Diagnosis

The specialists in the best position to diagnose oral cancer are otolaryngologists with training in surgery of the head and neck, and oral-maxillofacial surgeons.

A dentist is usually the first person to suspect that a person has oral cancer. The dentist usually refers the patient to an oral-maxillofacial surgeon. Once this diagnosing surgeon takes a history and conducts a physical examination, a biopsy is necessary. This involves taking a sample of the abnormal tissues so it can be tested to determine what type of growth it is. The surgeon can usually remove the sample under local anesthesia in an outpatient setting. Sometimes, however, the sample must be removed while the patient is under general anesthesia in an operating room. At that time, the surgeon examines other areas of the aerodigestive tract (such as the voice box, throat, and esophagus) and lungs. This is necessary because patients who have been diagnosed with oral cancer have a high risk of cancers developing in other parts of the aerodigestive tract.

Images produced by computed tomography (CT), magnetic resonance (MR), or positive emission tomography (PET) techniques may be useful in various situations, particularly to evaluate invasion of the jawbone and the presence of enlarged lymph nodes in the neck.

In at least one-third of patients with oral cancer, the cancer has spread (metastasized) to the lymph nodes of the neck. The spread of cancer to the lymph nodes of the neck reduces the cure rate by at least 50 percent.

If the cancer has spread to the lymph nodes, the physician usually orders a CT scan of the chest to rule out spread to other parts of the body as well (distant metastasis). If tests indicate that the patient has oral cancer, the next step is to determine the stage, or state of growth, of the cancer. The stage determines the treatment plan.