Examination

Oral cancer screening forms part of every comprehensive, periodic and limited oral examination. It takes only a short time and is an integral element of routine care. Early detection of oral cancer can save a patient’s life.

In this short video, Professor Michael McCullough demonstrates how to assess a patient for oral cancer risk as part of a routine appointment.

The oral cavity includes the lips, tongue, gums, floor and roof of the mouth. Oral cancer refers to malignancies of the oral cavity. Most malignant oral lesions are squamous cell carcinomas that originate in the mucosa.

The oropharynx is the middle part of the throat, from the soft palate and tongue base to the back of the mouth, including the tonsils. Oropharyngeal carcinomas, often present in cervical lymph nodes, are not easily observed but examination provides an opportunity to identify early signs such as a lump on the neck.

Put aside five minutes at each appointment to take a full medical history and conduct a systematic inspection of the oral cavity, head and neck, using good lighting, to identify signs of potentially malignant lesions. There are five key components:

  • Discuss oral and oropharyngeal cancer risk factors with your patient, including tobacco use, alcohol consumption, sun exposure and HPV
  • Thoroughly examine the buccal and labial mucosa
  • Look at the floor of the mouth, lateral margins of the tongue, palate and oropharynx
  • Do an extraoral exam, looking at the lymph nodes and upper cervical area
  • Record your findings, which may include photographs

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Oral cancer signs and symptoms:

  • Unexplained mouth ulcer or lump
  • Unexplained neck lump
  • Leukoplakia (white or red patches) of oral mucosa
  • Unexplained tooth mobility or non-healing extraction site

Oropharyngeal cancer signs and symptoms:

  • Unexplained hoarseness
  • Unexplained neck lump
  • Persistent sore throat
  • Difficulty swallowing
  • Altered speech
  • Spitting or coughing up blood
  • Unilateral blockage of the nose or ear

Common causes of oral mucosal changes are trauma, sharp cusps of teeth, broken fillings and ill-fitting dentures. These need treatment and should be reassessed for healing. Failure to improve within two weeks requires referral for further investigation.

Any lesion that has persisted for more than two weeks without a definite cause should be immediately referred. Multiple signs and symptoms, particularly in combination with underlying risk factors such as age, can indicate increased risk of oral cancer.

Record your findings in the patient’s medical history and clinical notes on your record system, including if the patient smokes or drinks, how much and any brief advice given. If you are referring the patient, clearly document this in the referral notes e.g. “Patient referred to RDHM Oral Med for suspected oral cancer”. Attach any photographs of suspicious lesions and investigation results. To protect patient confidentiality, images should not be shared via email or SMS. Relevant item numbers include:

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  • 011 comprehensive oral examination
  • 012 periodic oral examination
  • 013 limited oral examination
  • 019 referral letter
  • 051 biopsy of tissue
  • 131 dietary analysis (including alcohol consumption) and advice
  • 142 tobacco counselling

A digital SLR (DSLR) camera with a ring flash is recommended when taking intraoral mucosal photos. Its depth of field keeps more of the image sharp and clear than a standard intraoral camera, capturing changes in the mucosa at a suitable quality for analysis. This handy PDF guides you through assembling a DLSR camera, with tips for taking good intraoral photos. Keep the camera set up and ready to use in the clinic.

Last updated: March 2021