How To Self Check For Oral Cancer
Oral Cancer Self-Examination
Oral cancer is something that most people don't think about, and, unfortunately, that includes many doctors and other health professionals. The death rate is higher for oral cancer than for other cancers, such as malignant melanoma, Hodgkin's lymphoma, cervical, and thyroid cancers.
This high death rate isn't because oral cancer is hard to catch or necessarily difficult to remove, but because it's often only caught when it has already reached an advanced stage.
Unfortunately, over-scheduled doctors are often too busy paying attention to the clock rather than to their patients. As a result, life-saving advice often isn't passed on. Too often, too, we as patients take a back seat and trust others with our health--and our lives.
Disclaimer: This article is in no way a substitute for regular dental check-ups and dental cleanings. However, it can help you keep watch for anything abnormal. Talk with your hygienist about oral cancer the next time you go in, and be sure s/he does oral cancer screenings at each six-month recall appointment. If your hygienist or dentist does not do oral cancer screenings as a matter of course, I believe that says something.
Screening for oral cancer takes roughly 2-3 minutes.
Oral Cancer Facts
Oral Cancer Photo
- Oral cancer is usually completely painless in its early stages.
- The death rate for oral cancer is higher than for malignant melanoma, Hodgkin's lymphoma, laryngeal cancer, cancer of the testes, cervical, or thyroid cancers.
- 8,000 people in the US will die of oral cancer this year.
- 40,000 Americans will be diagnosed with oral or pharyngeal cancer this year.
- Of the 40,000 people diagnosed, only 57% will still be alive in 5 years.
- Approximately $3.2 billion is spent on oral cancer in the US per year.
- Worldwide, 640,000 people will be diagnosed with oral cancer this year.
- Late stage discovery of oral cancer is not the exception; it is the "norm."
- Discovery of oral cancer at a late stage usually means it has already spread to the larynx and other secondary locations.
- When discovered in a late stage, the chance of a recurrence is multiplied 20-fold for the next 10 years.
- Anyone can get oral cancer, though factors such as smoking, chewing tobacco, chewing betel nut, heavy drinking (alcoholism), HIV/AIDS, HPV-16 (virus), and aging increase the likelihood.
- Screening for oral cancer takes roughly 2-3 minutes
Before diving into what's abnormal, it would be good to know what's normal so you can easily spot what's not.
Oral health is a complex subject, and I can't touch on everything here, but I will give you a good start and will cover all the key things to look out for.
Click on the links for images (they open in a new window.)
- Linea alba: Thin white lines inside your cheeks. This is a normal, hyper-keratinized area where you bite your cheeks, or where your cheeks rest between your teeth. The thin line will follow the biting plane, or the area where your teeth meet.
- Parotid papillae: (Stensen's duct) Inside your cheeks, toward the front, you might notice there is a bump of extra tissue by each corner of your mouth (you may sometimes bite them by accident.) These bumps are an outlet for the saliva glands and are completely normal, unless you notice they are particularly hard.
- Fordyce granules: These are tiny (1 mm) white or yellowish-white spots on the inside of your cheek or lips. These are just ectopic sebaceous glands and are completely normal.
- Swollen lymph nodes: These are often associated with illness or inflammation. If the swelling doesn't go away within a week or two, go in to get them checked out. Lymph nodes are located on the front and back of your neck, in front of and behind your ears, in the cheek area, and on top of the shoulders. When swollen, they will often be sensitive or sore, and may be visible and/or palpable (they feel hard or lumpy.)
- Exostoses: Extra bone growth (single = torus; plural = tori) is commonly found under the tongue along the bony ridge, or on the hard palate. These growths may bulge out, and are often rounded, sometimes involving a few bony lumps in one mass (lobulated.) The ones under the tongue are often bilateral (one on each side of the face) while the ones on the hard palate are often single or lobulated.
- Aphthous ulcer: Also known as a canker sore. This is a small to medium, round ulcer, usually with a white interior and bright red border. They are very sensitive and sore and can affect oral hygiene and eating. They should go away within a week or two. Taking zinc will help speed this process, and will also help prevent them. If the ulcer does not go away within two weeks, you should go to the dentist to have it examined.
- Circumvallate papillae: Large, protruding bumps (taste buds) on the back of the tongue, arranged in a line forming a "V" shape across the dorsum (top) of the tongue. These can also sometimes be seen when looking at the side of the tongue toward the base of the tongue in the back. They are the largest of the 4 types of taste buds, and most people have about 10-14 of them.
Symptoms of Oral Cancer
If you have any one of these symptoms, go to your dentist immediately.
When caught early, many oral cancers respond well to treatment.
- Sores that don't heal within 2 weeks (on your lip, side of your tongue, hard palate, gums, etc.).
- White, red, black, or discolored patches that persist (and are not listed as normal findings).
- Swelling, lumps, bumps, or odd new growths that are not bilateral (not found on both sides of the face).
- Excessive or spontaneous bleeding or puss coming out of a lesion or open sore.
- An open sore or lesion that persists for more than two than 2 weeks and turns and becomes painful.
- Difficulty or pain when swallowing.
- Difficulty moving the jaw or tongue, or pain when moving the jaw or tongue.
- A constant feeling that something has gotten stuck in your throat.
- Continuous pain in the ear or a persistent headache.
How To Examine & Palpate
Visual inspection - Methodically look around the mouth for oral cancer. You will need a mirror and a light you can shine into your mouth. If you find something that looks or feels abnormal, look for it on the other side of the mouth in the same area. Most of the time if something is paired, it's meant to be there.
Everything that you palpate you should be visually inspecting as well.
Bidigital palpation - Use your thumb and forefinger to feel for lumps and hardened areas on the lips, cheeks, and tongue.
Bimanual palpation - Use the forefinger of one hand and a few fingers of the other hand to feel for lumps and hardened areas used on the floor of the mouth.
How To Check For Oral Cancer At Home
1: Lips: Use bidigital palpation to feel your lips. Put your forefinger (pointer finger) with the pad against the inside of your lip, with your thumb directly lined up with it on the outside of the lip. Apply a moderate pressure, pressing the lip tissue between your finger and thumb. Feel for any hard lumps or areas of soreness.
2: Cheeks: Use bidigital palpation to feel your cheeks. Use the same method as described in #1. Feel for any hard lumps or areas of soreness.
3: Floor of the mouth: Use bimanual palpation to feel the floor of your mouth, which is the area under your tongue. Place the pointer finger of one hand under your tongue, while pressing up with the other hand on the outside of the jaw, directly opposite the finger in your mouth. Feel for any hard lumps or areas of soreness. Press firmly.
Video: How To Self Check For Oral Cancer
4: Tongue: Use bidigital palpation to feel your tongue. Stick your tongue out, and palpate the body of the tongue, feeling for lumps or areas of soreness.
5: Lateral tongue: Stick your tongue out, grab the tip, and look at each lateral side of your tongue for anything out of place. The sides of the tongue are the most common place to find oral cancer. Don't confuse varicosities (veins) for something abnormal in this area. There will also be circumvallate papillae, noted above in the "What's Normal" section.
6: Oropharynx: Stick your tongue out, say "Ahh" and look at your oropharyngeal area (your tonsil area) for any inflammation or sores. It is normal for some people's tonsils to have indented pockets in them; look for something that looks inflamed and out of place.
7: The roof of the mouth: Tilt your head back and look at the roof of your mouth. Look for sores and inflammation (make sure you rule out pizza burns and food trauma in this area.)
8: Gums: Pull out your lips and look very closely at your gums. Are there sores on your gums, or patches of discolored tissue? Do your gums bleed when you lightly touch them, or when they're not stimulated at all?