Table of ContentsView AllTable of ContentsSelf-ExamPhysical ExaminationProceduresImagingStagingDifferential DiagnosesFrequently Asked QuestionsNext in Oral Cancer GuideHow Oral Cancer Is Treated
Table of ContentsView All
View All
Table of Contents
Self-Exam
Physical Examination
Procedures
Imaging
Staging
Differential Diagnoses
Frequently Asked Questions
Next in Oral Cancer Guide
About 132 people are diagnosed withoral cancereach day in the United States, according to the Oral Cancer Foundation. Perhaps a person undergoes a routine doctor, dental, or self-oral examination that reveals something suspicious, or perhaps it is asymptom, like a non-healing sore or persistent throat pain, that raises concern. Whatever the case, the diagnostic process fororal cancerbegins with a visit to an ear-nose-throat (ENT) doctor, which usually involves a head and neck examination,endoscopy, biopsy, and imaging tests to confirm and determine the spread of oral cancer.
While there is no official screening test for oral cancer, many experts and professional groups, like the American Association of Oral and Maxillofacial Surgeons, recommend periodic oral self-exams.
The point of self-exams is to detect oral cancer early before it spreads and becomes more difficult to treat and cure.
Here are the steps you can take to perform a self-exam. Of course, if you detect anything suspicious, like an abnormal lump or sore that bleeds easily, be sure to call and make a prompt appointment with an ENT doctor.
There are two types of procedures that may be used in the process of evaluating a possible case of oral cancer—one, endoscopy, that may only be used in some instances and another, biopsy, that is required for a formal diagnosis.
Endoscopy
In addition to a head and neck exam, an ENT doctor may perform an endoscopy to better examine your throat.During an endoscopy, the ENT doctor will place a thin, flexible instrument into your mouth and slide it down your throat. This instrument, called an endoscope, has a camera and light on its tip, so otherwise, hard-to-see areas can be visualized.
Sometimes a more extensive endoscopy procedure called a panendoscopy is required. A panendoscopy entails the use of several types of scopes to visualize all parts of the mouth, throat, voice box, nose, and even the esophagus and/or windpipe. Due to the complexity of this procedure, it’s usually performed under general anesthesia in an operating room.
Biopsy
In addition to HPV testing, which is important for staging the cancer (establishing the extent of the disease) and determining the best course of treatment, a fine needle aspiration (FNA) biopsy of one or more lymph nodes in the neck may be performed.
During an FNA, a healthcare provider inserts a thin needle attached to a clear tube, called a syringe, into a lymph node. He will then suck out, or aspirate, cells from the suspicious area. These cells are then examined closely under a microscope.
After the diagnosis of oral cancer is made, the stage of the cancer is defined with the help of imaging tests, such as:
How Mouth Cancer Looks
Defining the stage of oral cancer is essential for determining a person’s treatment plan and predicting their outcome (called prognosis).
HPV Status
If the cancer is within the oropharynx (the back and middle region of the throat, including the base of the tongue andtonsils), the first step in the staging process is to determine whether the cancer is HPV positive or negative. An HPV positive oropharyngeal cancer means that the tumor makes too many copies (called overexpression) of the protein p16. HPV negative oropharyngeal cancer means that the tumor does not overexpress p16. Overall, HPV positive oropharyngeal cancer has a better prognosis than HPV negative oropharyngeal cancer.
Once the HPV status of a cancer is determined (if its located within the oropharynx), the stage of the cancer is accessed, based on the American Joint Committee on Cancer (AJCC) TNM system.
The AJCC system uses three main parameters:
To define the stage of the cancer, numbers are placed after TNM (T 0-4, N 0-3, M 0-1). Higher numbers indicate the cancer is more advanced. For example, the designation, T1, means the cancer size is 2 centimeters or smaller. T2 means the cancer is bigger than 2 centimeters but smaller than 4 centimeters.
The letter/number code is then translated into an overall stage (I, II, III, IV) using a standard chart. For example, a T1N0M0 cancer, which means the cancer is smaller than 2 centimeters and has not spread to lymph nodes or distant organs, is an AJCC stage I cancer.
Infection with certain strains ofHPVis an important risk factor for oral cancer.
Pathologic Versus Clinical Stage
It’s important to note that the AJCC system uses two staging systems, the pathologic (also called the surgical stage) and the clinical stage.
The pathologic is determined during an operation, as the surgically-removed cancerous tissue is examined. Only patients undergoing surgery (the majority) receive a pathologic stage. All patients undergo a clinical stage, which is based on findings from the physical exam, endoscopy, biopsy, and imaging tests.
While there are separate pathologic and clinical TNM stage grouping systems (the letter/number codes) for HPV positive oropharyngeal tumors, there is no separation of stage groupings for HPV negative oropharyngeal cancer or oral cavity cancer (which includes the lips, cheeks, gums, front two-thirds of the tongue, and the floor and the roof of the mouth).
Summarized below is the pathologic staging for HPV positive oropharyngeal cancer, as well as staging for HPV negative oropharyngeal cancer and oral cavity cancer.
HPV Positive Staging
HPV Negative Staging
Oral Cavity Cancer
There are many possible diagnoses when it comes to abnormal-appearing spots, sores, or lesions within the inner lining of the mouth. These diagnoses range from the common canker sore (called an aphthous ulcer) to infections withcoxsackieorherpes simplex viruses, as well as autoimmune concerns (for example, Behcet’s disease or lupus erythematosus).
In some cases, a healthcare provider can make a diagnosis based on a medical history and physical examination alone.
If a healthcare provider cannot determine the diagnosis from a medical history and physical examination, or if there is any suspicion for cancer (like bleeding from the mouth or a persistent sore), a tissue sample is critical to ensure an accurate diagnosis. Benign lesions that closely resemble that of oral cancer or pre-cancer may also need to be biopsied for confirmation. Some of these lesions include:
Like mouth lesions, some tongue abnormalities can be diagnosed based on history and appearance alone.
Other tongue conditions may require more testing, like blood tests or a biopsy, to confirm the diagnosis. For example,atrophic glossitis,in which the tongue is tender and appears smooth and glossy on a red or pink background, is associated with vitamin B12 deficiency, which can be diagnosed with a single blood test.
Frequently Asked QuestionsIt varies, but often, signs are first noticed on the floor of the mouth, the area under the tongue.The front part of thetongueand lowergumsare also fairly common sites where oral cancer develops. These cancerous growths begin as white patches, red patches, or irritated sores.
It varies, but often, signs are first noticed on the floor of the mouth, the area under the tongue.The front part of thetongueand lowergumsare also fairly common sites where oral cancer develops. These cancerous growths begin as white patches, red patches, or irritated sores.
How Oral Cancer Is Treated
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The Oral Cancer Foundation. The Oral Cancer Foundation. Sept 14, 2019.Warning Signs of Oral Cancer. American Association of Oral and Maxillofacial Surgeons.Tests for Oral Cavity and Oropharyngeal Cancers. American Cancer Society. Mar 9, 2018.Singh A, Thukral CL, Gupta K, Sood AS, Singla H, Singh K.Role of MRI in Evaluation of Malignant Lesions of Tongue and Oral Cavity. Pol J Radiol. 2017;82:92-99. doi:10.12659/PJR.899352Elrefaey S, Massaro MA, Chiocca S, Chiesa F, Ansarin M.HPV in oropharyngeal cancer: the basics to know in clinical practice. Acta Otorhinolaryngol Ital. 2014;34(5):299-309.Kansky AA, Didanovic V, Dovsak T, Brzak BL, Pelivan I, Terlevic D.Epidemiology of oral mucosal lesions in Slovenia. Radiol Oncol. 2018;52(3):263-266. doi:10.2478/raon-2018-0031Rutkowska M, Hnitecka S, Nahajowski M, Dominiak M, Gerber H.Oral cancer: The first symptoms and reasons for delaying correct diagnosis and appropriate treatment.Adv Clin Exp Med. 2020;29(6):735-743. doi:10.17219/acem/116753Additional ReadingAmerican Association of Oral and Maxillofacial Surgeons. (n.d.).Warning Signs of Oral Cancer. www.aaoms.org/images/uploads/pdfs/oralcancerselfexam.pdfAmerican Cancer Society. (2018).Tests for Oral Cavity and Oropharyngeal Cancers. www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/how-diagnosed.html.American Cancer Society. (2018).Oral Cavity and Oropharyngeal Cancer Stages. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/staging.html.Garg P, Karjodkar F.“Catch Them before it Becomes Too Late”—Oral Cancer Detection. Report of Two Cases and Review of Diagnostic AIDS in Cancer Detection.Int J Prev Med. 2012 Oct;3(10):737-41.Goldstein BG, Goldstein AO. (2017). Oral lesions. Dellavalle RP, Deschler DG, eds. UpToDate. Waltham, MA: UpToDate Inc.Oral Cancer Foundation. (2018).The Oral Cancer Foundation. www. oralcancerfoundation.org/.U.S. Preventive Services Task Force.Screening for Oral Cancer: Recommendation Statement.Am Fam Physician. 2015 Mar 15;91(6):online.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.The Oral Cancer Foundation. The Oral Cancer Foundation. Sept 14, 2019.Warning Signs of Oral Cancer. American Association of Oral and Maxillofacial Surgeons.Tests for Oral Cavity and Oropharyngeal Cancers. American Cancer Society. Mar 9, 2018.Singh A, Thukral CL, Gupta K, Sood AS, Singla H, Singh K.Role of MRI in Evaluation of Malignant Lesions of Tongue and Oral Cavity. Pol J Radiol. 2017;82:92-99. doi:10.12659/PJR.899352Elrefaey S, Massaro MA, Chiocca S, Chiesa F, Ansarin M.HPV in oropharyngeal cancer: the basics to know in clinical practice. Acta Otorhinolaryngol Ital. 2014;34(5):299-309.Kansky AA, Didanovic V, Dovsak T, Brzak BL, Pelivan I, Terlevic D.Epidemiology of oral mucosal lesions in Slovenia. Radiol Oncol. 2018;52(3):263-266. doi:10.2478/raon-2018-0031Rutkowska M, Hnitecka S, Nahajowski M, Dominiak M, Gerber H.Oral cancer: The first symptoms and reasons for delaying correct diagnosis and appropriate treatment.Adv Clin Exp Med. 2020;29(6):735-743. doi:10.17219/acem/116753Additional ReadingAmerican Association of Oral and Maxillofacial Surgeons. (n.d.).Warning Signs of Oral Cancer. www.aaoms.org/images/uploads/pdfs/oralcancerselfexam.pdfAmerican Cancer Society. (2018).Tests for Oral Cavity and Oropharyngeal Cancers. www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/how-diagnosed.html.American Cancer Society. (2018).Oral Cavity and Oropharyngeal Cancer Stages. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/staging.html.Garg P, Karjodkar F.“Catch Them before it Becomes Too Late”—Oral Cancer Detection. Report of Two Cases and Review of Diagnostic AIDS in Cancer Detection.Int J Prev Med. 2012 Oct;3(10):737-41.Goldstein BG, Goldstein AO. (2017). Oral lesions. Dellavalle RP, Deschler DG, eds. UpToDate. Waltham, MA: UpToDate Inc.Oral Cancer Foundation. (2018).The Oral Cancer Foundation. www. oralcancerfoundation.org/.U.S. Preventive Services Task Force.Screening for Oral Cancer: Recommendation Statement.Am Fam Physician. 2015 Mar 15;91(6):online.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
The Oral Cancer Foundation. The Oral Cancer Foundation. Sept 14, 2019.Warning Signs of Oral Cancer. American Association of Oral and Maxillofacial Surgeons.Tests for Oral Cavity and Oropharyngeal Cancers. American Cancer Society. Mar 9, 2018.Singh A, Thukral CL, Gupta K, Sood AS, Singla H, Singh K.Role of MRI in Evaluation of Malignant Lesions of Tongue and Oral Cavity. Pol J Radiol. 2017;82:92-99. doi:10.12659/PJR.899352Elrefaey S, Massaro MA, Chiocca S, Chiesa F, Ansarin M.HPV in oropharyngeal cancer: the basics to know in clinical practice. Acta Otorhinolaryngol Ital. 2014;34(5):299-309.Kansky AA, Didanovic V, Dovsak T, Brzak BL, Pelivan I, Terlevic D.Epidemiology of oral mucosal lesions in Slovenia. Radiol Oncol. 2018;52(3):263-266. doi:10.2478/raon-2018-0031Rutkowska M, Hnitecka S, Nahajowski M, Dominiak M, Gerber H.Oral cancer: The first symptoms and reasons for delaying correct diagnosis and appropriate treatment.Adv Clin Exp Med. 2020;29(6):735-743. doi:10.17219/acem/116753
The Oral Cancer Foundation. The Oral Cancer Foundation. Sept 14, 2019.
Warning Signs of Oral Cancer. American Association of Oral and Maxillofacial Surgeons.
Tests for Oral Cavity and Oropharyngeal Cancers. American Cancer Society. Mar 9, 2018.
Singh A, Thukral CL, Gupta K, Sood AS, Singla H, Singh K.Role of MRI in Evaluation of Malignant Lesions of Tongue and Oral Cavity. Pol J Radiol. 2017;82:92-99. doi:10.12659/PJR.899352
Elrefaey S, Massaro MA, Chiocca S, Chiesa F, Ansarin M.HPV in oropharyngeal cancer: the basics to know in clinical practice. Acta Otorhinolaryngol Ital. 2014;34(5):299-309.
Kansky AA, Didanovic V, Dovsak T, Brzak BL, Pelivan I, Terlevic D.Epidemiology of oral mucosal lesions in Slovenia. Radiol Oncol. 2018;52(3):263-266. doi:10.2478/raon-2018-0031
Rutkowska M, Hnitecka S, Nahajowski M, Dominiak M, Gerber H.Oral cancer: The first symptoms and reasons for delaying correct diagnosis and appropriate treatment.Adv Clin Exp Med. 2020;29(6):735-743. doi:10.17219/acem/116753
American Association of Oral and Maxillofacial Surgeons. (n.d.).Warning Signs of Oral Cancer. www.aaoms.org/images/uploads/pdfs/oralcancerselfexam.pdfAmerican Cancer Society. (2018).Tests for Oral Cavity and Oropharyngeal Cancers. www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/how-diagnosed.html.American Cancer Society. (2018).Oral Cavity and Oropharyngeal Cancer Stages. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/staging.html.Garg P, Karjodkar F.“Catch Them before it Becomes Too Late”—Oral Cancer Detection. Report of Two Cases and Review of Diagnostic AIDS in Cancer Detection.Int J Prev Med. 2012 Oct;3(10):737-41.Goldstein BG, Goldstein AO. (2017). Oral lesions. Dellavalle RP, Deschler DG, eds. UpToDate. Waltham, MA: UpToDate Inc.Oral Cancer Foundation. (2018).The Oral Cancer Foundation. www. oralcancerfoundation.org/.U.S. Preventive Services Task Force.Screening for Oral Cancer: Recommendation Statement.Am Fam Physician. 2015 Mar 15;91(6):online.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
