Diagnosis of Lip & Oral Cavity Cancer

Diagnosis of Lip & Oral Cavity Cancer

The following tests and procedures may be used to diagnose lip and oral cavity cancer:
  • Physical exam of the lips and oral cavity: An exam to check the lips and oral cavity for abnormal areas. The doctor or dentist will feel the entire inside of the mouth with a gloved finger and examine the oral cavity with a small long-handled mirror and lights. This will include checking the insides of the cheeks and lips; the gums; the roof and floor of the mouth; and the top, bottom, and sides of the tongue. The neck will be felt for swollen lymph nodes. A history of the patient’s health habits and past illnesses and medical and dental treatments will also be taken.
  • Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
  • X-rays of the head, neck, and chest: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. If leukoplakia is found, cells taken from the patches are also checked under the microscope for signs of cancer.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Exfoliative cytology: A procedure to collect cells from the lip or oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, mouth, or throat. The cells are viewed under a microscope to find out if they are abnormal.
  • Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and x-rays are taken. This procedure is also called an upper GI series.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide 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.

Factors Affecting Prognosis and Treatment Options

Prognosis (chance of recovery) depends on the following:
  • The stage of the cancer.
  • Where the tumor is in the lip or oral cavity.
  • Whether the cancer has spread to blood vessels.
For patients who smoke, the chance of recovery is better if they stop smoking before beginning radiation therapy. Treatment options for lip and oral cavity cancer depend on the following:
  • The stage of the cancer.
  • The size of the tumor and where it is in the lip or oral cavity.
  • Whether the patient’s appearance and ability to talk and eat can stay the same.
  • The patient’s age and general health.

Stages of Lip and Oral Cavity Cancer

The process used to find out if cancer has spread within the lip and oral cavity or to other parts of the body is called staging. The results of the tests used to diagnose lip and oral cavity cancer are also used to stage the disease. Cancer spreads in the body through tissue, lymph system or blood. When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The following stages are used for lip and oral cavity cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and the tumor is 2 centimeters or smaller. Cancer has not spread to the lymph nodes.

Stage II

In stage II, the tumor is larger than 2 centimeters but not larger than 4 centimeters, and cancer has not spread to the lymph nodes.

Stage III

In stage III, the tumor:
  • may be any size and has spread to a single lymph node that is 3 centimeters or smaller, on the same side of the neck as the cancer; or
  • is larger than 4 centimeters.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC as follows:
  • In stage IVA, the tumor:
    • has spread to nearby tissues in the lip and oral cavity; or
    • is any size and may have spread to nearby tissues in the lip and oral cavity. Cancer has spread to 1 or more lymph nodes on one or both sides of the neck, and the involved lymph nodes are 6 centimeters or smaller.
  • In stage IVB, the tumor:
    • may be any size and has spread to one or more lymph nodes that are larger than 6 centimeters; or
    • has spread to the muscles or bones in the oral cavity, or to the base of the skull and/or the carotid artery. Cancer may have spread to one or more lymph nodes on one or both sides of the neck.
  • In stage IVC, the tumor has spread beyond the lip and oral cavity to other parts of the body. The tumor may be any size and may have spread to the lymph nodes.

Recurrent Lip and Oral Cavity Cancer

Recurrent lip and oral cavity cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the lip or mouth or in other parts of the body. If you have symptoms associated with lip and oral cavity cancer, contact us to request an appointment with our oncology specialists to begin diagnostic testing.