Oral Cancer

Types of Oral Cancer

More than 90% of all oral cavity tumors are squamous cell carcinomas. Squamous cells make up the lining of the oral cavity, also called the mucosa.

Other less common types of oral cancer include tumors of the salivary glands, including adenoid cystic carcinoma, adenocarcinoma, and other salivary glands cancers.

Biopsy

Biopsy

These are three ways to take a biopsy to check for oral cancer:

  • Exfoliative cytology. Your doctor may scrape some cells from the suspicious lesion and put them on a slide. This can be done in a doctor’s office.
  • Incisional biopsy. Your doctor may cut out a small sample of tissue. If the suspicious area is easy to reach, your doctor can numb your mouth and do this in his office. If the area is deeper in the mouth or throat, this is done in the operating room.
  • Fine-needle aspiration. Your doctor may have noticed a lump in your neck. If so, he or she uses a thin needle to remove a small sample of tissue. This can be done in a doctor’s office.

Once the biopsy is completed, the pathologist examines the tissue samples in a lab. He or she looks at the tissue under a microscope to check for cancer cells. It usually takes several days for the results of your biopsy to come back. A biopsy is the only sure way to tell if you have cancer and what kind of cancer it is.

CT scan

CT Scan

The CT scan is much more sensitive than a typical X-ray. Your doctor may get scans of your head and neck area, to see if a tumor exists in the oral cavity, lymph nodes, or elsewhere. Your doctor may also get scans of your entire lower jawbone, also called the mandible.

To have the test, you lie still on a table as it gradually slides through the center of the CT scanner. Then the scanner directs a continuous beam of X-rays at your head. A computer uses the data from the X-rays to create many pictures of your jawbone, which can be used together to create a three-dimensional picture.

A CT scan is painless and noninvasive. You may be asked to hold your breath one or more times during the scan. Often, after the first set of pictures is taken, you’ll get an injection of a dye that helps doctors get an even clearer view of what’s happening inside your body. Then technicians take a second set of scans.

MRI

MRI

MRIs are used to determine if cancer has spread from your mouth to your neck. MRIs can also show the size and extent of any cancer that has spread. These pictures can show the difference between normal and diseased tissue.

For this test, you lie still on a table as it passes through a tube-like scanner. Then the scanner directs a continuous beam of radiofrequency radiation at the area being examined. A computer uses the data from the radio waves to create a three-dimensional picture of the inside of your body. You may need more than one set of images. Each one may take two to 15 minutes, so that the whole experience may take an hour or more. You may be injected with a dye before getting this scan to help the doctors get an even clearer view of what’s happening inside your body. This test is painless and noninvasive. Ask for earplugs if they aren’t offered because there is a loud thumping noise during the scan. If you are claustrophobic, you may be given a sedative before having this test.

PET scan

PET/CT Scan

Stanford is the first health care institution in Northern California to offer patients a powerful new diagnostic imaging system known as Positron Emission Tomography/Computerized Tomography (PET/CT) scanning.

This hybrid technology combines the strengths of two well-established imaging modalities in one imaging session to more accurately diagnose and locate cancers while increasing patient comfort.

Today, most PET scans are performed on instruments that are combined PET and CT scanners. The combined PET/CT scans provide images that pinpoint the location of abnormal metabolic activity within the body, like malignant tumor cells. The combined scans have been shown to provide more accurate diagnoses than the two scans performed separately.

Every PET/CT scan at Stanford is reviewed and correlated by both a board certified nuclear medicine doctor and a board certified radiologist at a daily joint review session. Separate full reports are generated from each division for each patient.

The PET and CT scans are done at the same time on the same machine. The physician is able to precisely overlay the metabolic data of the PET scan and the detailed anatomic data of the CT scan to make a more detailed image than either test would make by itself. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. Some people are sensitive to the radioactive glucose and may have nausea, headache, or vomiting.

What PET scans do

PET, or positron emission tomography, monitors the biochemical functioning of cells by detecting how they process certain compounds, such as glucose (sugar). Cancer cells metabolize glucose at a much higher level than normal tissues.

Barium swallow

Barium Swallow / Upper Gastrointestinal Series

A barium swallow (also called an upper gastrointestinal (GI) series) is a diagnostic test that examines the organs of the upper part of the digestive system, including the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

Panorex films

Panorex Films

This test uses X-rays to take a picture of your upper and lower jawbones. It can tell whether cancer has spread to these bones. You sit or stand and place your chin on a rest, looking straight ahead. The machine moves around your head, taking the X-ray picture of your jaws.

Chest X-ray

What Is a Chest X-Ray?

A chest X-ray is a type of diagnostic radiology procedure used to examine the chest and the organs and structures located in the chest. Chest X-rays may be used to assess the lungs, as well as the heart (either directly or indirectly) by looking at the heart itself. Certain conditions of the heart may cause changes in the lungs and/or the vessels of the lungs.

Chest X-rays are used to assess the lungs and heart including enlargement, masses, spots, or to help show whether cancer has spread into the lungs. A chest X-ray can see changes in the normal structure of the heart, lungs, and/or lung vessels like extra blood flow, which may indicate disease or other conditions.

Chest X-rays use invisible X-ray beams to produce images that provide important information regarding the size, shape, contour, and anatomic location of the heart, lungs, bronchi, great vessels (aorta, aortic arch, pulmonary arteries), mediastinum (an area in the middle of the chest separating the lungs), and the bones (cervical and dorsal spine, clavicles, shoulder girdle, and ribs).

Depending on the results of the chest X-ray, additional tests or procedures may be requested by your physician for further diagnostic information.

Other related procedures that may be used to diagnose problems of the chest and respiratory tract include:

  • Chest fluoroscopy
  • Chest ultrasound
  • Computed tomography (CT scan) of the chest
  • Lung biopsy
  • Lung scans
  • Mediastinoscopy
  • Positron emission tomography (PET scan) of the chest
  • Pleural biopsy
  • Thoracentesis
  • Sinus X-rays
  • Pulmonary angiogram
  • Bronchoscopy
  • Bronchography

Stage 0 oral cancer

In this stage, cancer is only in the layer of cells lining your oral cavity or oropharynx. The cancer is very tiny. It has not spread or gone deeper. Cancer at this stage is also calledcarcinoma in situ. You might hear the terms Tis, N0, or M0 used to describe a stage 0 tumor.

Stage 1 oral cancer

In stage 1, there is cancer in your mouth, but it is 2 centimeters (cm) (about 3/4 inches) or less in size. The cancer has not spread to the lymph nodes or to other places in your body. Cancer at this stage offers a very good chance of survival.

You might hear the terms T1, N0, and M0 used to describe a stage I tumor.

Stage 2 oral cancer

In stage 2, the cancer is between 2 and 4 cm (about 1-1/2 inches) in size. The cancer has not spread to the lymph nodes or other places in your body. The chance of survival is very good at this stage.

You may hear your doctor use these the terms T2, N0, and MO to describe a stage II tumor.

Stage 3 oral cancer

In stage 3, the tumor is larger than 4 cm (about 2 inches) and has not spread to the lymph nodes or to other places in your body.Or the cancer is any size and has spread to nearby lymph nodes, but not to other places in your body.

You may hear several TNM terms to describe a stage III tumor: T3, N0, M0; T1, N1, M0; T2, N1, M0; and T3, N1, M0.

Stage 4 oral cancer

In stage 4, the tumor can be any size, but the cancer has spread to the lymph nodes or other parts of your body.

You may hear a TNM description that includes any T number (1 to 4), any N number (0 to 3), and either M0 or M1.

Recurrent oral cancer

Recurrent oral cancer is cancer that has come back after it was treated. When cancer occurs again, the staging process is also begun again. You’ll probably have tests similar to those you had the first time to determine the extent of the cancer.

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