allows you to educate them about the signs and symptoms of oral, head, and neck cancer and how