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Diagnosis Of Oral Cancer
By peace | July 7, 2006
You will probably begin by seeing your family doctor (general practitioner) or dentist, who will examine you and arrange for you to have any further tests that are necessary. If you are seeing the dentist for a routine checkup, be sure to ask him or her about any changes in the mouth you have had for more than a couple of weeks. You will need to be referred to hospital for these tests and for specialist advice and treatment, normally from an oral and maxillofacial surgeon who is qualified as a dentist and a doctor.
At the hospital the specialist will ask you about your medical background before examining your mouth, throat and neck using small mirrors and a bright light if necessary.
Sometimes the doctor will examine the lump or raw area with a gloved finger or a small mirror. This can be uncomfortable and you may be given a local anaesthetic lozenge to suck, which numbs the mouth for a few minutes, or an anaesthetic spray. If you do have a local anaesthetic to your throat you shouldn’t eat or drink anything for about an hour afterwards until your throat has lost the numb feeling, otherwise there is a risk of things going down the wrong way when you swallow.
Occasionally the doctor will pass a very thin flexible tube with a light at the end (nasendoscope) into the nose in order to get a better view of the back of the mouth and throat. This may be uncomfortable but only takes a few minutes.
You will probably also have a blood test and a chest X-ray to check your general health.
The doctor can only make a definite diagnosis by looking at a sample of cells from the suspected cancer under a microscope (biopsy). The sample of cells can usually be obtained by first numbing the affected area with some local anaesthetic and then removing a small piece of the suspected cancer.
If there is a strong possibility of cancer, the specialist will want to examine your whole mouth and throat area, so it may be necessary for you to have a general anaesthetic. Usually this is done on a day visit, with no need to spend the night in hospital.
Further tests
If the sample shows you have cancer your doctor may want to do some further tests to find out the extent of the cancer. These results help the doctor decide which is the best type of treatment for you.
X-ray
Sometimes the doctor may want to take X-rays of your mouth and throat to see if there are any other lumps and swellings, or to check whether any bones in your face or neck have been affected. If the cancer is at the bottom of the mouth an X-ray known as an orthopantomogram (OPG) may be needed to look at the jaw and the teeth.
A chest X-ray will be taken to check whether the cancer has spread to the lungs.
CT (CAT) scan
In this scan, several small X-rays are taken of the area in question and fed into a computer. This builds up a detailed picture of the size and position of the cancer.
To increase the detail shown in the pictures, a dye may be injected into a vein, usually in your arm. For a few minutes, this may make you feel hot all over. The scan is painless but it will mean lying still for about 30-40 minutes.
You will probably be able to go home as soon as the scan is over.
Magnetic resonance imaging (MRI or NMR scan)
This test is similar to a CT scan, but uses magnetism instead of X-rays to build up cross-sectional pictures of your body.
As with CT scans, some people are given an injection of dye into a vein in the arm to improve the image.
During the test you will be asked to lie very still on a couch inside a long chamber for up to an hour. This can be unpleasant if you don’t like enclosed spaces: if so, it may help to mention this to the radiographer. The MRI scanning process is also very noisy, but you will be given ear plugs. You can usually take someone with you into the room to keep you company.
The chamber is a very powerful magnet, so before entering the room you should remove any metal belongings. People who have cardiac monitors, pacemakers or surgical clips cannot have an MRI because of the magnetic fields.
Radioisotope bone scan
A radioisotope scan may be done for some tumours, to see if the cancer has spread into nearby bones such as the jaw bone. For this test a tiny amount of radioactive dye is injected into a vein, usually in the arm, and the patient is then scanned by a machine which measures minute amounts of radioactivity.
The doctor can tell if there has been any spread of the cancer, as a larger amount of radioactivity is found in areas of bone affected by cancer cells.
After the dye has been injected, you will have to wait for about an hour before having the scan, so you may want to take a magazine or book with you to pass the time.
The test does not make you radioactive as the amount of radioactivity used is so small. The radioactivity disappears from your body within a few hours.
Most people are able to go home once their scan is over. It will probably take several days for the results of your tests to be ready, and this waiting period will obviously be an anxious time for you. It may help if you can find a close friend or relative with whom to talk things over.
Apart from the lymph glands in the neck, cancers of the mouth and throat do not usually spread to other parts of the body. For this reason, further tests which check whether the cancer has spread beyond the head and neck may not be necessary. Should you need any further tests, your doctor will discuss them with you.
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