Recognising the signs

Recently, it has come to light that a lollipop is being developed with the aim to detect the early signs of mouth cancer. This comes as many patients find the prospect of a biopsy very daunting, causing anxiety not only about the result, but the procedure itself. Currently, the lollipop is required to be immersed in the sample for up to 12 hours, making it inappropriate for use in the practice.[i] However, it is true that quick pre-diagnostic tests are a great tool for detecting mouth cancer in its early stages, without frightening patients with the prospect of a biopsy.

Mouth cancer diagnosis

Diagnosing mouth cancer begins with noticing the symptoms. For instance, if a clinician spots an unusual lesion or discolouration in the mouth during a routine examination, it is likely to require further assessment. Most commonly, a symptom of mouth cancer might appear to be a mouth ulcer which does not heal in three weeks. It can affect the inside of the cheeks, roof of the mouth, lips, gingiva, and tongue. However, symptoms can also include a lump in the mouth, bleeding, and red or white patches.[ii] Sometimes, symptoms are similar to minor issues, so patients may not realise that they could have the early signs of mouth cancer. As such, it’s important that clinicians look out for the signs in every appointment.

Usually, at this point, if mouth cancer is suspected, the patient is referred to a specialist doctor for further assessments. In order to make a diagnosis, a doctor will remove a small piece of tissue from the affected area, which is then tested to check for cancer cells.[iii]

Detecting it early

In order to offer patients the best possible outcomes, it’s important to detect mouth cancer in its early stages. Currently, over 70% of mouth cancer cases are diagnosed at stage III or IV, with five-year survival rates approximately 50%. This highlights the importance of early detection as, when it is detected at stages I and II, five-year survival rates improve to around 90%.[iv] This drastic improvement is lifechanging for patients, determining the severity of their cancer, the extent of the treatment they need, and their chances of recovery. As such, clinicians’ ability to recognise the signs and symptoms of mouth cancer is crucial, as is knowing how and when to act.

This vigilance is particularly key at a time when many patients are experiencing delays when accessing dental care, potentially allowing problems to go unnoticed for longer than normal. If a patient is not familiar with the early symptoms of oral cancer, they are unlikely to seek urgent care for a lingering mouth ulcer until it’s reached its later stages.

Pre-diagnostic tests

Whilst it is important to be familiar with the early symptoms of mouth cancer, clinicians may not come across them regularly during check-ups. Because of this, they may feel uncertain about their decision making when referring patients for a biopsy. As such, some may feel it more appropriate to adopt a ‘wait and see’ approach, inadvertently extending the time to diagnosis. In order to avoid unnecessary delays, pre-diagnostic tests can be incredibly helpful for ensuing patients receive the care they need as quickly as possible.

Initial examinations include a visual exam in which a clinician looks for lesions in the mouth and throat, and any discolouration. An examination will also include palpation, using the fingers to feel for any unusual lumps or bumps around the neck, face, and jaw. Some practitioners also use a pre-diagnostic tool called toluidine blue dye to coat any lesions which are likely to be cancerous, or an oral cancer screening light along with a fluorescent mouthwash to identify abnormal tissue.[v]

To avoid a ‘wait and see’ approach, and to ensure that patients receive a diagnosis as soon as possible, the use of a pre-diagnostic tool is useful. When a clinician identifies an unusual lesion, the BeVigilant™ OraFusion™ System detects biomarkers in a single saliva sample, and when combined with common risk factors, establishes a patient’s risk of mouth cancer. The results of the test are accurate, and can be used by practitioners to decide whether to take no action, schedule a follow up exam, or refer to a specialist for biopsy. The BeVigilant™ OraFusion™ System produces a result in 15 minutes or less, and is ideal for chairside use, ensuring patients gain a diagnosis and start treatment as soon as possible.

Even though dentists are unable to diagnose mouth cancer in the practice, the use of thorough exams and pre-diagnostic tests enable clinicians and their patients to be informed about their level of risk, and refer them for biopsy with confidence.

For more details about the BeVigilant™ OraFusion™ System, visit the Total TMJ website www.totaltmj.co.uk/products/bevigilant-orafusion/, or email info@totaltmj.co.uk