A clinician should always take a full history and make a thorough and systematic clinical examination of the oral mucosa and particularly of those sites that are especially predisposed to cancer, such as the sides of the tongue and the floor of mouth. A comprehensive mouth examination with a good light is required. It is crucial also to palpate the neck lymphoid tissue (cervical lymph nodes) to detect masses which might represent metastases.
Location
The most common locations for mouth cancer are the lower lip (40 per cent) (fig 1), and the tongue and the floor of the mouth (50 per cent). Other oral areas involved are the buccal mucosa, retromolar area, gingiva, soft palate and, less frequently, the posterior tongue and hard palate.
Features
Lesions of oral cancer can range from a few millimeters, to several centimetres diameter in the more advanced cases. The initial lesions are usually solitary and asymptomatic when they are small and thus, in the early
Clinical features of OSCC stages, it is quite possible to make a misdiagnosis. Oral cancer in the initial clinically detectable stage is a red or red and white
(erytholeukoplastic) area without symptoms; early cancers are rarely painful. However, in more advanced cancers there is a red or red and white single lesion, ulcer or lump with irregular margins which are rigid to touch (indurated) and there may be pain especially in tongue and floor of the mouth lesions.
The ‘RULE’ is that a single lesion of three or more weeks duration, especially a Red and/or white lesion, Ulcer, Lump, Especially a combination, or if indurated (firm on palpation) should be regarded with suspicion, and biopsy arranged.
Other features may be;
? Anaesthesia
? Bone destruction
? Dysarthria
? Dysphagia
? Pain
? Paraesthesia
? Pathological fracture
? Tooth mobility
The most important task is to establish an early diagnosis in the first stages of the disease, when treatment indicated is less severe and prognosis is best. The clinical appearance of an oral ulcer on its own is rarely diagnostic. Any single ulcer lasting more than three weeks must be regarded with suspicion. In the light of multiple causes, some systematic way of dealing with ulceration is needed, such as my system of splitting causes into;
? Systemic causes(infections, or diseases of blood, gastrointestinal tract, or skin)
? Malignancy
? Local
? Aphthae
? Drugs.
The different diagnosis for oral cancer includes other malignant diseases such as lymphomas, sarcomas and metastases, which grow rapidly as opposed to a typical OSCC; and chronic infections such as syphilis, tuberculosis, or histoplasmosis.
Other cancer features may include ear pain, bleeding, tooth mobility, problems in breathing, difficulty in speech, dysphagia and problems using prostheses, trismus, and paraesthesia or hypoaesthesia. Symptoms such as ear pain, voice changes, and dysphagia are more common in tumours at the tongue base. Occasionally, patients present with cervical lymphadenopathy. In terminal stages, skin fistulas, bleeding, severe anaemia and cachexia may develop.
References available on request