Mouth and Oropharynx Cancer Tests

Updated on 6/4/09

If you notice symptoms of mouth and oropharynx cancer, visit your doctor or dentist as soon as possible.

Your dentist or doctor will examine the inside of your cheeks and lips, the back of the throat, the floor and roof of the mouth, the tongue, and the lymph nodes in the neck. He or she will ask questions about your health and past illnesses and dental problems. Be sure to tell your doctor or dentist if you use or have used tobacco in any form.

Blood tests cannot diagnose cancer, but they may be used to find out more about your general health. If your dentist or doctor suspects cancer, he or she most likely will conduct further tests or refer you to another doctor for more tests.

Diagnostic tests

If your dentist or doctor finds an abnormal area or suspects cancer, he or she may first perform a noninvasive procedure to rule out cancer. If the test is inconclusive or shows the possibility of cancer, your dentist or doctor probably will perform a biopsy (removal of a small piece of tissue to examine under a microscope) or refer you to another doctor who will perform a biopsy.

Diagnostic tests for mouth and oropharynx cancer include:

Mucosal staining

A blue dye called toluidine blue O is applied to the area where cancer is suspected, and then you will rinse with a vinegar solution. If any blue areas remain, they will probably be investigated with a biopsy.

Chemiluminescent light

You will rinse your mouth with a mild acid solution, and then your mouth will be examined with a special light. Healthy cells do not reflect the light; cancerous cells do.

Biopsy

If your doctor or dentist is fairly certain a suspicious area is cancerous or precancerous, or if a diagnostic test is inconclusive or shows cancerous or precancerous cells, a biopsy probably will be performed. A biopsy is the removal of tissue to examine under a microscope.

If a biopsy shows you have mouth or oropharynx cancer, your doctor may ask you to have other tests, including an endoscopy, imaging tests, blood tests, and a complete physical exam to determine the cancer's stage (the size of the tumor and if the cancer has spread).

Brush biopsy or exfoliative cytology

This relatively new type of biopsy, which is painless and does not require anesthetic, is used to examine questionable areas. The dentist or doctor rotates a small stiff-bristled brush on the area, causing abrasion or pinpoint bleeding. Cells from the area are collected and examined under a microscope by a pathologist. If results are inconclusive or show cancer, an incisional biopsy will be completed.

Conventional incisional biopsy

This is the traditional, most common type of biopsy. The doctor or dentist surgically removes part or all of the tissue where cancer is suspected. Usually, this procedure is completed in the doctor's office or clinic under local anesthesia, similar to what is used in a dentist's office. But if the tumor is inside the throat, the biopsy may be done in an operating room with general anesthesia.

Fine-needle-aspiration biopsy (FNA)

This type of biopsy often is used if a patient has a lump in the neck that can be felt. In this procedure, a thin needle is inserted into the area. Then cells are withdrawn and examined under a microscope.

This procedure usually is done in the doctor's office. In many cases, no anesthesia is needed. Sometimes, an injection of local anesthetic, similar to what is used in a dentist's office, may be given in the area.

The needle is inserted into the nodule for about 10 seconds. It usually is inserted in two or three locations on the nodule. If lumps are too small to be felt, an ultrasound image may help guide the needle.

FNAs are safe, and the only complication is bleeding. This is not common, unless the patient has a bleeding disorder. Tell your doctor before the test if you have a bleeding disorder.

Patients who have been diagnosed with mouth or oropharynx cancer may have an FNA to find out if the cancer has spread to lymph nodes in the neck. Lymph nodes are small almond-shape glands that help fight infection or trap cancer cells.

Patients who have been treated for mouth or oropharynx cancer may have an FNA to determine if a new neck mass is cancer or scar tissue.

Imaging

Sometimes imaging tests, which give doctors a picture of the body, may be needed to find or diagnose the cancer. They may also be used to determine if cancer has spread.

Computer tomography scan

This test uses an X-ray machine and a computer to create detailed pictures of the body, including three-dimensional images. A CT scan determines the size, shape, and position of a tumor and whether the cancer has spread. Although a CT scan can detect the presence of a tumor, a biopsy is necessary to show if the tumor is cancerous.

You will lie on a table during the test, which takes a little longer than a regular X-ray. A large ringlike apparatus will move over your body to take images.

As part of a CT scan, you may swallow or receive an injection of a contrast dye. Some people experience heat or a flushed feeling, hives, or allergic reactions. If you have had an allergic reaction to contrast material used for X-rays, tell your doctor before a CT scan.

Positron emission tomography

This test uses a radioactive atom, which is included in liquid glucose (a type of sugar) that you swallow. Cancer cells absorb the radioactive sugar more than normal cells, and this makes them appear brighter than normal cells. A special camera, called a PET scanner, rotates around the body, taking images of the cells.

Sometimes PET and CT scans are used together.

Magnetic resonance imaging

Using magnetic fields and radio waves, this test creates computerized pictures of the body. You may be placed in a tube, which can feel confining to people who have a fear of enclosed spaces. The MRI is noisy while it is operating, and you will probably be given earplugs. You may receive an injection of contrast dye fluid. Like CT scans, MRIs are used to detect tumors, but a biopsy is required to diagnose cancer.

Chest and dental X-rays

X-rays may be used to find if cancer has spread to other parts of the body.

Barium swallow

Also called an upper GI series, for gastrointestinal tract, this set of X-rays of the esophagus and stomach may be used to look for other cancers and determine how well you swallow. First, you will drink a liquid that contains barium, which is a metallic compound, which coats the stomach. X-rays are then taken.

Endoscopy

Endoscopy is a procedure in which an endoscope (a long, thin tube with a light and lens through which the doctor can view organs and tissue) is inserted through the mouth, nose, or an incision. The endoscope also has a tool to remove tissue samples to be examined under a microscope.

This procedure is usually done in an outpatient clinic, a hospital, or the doctor's office. You will receive local anesthesia to help prevent gagging and discomfort. Sometimes a light sedative or general anesthesia is given as well.