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Inside Dentistry

March 2007, Volume 3, Issue 3
Published by AEGIS Communications


Oral Cancer—What to Look For

Michael Kahn, DDS

In a follow-up to Inside Dentistry’s January 2007 cover story, “Oral Cancer: The Forgotten Disease,” Michael A. Kahn, DDS, offers this pictorial mini-guide to identifying early oral cancer lesions. Dr. Kahn also authored an Inside Report article in our October 2006 issue titled, “Screening for Oral Cancer: A Matter of Life and Death,” in which he discussed the most common malignant lesion of the oral cavity, the squamous cell carcinoma, and how to identify it in its earliest stages when the patient’s chances for survival are greatest.

Oral cancer typically affects the tongue, oral soft tissues, throat, and pharynx. The most common sign of the cancer is a sore in the mouth that lasts longer than 2 weeks. Other symptoms clinicians should be cognizant of are lumps or other thickening of the mucosa; white or red patches on the gums, tongue, or tonsils; or a lining anywhere in the mouth. Patients may report symptoms such as a persistent sore throat, the feeling of something being caught in the throat, or difficulty chewing and/or swallowing.

As Inside Dentistry reported in January, currently an alarming two thirds of all oral cancer cases go undiagnosed until they are in the advanced stages, when the cancer has already metastasized from its original site to regional lymph nodes or, worse, distant organs. If and when oral cancer advances this far, statistically only a quarter of its victims will survive 5 years. The patient’s body will be ravaged and disfigured in horrific ways not found in many other invasive cancers; in addition to conventional chemotherapy and radiation treatments, advanced oral cancer usually requires removing parts of the tongue and/or jaw. Indeed, maxillofacial reconstruction could be considerable, and adversely affect the patient in terms of speech and mastication function as well as negative feelings of self-worth.

However, the good news is that if oral cancer is found early enough, the 5-year survival rate is close to 90%. It is up to today’s clinicians to know what to look for in order to save lives. Dr. Kahn’s clinical philosophy is that in addition to being vigilant, dentists should have a good understanding of the signs and symptoms of oral cancer because they may find themselves directly involved in its early detection. Because the subtle surface tissue changes that can herald the onset of oral cancer can be easily missed, he strongly urges clinicians to supplement their visual and palpation examinations with some of the ancillary and adjunctive screening and diagnostic tools, such as chemiluminescence and autofluorescence, which are now available.

Here, Dr. Kahn provides eight pictorial examples of how and where early-stage oral cancer lesions may appear, with short descriptions of the type of lesion shown. Figure 1; Figure 2; Figure 3; Figure 4; Figure 5; Figure 6; Figure 7; Figure 8.

About the Author

Michael Kahn, DDS
Professor and Chairman
Department of Oral and Maxillofacial Pathology
Tufts University School of Dental Medicine
Boston, Massachusetts


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Image Gallery

Figure 1 Verrucoid leukoplakia of the right commissure and anterior buccal mucosa. The biopsy indicated severe epithelial dysplasia.

Figure 1

Figure 2 Erythroplakia of the left posterior tongue, soft palate, and tonsilar pillar area.

Figure 2

Figure 3 Small leukoplakia of the left mid-lateral border of the tongue. Lesions this size can possess significant dysplasia or early invasive squamous cell carcinoma.

Figure 3

Figure 4 Extensive, scattered, and discontinuous leukoplakia of the left lateroventral tongue. This is an example of the concept of

Figure 4

Figure 5 Smokeless tobacco lesion of the anterior mandibular vestibule with the characteristic

Figure 5

Figure 6 Left anterior floor-of-mouth leukoplakia with skip areas crossing the midline.

Figure 6

Figure 7 Subtle, diffuse leukoplakia of the left retromolar pad and a separate leukoplakia of the inferior, posterior buccal mucosa adjacent to the vestibule.

Figure 7

Figure 8 Right lateral tongue leukoplakia that, upon incisional biopsy, demonstrated mild epithelial dysplasia.

Figure 8