Physical exam: A doctor will examine the lips and mouth for abnormalities such as sores and white patches (also known as leukoplakia).
Biopsy: If a suspicious area is found, a sample of cells will be removed and sent to a lab for testing. The pathologist analyses the cells for cancer. Sometimes they may detect precancerous changes which can indicate a future risk of cancer.
Endoscopy: The clinician will inspect your throat (also referred to the nasopharynx, oropharynx and laryngopharynx) with a small, flexible camera under local anesthesia. It is primarily done to look for signs that cancer has spread beyond the mouth.
Radiological Tests: The doctor may start with simple tests such as neck ultrasound and dental CT. More advanced tests such as MRI may be used for the staging of the tumour which helps decide the treatment protocol. Imaging tests such as X-ray, CT, MRI and positron emission tomography (PET) are done to look for spread of the cancer beyond the mouth.
The management of cancer depends on various factors, including the stage of the cancer, additional health issues, age etc. Surgery, radiation or chemotherapy may be used.
Targeted therapy: Targeted drugs block specific pathways in cancer cells to stop their growth. These drugs are used alone or in combination with chemotherapy or radiotherapy. Side effects: These depend on the agent used but common side effects include skin rash, itching, headache, diarrhoea and infections.
Surgery: The aim of surgery to remove all of the cancer cells. This includes both the tumour and a margin of healthy tissue that surrounds it. Early-stage and smaller cancers may be removed by minor surgery but large tumours require more-extensive procedures such as removing a part of the jawbone or tongue. If there is spread to lymph nodes, especially in the neck, those will be removed as well. [i] Post the operation a reconstruction procedure is conducted using tissue flaps and skin grafts. These are done so that the patient can regain the ability to talk and eat. Side effects: Bleeding, infection, post-surgery a tube will be needed for feeding until reconstruction is done, voice and speech will be affected.
Radiotherapy: Radiation therapy uses high-energy beams to kill cancer cells and may be delivered from a machine outside the body (external beam radiation), or with radioactive seeds placed near the tumour (brachytherapy). Radiation therapy is often used after surgery to clear any cancer cells that may have been left behind. Side effects: Damage to the jaw bone, dry mouth, scarring, swelling, problems with swallowing, tooth decay etc.
Chemotherapy: Chemotherapy uses chemical agents to kill cancer cells. These drugs can be given alone, in combination with other drugs or in combination radiotherapy. It is sometimes called biologic. Side effects: Side effects depend on the agent used but commonly include nausea, vomiting, hair loss, kidney damage, nerve damage, tingling sensation, lowered immunity, soreness of palms and feet, numbness, skin peeling etc.
Immunotherapy: This form of therapy uses your immune system to fight cancer cells. It is commonly used for advanced cancer especially in those not responding to regular treatment.
Palliative Care: The diagnosis and treatment of oral cancer can have a deep psychological and physical effect on patients. Palliative care specialists help patients with these symptoms and hence help in rehabilitation post-surgery. In some cases, distress management, through a professional psychological counsellor, may be required to help the patient cope with cancer.
Sources: Mayo Clinic; European Society of Medical Oncology (ESMO); Cancer Treatment Centres of America;