Exam 2 Oral Cancer Screening

Five year survival rate

What is the survival rate for oral cancer?

Process by which a practitioner evaluates an asymptomatic patient to determine if they're likely or unlikely to have a potentially malignant lesion

What is screening?

Early detection of oral cancer and reduces mortality or adverse affects associated with treatment

What are the benefits of oral cancer screening?

We're the first one the patient meets so we need to establish rapport

Then we assess the patients risk of developing disease by going over HHx and performing an EIOE

Next we refer any lesions that look suspicious

Last we teach them how to perform a self cancer screen exam

What is our role in cancer screening?

People who: smoke, chew tobacco, abuse alcohol, exposed to sun, family history of cancer, over the age of 40, HPV, mucosal diseases, immunosuppressed, and anti-rejection medication for organ transplant, all at risk

Who is at risk for oral cancer?

The tongue, lower lip, floor of the mouth, oropharynx and soft palate

What structures are in the U Shaped zone of the mouth and have the greatest risk for cancer?

• indurated lymph nodes

• unexplained mass or swelling

• Changes in mole/wart/discolored area

• crust eroded on lips and ares outside of mouth

What are we looking for outside mouth?

lymphadenopathy

What is the tern for a firm fixed non-movable lymph node?

Asymmetry Border Color Diameter

How can we use ABCD to describe changes in mole war or discolored area?

When half of the mole does not match the other half

Asymmetry refers to

when the border (edges) of the mole are ragged or irregular

Border refers to

When the color of the mole varies throughout

Color refers to

If the moles diameter is larger than a pencil eraser

Diameter refers to

actinic keratosis -basal cell carcinoma

Squamous cell carcinoma

what type of carcinomas are you going to see crusts?

eroded areas on lips and areas outside of the mouth

What do crust look like?

Plaques in the mouth or on the lips - leukoplakia, erythroplakia, erythroleukoplakia exophytic mass

Loose teeth

Ulcers that will not heal

Difficulty wearing denture or swallowing

Bleeding

Numbness

Sore throat

Changes in voice

What are you looking for inside the mouth? (8)

Teeth don't get cancer

Why do we look at tissues before teeth?

Cancer is only growing in epithelium, has not grown deeper or spread to nearby structures

Stage 0 oral cancer

Cancer is less than 2 cm and has not spread to nearby structures

Stage 1 oral cancer

Cancer is larger than 2 cm across but smaller than four and has not spread to nearby structures

Stage 2 oral cancer

cancer can either be 4 cm in size

spread to only one ipsilateral lymph node

lymph node that contains cancer is no more than 3 cm

stage 3 oral cancer

cancer can either spread to tissues around the lip or oral cavity

Lymph nodes in the area may or may not contain cancer

Cancer is any side and has spread to more than one lymph node

Cancer has spread to other parts of the body

stage 4 oral cancer

Localized or generalized

Single or multiple

Size

Color

Morphology

Location

duration

Clinical impression

Disposition - what am I gonna do about it?

How would you record this in a progress note?

Visual and tactile examination

Routine oral screenings of asymptomatic patients can detect some potentially dangerous solutions at earlier stages

providing lesion description

Taking photos

keeping a visual record of what you see or feel

how do dental clinicians detect oral cancer?

Yes, every 7 to 14 days to minimize the false positive screening results. It allows us to confirm persistence or progression of lesions.

Should you follow up with patients?

tells us there's an area of concern, but cannot be used for definitive diagnosis

The ADA has found insufficient evidence to make a recommendation for or against its use

The adjunctive devices for detecting oral cancer do what

ViziLit Plus and Microlux/DL

which adjunctive device uses chemiluminescence

patient will rinse with 1% acetic acid cleansing solution

Clinician examines patient mouth with light wand

How do you use chemiluminescence light systems (ViziLit Plus and Microlux/DL)

normal epithelium is bluish and color

Abnormal epithelium will be white

Blue base metachromatic dye will mark outline for documentation of biopsy

Record appearance, location, history, morphology of the lesion and include photograph

What are the results of chemiluminescence (ViziLit Plus and Microlux/DL)

VELscope

Which adjunctive device uses autofluorescence

this one is more common

turn off the lights and shine it in the mouth.

It uses a specific wavelength, a blue light that disrupts the epithelial tissue.

How do you use autofluorescence (VELscope)

The lighted tissue emits, a pale green fluorescent

Differences in green reveal abnormalities

Prominent vascularity inflammation and melanin pigmentation, emit the same dark appearance

what are the results of auto fluorescence? (VELscope)

it will stay in an area of carcinoma, does not stain normal mucosa

indicated to diagnose

Not to be used as a standalone adjunct for oral cancer

what is the toluidine blue test? What does it stain

leukoplakia or dysplasia

Differentiate a traumatic or inflammatory ulcer from cancer

Determine the margins of resection prior to excision

Demonstrates small second primary or satellite lesion adjacent to larger lesion

What is the toluidine blue test indicated to diagnose?

evaluation of lesions that do not immediately raise suspicion of cancer

what does the transepithelial cytology oral CDx brush test used for?

Sample of lesion is placed on a dry slide fixed and sent to lab for analysis and evaluation

how is the transepithelial cytology oral CDx brush test done?

an adjunct screening tool that collects oral epithelial cells that have shed in saliva and are collected to detect genetic alterations in the oral epithelium of patients at higher risk for oral cancer

what is the saliva analysis oral DNA lab test?

It asks too many personal sexual questions

why don't people like saliva analysis oral DNA lab tests?

A tissue biopsy is a diagnosis of oral cancer that gives a better prediction of the potential for progression to SCC

What is the gold standard diagnostic test?

Those that are at the highest risk

Which patients would you have doing oral cancer screenings at home?

Provide them with pamphlets, such as mouth and throat cancer self examination or the eight step oral cancer screening

How would you teach a patient to do an oral cancer self screening exam?