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Becoming familiar with the early signs of mouth cancer

17 January 2024

During each check-up there are many assessments which must be undertaken to establish a patient’s oral health status. This should always involve examining patients’ dental and periodontal health, looking for signs of caries and gingivitis, and recommending preventative advice or treatments. However, for a thorough oral health check, clinicians should always look out for signs of oral cancer, and take action if they find anything suspicious.

Thorough examination

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To check for the early signs of oral cancer, it’s important to know what to look for. When oral cancer is identified in its early stages, treatment outcomes are far more successful, and less invasive when compared to later stages. Clinicians should check for mouth ulcers which have lasted longer than 3 weeks, red or white patches inside the mouth, and lumps in the mouth, lips, and throat. Clinicians should also ask patients if they have experienced any oral pain, or had difficulty swallowing or speaking.[i]

Visual oral examinations are essential for picking up on and monitoring changes in the mouth.[ii] However, if clinicians do not easily recognise the early-stage symptoms of mouth cancer – because they do not come across them regularly, or are unfamiliar with them – it can mean that signs go unnoticed, with both dentists and patients unaware of the problem until it becomes more severe.

Tests to aid in early-stage cancer assessments

Becoming familiar with the early signs of mouth cancer

In order to help pick up on the early signs of oral cancer, there are a number of adjunctive tests which can help clinicians to determine whether a lesion could be cancerous. Visual oral examinations are the gold standard, however, additional tests can be helpful when clinicians are unsure. Adjunctive tests include toluidine blue staining, autofluorescence, chemiluminescence, cytology, and narrow band imaging.

Toluidine blue stain is used to differentiate lesions which may be at a high-risk of progressing, helping to identify mouth cancer earlier, with a study[iii] showing its reliability. Autofluorescence is a rapid test used to identify a change in concentration of fluorophores, to aid in the recognition of malignant tissues.[iv] Chemiluminescence testing is use to distinguish between pre-cancerous and malignant lesions, as abnormal cells reflect the wavelength used – although research shows this is less effective than toluidine blue staining.[v] Cytology can be efficient at identifying early cancer, and is non-invasive. Cancerous cells can be more easily brushed away when compared to normal cells, which can then be analysed under a microscope.[vi] Narrow band imaging has been shown to be a promising adjunctive test, highlighting the surficial blood vessels as blue or brown in order to more easily identify abnormalities.[vii] Research suggests that, compared to the other adjuncts mentioned above, narrow band imaging is the most useful aid.ii

Diagnosis and pre-diagnosis

By identifying abnormalities early, and beginning treatment before the cancer reaches its later stages, clinicians avoid a ‘watch and wait’ approach, which can allow cancer to progress untreated until it is advanced enough for a biopsy. By adopting measures to aid initial assessments, when clinicians spot an abnormality, they may be able to pick up on mouth cancer more quickly. However, the previously mentioned adjunctive tools can be invasive and time consuming, potentially discouraging patients from accepting tests, and allowing more time for the cancer to progress. As such, it may be useful for clinicians to use a non-invasive and rapid test to quickly highlight areas of concern during check-ups. A point of care system would allow clinicians to quickly establish a patient’s risk level, to therefore inform further tests or referrals.

The BeVigilant™ OraFusion™ system from Vigilant Biosciences® is able to accurately determine the risk of oral cancer based on biomarkers found in saliva combined with lifestyle factors. Producing a result in just 15 minutes, the innovative system is ideal for detecting mouth cancer early, enabling clinicians to conduct a simple test each time they notice an unusual lesion. A German study[viii] reveals that clinicians use the system to test patients who they deem to be at a heightened risk of mouth cancer due to use of alcohol and tobacco as a tool to encourage behaviour changes. The test also provides a baseline test result for patients.

In order to identify the signs of oral cancer in its early stages, clinicians must be familiar with its symptoms, and should have the adjustive tools necessary to assist them in identifying unusual lesions. While there are a number of adjunctive tests that clinicians may use when assessing a lesion, these are often invasive, and can take time to produce results. As such, utilising innovative new tools to assist in the early detection of mouth cancer can help to improve outcomes, and reduce the impact of the required treatment for patients.

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[i] NHS. Symptoms of mouth cancer. Accessed Dec 23.

[ii] Kim, D.H., Kim, S.W., & Hwang, S.H. (2022). Efficacy of non-invasive diagnostic methods in the diagnosis and screening of oral cancer and precancer. Brazilian Journal of Otorhinolaryngology 88(6), 937-947.

[iii] Allegra E, Lombardo N, Puzzo L, Garozzo A. The usefulness of toluidine staining as a diagnostic tool for precancerous and cancerous oropharyngeal and oral cavity lesions. Acta Otorhinolaryngol Ital. 2009 Aug;29(4):187-90. PMID: 20161875; PMCID: PMC2816365.

[iv] Balasubramaniam AM, Sriraman R, Sindhuja P, Mohideen K, Parameswar RA, Muhamed Haris KT. Autofluorescence based diagnostic techniques for oral cancer. J Pharm Bioallied Sci. 2015 Aug;7(Suppl 2):S374-7. doi: 10.4103/0975-7406.163456. PMID: 26538880; PMCID: PMC4606622.

[v] Do Hyun Kim, Jaeyoon Lee, Min Hyeong Lee, Sung Won Kim, Se Hwan Hwang,

Efficacy of chemiluminescence in the diagnosis and screening of oral cancer and precancer: a systematic review and meta-analysis, Brazilian Journal of Otorhinolaryngology, Volume 88, Issue 3, 2022, Pages 358-364, ISSN 1808-8694,

[vi] Oral Cancer Foundation. Detailed Brush Cytology. Accessed Dec 23.

[vii] Zhang, You, et al. “Accuracy of narrow band imaging for detecting the malignant transformation of oral potentially malignant disorders: A systematic review and meta-analysis.” Frontiers in Surgery 9 (2023): 1068256.

[viii] DH Sabine Hiemer, Dresden. Wie bedeutsam ist Mundhöhlenkrebs-Prävention? 10/2023

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