Signs and symptoms of oral cavity or oropharyngeal cancer

Possible signs and symptoms of these cancers can include:

• a sore in the mouth that does not heal (most common symptom)
• pain in the mouth that doesn't go away (also very common)
• a persistent lump or thickening in the cheek
• a persistent white or red patch on the gums, tongue, tonsil, or lining of the mouth
• a sore throat or a feeling that something is caught in the throat that doesn't go away
• trouble chewing or swallowing
• trouble moving the jaw or tongue
• numbness of the tongue or other area of the mouth
• swelling of the jaw that causes dentures to fit poorly or become uncomfortable
• loosening of the teeth or pain around the teeth or jaw
• voice changes
• a lump or mass in the neck
• weight loss
• persistent bad breath

Many of these signs and symptoms can also be caused by less serious, benign problems, or even by other cancers. It is important to see a doctor or dentist if any of these conditions lasts more than 2 weeks. Remember, the sooner you receive a correct diagnosis, the sooner you can start treatment and the more effective your treatment will be.

If you have any of the signs or symptoms that suggest cancer may be present, your doctor may recommend additional tests.

Tests used to find oral cavity or oropharyngeal cancers

Medical history and physical exam

As a first step, your doctor will probably ask you questions about symptoms, possible risk factors, and any other medical conditions you may have.Your doctor will physically examine you to look for possible signs of an oral or oropharyngeal cancer (or pre-cancer). These could be bumps or other abnormal areas on your head, face or neck, or problems with the nerves of the face and mouth. The doctor will look at the entire inside of your mouth, and may feel around in it with a gloved finger.

If there is a reason to think you might have cancer, your doctor will refer you to a doctor who specializes in these cancers, such as an oral and maxillofacial surgeon or a head and neck surgeon (also known as an ear, nose, and throat [ENT] doctor or an otolaryngologist). This specialist will probably do other tests.

Complete head and neck exam

The ENT doctor will pay special attention to the head and neck area, being sure to look and feel for any abnormal areas. This exam will include the lymph nodes of the neck, which will be felt carefully for any signs of cancer.

Because the oropharynx is deep inside the neck and some parts are not easily seen, the doctor may use mirrors or special fiber optic scopes (flexible, lighted, narrow tubes inserted through the mouth or nose) to examine these areas.

Indirect pharyngoscopy and laryngoscopy: These procedures use small mirrors placed at the back of the mouth to look at the throat, base of the tongue, and part of the larynx (voice box).

Direct laryngoscopy and nasopharyngoscopy: A fiber optic scope (called an endoscope) is used to look at areas that can't easily be seen with mirrors, such as the region behind the nose (nasopharynx) and the larynx.

Panendoscopy (including laryngoscopy, esophagoscopy, and possible bronchoscopy): If the chances that a head or neck cancer are present are high, the entire area may be examined more thoroughly, including the oral cavity, oropharynx, larynx, esophagus (tube leading to the stomach), and the trachea and bronchi (breathing passageways that lead to the lungs). This exam, called a panendoscopy, is done in the operating room, while you are under general anesthesia (in a deep sleep). This allows these areas to be looked at more closely.

During this exam, the doctor will use endoscopes to look at the throat, larynx, and esophagus, and possibly the windpipe (trachea) and bronchi. If any tumors are found, the doctor will remove samples to look at under a microscope.

Types of specimens used to diagnose oral cavity and oropharyngeal cancer

The actual diagnosis of oral and oropharyngeal cancers can only be made by a biopsy. A sample of tissue or cells is always needed to confirm that cancer is really present before starting treatment. Several sample procedures may be used, depending on each individual case.

Exfoliative cytology

In this technique, the doctor scrapes a suspicious area and smears the collected tissue onto a glass slide. The sample is then stained with a dye so the cells can be seen under the microscope. Then, if any of the cells look abnormal, the area can be biopsied. The advantage of this technique is that it is easy, and even minimally abnormal-looking areas can be examined. This can make for an earlier diagnosis and a greater chance of cure if there is cancer. But this method does not detect all cancers. Sometimes it's not possible to tell the difference between cancerous cells and abnormal but non-cancerous cells (dysplasia) with this approach, so a biopsy would still be needed.

Incisional biopsy

This can be done either in the doctor's office or in the operating room, depending on the location of the tumor and how easy it is to get a good tissue sample. If it can be done in the doctor's office, the area around the tumor will be numbed before the biopsy is taken. When the biopsy can't be done in the doctor's office because the tumor is deep inside the mouth or throat, it is done in the operating room with the patient under general anesthesia (in a deep sleep). The surgeon uses special instruments through an endoscope to remove small tissue samples.

Fine needle aspiration biopsy

For this test, the doctor uses a very thin needle attached to a syringe to draw (aspirate) some cells from a mass (tumor or lump). These cells are then looked at under a microscope to see if cancer is present. Fine needle aspiration (FNA) biopsy is not used to find the cause of a lesion in the mouth or throat, but is sometimes used when a patient has a neck mass that can be felt or seen on a CT scan. FNA can be helpful in several different situations, such as:

Finding the cause of a new neck mass: An FNA biopsy is sometimes used as the first test for someone with a newly found neck mass. The FNA may show that the neck mass is a benign lymph node that has grown in reaction to a nearby infection, such as a sinus or tooth infection. In this case, treatment of the infection is all that is needed.

The FNA may find a benign (non-cancerous) fluid-filled cyst that can be cured by surgery. Even when the FNA results are benign, if the patient has symptoms suggesting cancer, more tests (such as pharyngoscopy and panendoscopy) are needed.

If the FNA finds cancer, the doctor looking at the sample can usually tell what type of cancer it is. If the cells seen look like a squamous cell cancer, more exams will be done to search for a cancer in the mouth and throat. If the FNA shows a different type of cancer, such as lymphoma or a cancer that has spread to a lymph node in the neck from another organ (like the thyroid, stomach, or lungs) more tests will be done to find it, and specific treatment for that type of cancer will be given.

Learning the extent of a known cancer: FNA is often done in patients known to have oral or oropharyngeal cancer to find out whether or not the cancer has metastasized, or spread, to lymph nodes in the neck. This information will help the doctor decide if more treatment (such as a neck dissection or radiotherapy) is needed.

Seeing if cancer has come back after treatment: FNA may be used in patients whose cancer has been treated by surgery and/or radiation therapy, to find out if a new neck mass in the treated area is scar tissue or a cancer that has come back.

Imaging tests

For oral and oropharyngeal cancers, imaging tests are often used to help determine the stage (extent) of the cancer once it has already been found. They may also help a doctor make a diagnosis if there is some question about whether a person has cancer.

Chest x-ray

An x-ray of your chest may be done to see if the cancer has spread to your lungs. Unless your cancer is far advanced, it is not likely that it will have spread. This x-ray is most often done in an outpatient setting. If the results are not normal, your doctor may order a computed tomography (CT) scan or other test to look at your lungs in more detail.

Computed tomography scan

The computed tomography (CT) scan is a special kind of x-ray that gives detailed, cross-sectional images of your body. Instead of taking one picture, like a standard x-ray, a CT scanner takes many pictures of the part of your body being studied as it rotates around you. A computer then combines these pictures into images of slices of the part of your body being studied.

For some scans, you may be asked to drink a contrast solution. This helps better outline the intestine, so that tumors can be seen more clearly. This is commonly used when a CT scan is used to look at the abdomen or pelvis.

After the first set of pictures is taken you may also receive an intravenous (IV) injection of a contrast dye. This can also help tumors be seen more clearly. A second set of pictures is then taken.

The injection may cause some flushing (a feeling of warmth, especially in the face). Some people are allergic and get hives. Rarely, more serious reactions like trouble breathing or low blood pressure can occur. Be sure to tell the doctor if you have any allergies or have ever had a reaction to any contrast material used for x-rays.

CT scans take longer than regular x-rays. You need to lie still on a table while they are being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring you have to lie in while the pictures are being taken.

The CT scan provides information about the size, shape, and position of any tumors, and can help find enlarged lymph nodes that might contain cancer.

Magnetic resonance imaging scan

Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed by the body and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. This produces cross-sectional slices of the body like a CT scanner, but it can also show slices (views) from several angles. As with CT scans, a contrast material might be injected, but this is done less often.

MRI scans take longer than CT scans -- often up to an hour. During the scan, you need to lie still inside a narrow tube, which is confining and can upset people who have claustrophobia (fear of enclosed spaces). The machine also makes clicking and buzzing noises that disturb some people. Some places provide headphones with music to block this noise out.

MRI scans are very useful in looking at the brain and spinal cord. They are used less often for oral and oropharyngeal cancer.

Positron emission tomography scan

Positron emission tomography (PET) scans involve injecting glucose (a form of sugar) that contains a radioactive atom into the blood. Because cancer cells in the body are growing rapidly, they absorb large amounts of the radioactive sugar. A special camera can then create a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it provides helpful information.

This test can be useful in seeing whether the cancer has spread to lymph nodes, but it may not take the place of removing lymph nodes to see if they contain cancer. PET scans are also useful when your doctor finds cancer in a lymph node, but doesn't know where the cancer started. PET can also be used when the doctor thinks the cancer has spread, but doesn't know where. Devices that combine a CT scan and a PET scan can pinpoint tumors even better.

Barium swallow

A barium swallow (also known as an upper GI series) can be used to examine the lining of the upper part of the digestive system, especially the esophagus (the tube connecting the throat to the stomach). Patients getting this test first drink a solution of barium, a chalk-like drink with the consistency of a milk shake. X-ray pictures are then taken.

Because patients with oral and oropharyngeal cancers are at risk for cancer of the esophagus, your doctor may order this test to check for this cancer. It is also useful to see if the cancer is interfering with normal swallowing.

Other tests

Blood tests

No blood tests can diagnose tumors of the oral cavity or oropharynx. However, your doctor may order routine blood tests to help determine your overall health, especially before treatments such as surgery. Such tests can help diagnose malnutrition, low red blood counts (anemia), liver disease, and kidney disease. Blood tests can also suggest the possibility of cancer spread to the liver or bone. When this occurs, more testing is needed.

Dental exam

When radiation therapy will be used as part of the treatment, it is likely you will be asked to see a dentist, who will help with preventive dental care and removing teeth, if necessary, before radiation treatment is started.

If the cancer is located in the jaw or roof of the mouth, a dentist with special training (a prosthodontist) may be asked to evaluate you. This dentist can make replacements for missing teeth or other structures of the oral cavity to restore your appearance, comfort, and ability to chew, swallow, and speak after treatment. If part of the jaw or roof of the mouth (palate) will be removed with the tumor, the prosthodontist will work to ensure that the replacement artificial teeth and the remaining natural teeth fit together correctly. This can be done with dentures, other types of prostheses, or dental implants.

Last Medical Review: 09/24/2009
Last Revised: 09/24/2009