Diagnosing Oral Cancer

NYU Langone doctors use biopsy to diagnose oral cancer in adults and imaging tests to determine how far it has spread.

Oral cancer develops in the oral cavity, or mouth, which has several key functions. Food is chewed and mixed with saliva in the mouth, so it can be swallowed. The mouth, tongue, and lips also help create the sounds needed for speech.

Oral cancer can sometimes arise from precancerous cells found in the lining of mouth, called the mucosa. The mucosa covers the inside of the cheeks, the inside of the lips, the gums, the tongue, the roof of the mouth, and the floor of the mouth.

When viewed under a microscope, these precancerous cells, called dysplasia, look abnormal compared to healthy oral cavity cells. Precancerous lesions are often detected during routine screening conducted by a dentist or primary care doctor.

The most common form of oral cancer is called squamous cell carcinoma. These cancers develop in squamous cells, the flat cells that make up the mucosa. Squamous cells are also found in the skin covering the outside surface of the lips. These cancerous cells grow through the mucosa or skin covering the lips and into the tissue below.

Oral cancer can spread to nearby lymph nodes in the neck. Lymph nodes are small, bean-shaped structures that make and store lymphocytes, a type of infection-fighting white blood cell. The lymphatic system is made up of a network of vessels, tissue, and organs that circulate lymph, a fluid that contains these lymphocytes.

Oral cancer can also spread to nerves in the head and neck. Rarely, advanced oral cancer may be found in distant sites in the body, including in the lungs, liver, and bones.

Risk Factors and Symptoms of Oral Cancer

Using tobacco and drinking alcohol, especially together, increases the risk of developing oral cancer and precancerous lesions. NYU Langone doctors encourage people to drink in moderation and, if they smoke or chew tobacco, to quit. Perlmutter Cancer Center’s tobacco cessation programs can offer guidance and support.

Taking medications that suppress the immune system to prevent the body from rejecting a transplanted organ or to manage immune system conditions can increase the risk of oral cancer. Rare genetic syndromes, such as Fanconi anemia or dyskeratosis congenita, can affect bone marrow—the soft tissue in the center of bones, where blood cells are made—and may also increase the risk of developing oral cancer.

Men are more likely than women to develop oral cancer, possibly because rates of smoking are higher among men, although this gap is closing. People older than age 40 are more likely to be diagnosed with oral cancer than younger people.

Symptoms of oral cancer can include a lump or a sore on the lip or in the mouth that does not heal. Some people experience numbness, pain, or bleeding in the mouth or have trouble moving the tongue or swallowing. Other symptoms of oral cancer include a sore throat, recent changes in the fit of dentures, hoarseness, or a lump on the neck, which may be caused by a cancerous lymph node.

Cancerous nodes can grow in size, become hard, and may be painful. Oral cancer can spread to the lymph nodes in the neck.

To detect oral cancer and precancerous changes as early as possible, NYU Langone doctors encourage screening during regular visits to a dentist or primary care doctor.

If specialists suspect you have oral cancer or a precancerous growth, they may ask about your symptoms and medical history, including whether you smoke or drink alcohol. Then they may perform a biopsy and additional tests.

Biopsy

Using a local anesthetic, your NYU Langone doctor may perform an in-office biopsy, in which he or she removes a small amount of tissue from a suspicious growth in the oral cavity. A pathologist examines the tissue sample under a microscope for signs of cancer or dysplasia.

Doctors may also perform more extensive surgical biopsies in the hospital using general anesthesia.

After a biopsy, you may experience some discomfort or minor bleeding for a few days. Doctors can prescribe medication to relieve any pain.

Fine Needle Aspiration

Oral cancer can spread to nearby lymph nodes, causing swelling and one or more neck masses. If you have these symptoms, your NYU Langone doctor may perform fine needle aspiration, in which he or she inserts a small needle into a mass and removes a sample of cells for examination under a microscope.

During the procedure, the doctor may use ultrasound—in which sound waves are used to create images of the neck—to guide the needle.

CT Scans

If you’ve received a diagnosis of oral cancer, your doctor may recommend a CT scan, in which two- or three-dimensional, cross-sectional images of the body are created using X-rays and a computer. This helps the doctor determine whether the cancer has spread to nearby lymph nodes in the neck or to structures like the hard palate or the upper or lower jawbone. This type of scan can also detect cancer in distant parts of the body, such as the lungs or liver.

A special dye may be injected into a vein in the arm to enhance the images.

MRI Scans

An MRI scan uses a magnetic field to create images of the body. It can detect whether oral cancer has spread to the soft tissue of the head and neck, including brain tissue. A special dye may be used to enhance the images.

PET/CT Scans

To determine whether oral cancer has spread throughout the body, your doctor may order a PET/CT scan, which combines CT scan technology and PET imaging.

The PET portion of the scan requires an intravenous (IV) infusion of radioactive glucose, or sugar, into a vein. The substance collects in cancer cells, which helps to make them visible during the scan.

Clinical Trials

NYU Langone doctors are investigating a new way to diagnose early oral cancer. As part of a clinical trial, researchers are evaluating whether a special microchip sensor can identify oral cancer in cell samples removed from the surface of the mouth.

If you have a suspicious growth in your mouth, you and your doctor can discuss whether participating in this clinical trial may be a good option for you.