Oral cancer — Frequently asked questions (FAQ)
1) What does this algorithm cover?
This algorithm guides risk assessment, opportunistic screening, examination of the oral cavity and referral of lesions suspicious for oral cancer. It incorporates the identification of risk factors, warning symptoms, potentially premalignant lesions such as leukoplakia and erythroplakia, and criteria for biopsy and specialist referral.
2) Who should be considered at increased risk of oral cancer?
Individuals should be considered at increased risk when they have one or more factors such as age over 40 years, male sex, tobacco use and excessive alcohol consumption. The risk is particularly increased when tobacco and alcohol exposure occur together.
3) Should opportunistic screening for oral cancer be performed?
Yes. In higher-risk individuals, opportunistic screening through systematic examination of the oral cavity may be performed during a clinical consultation. Where applicable, it should be repeated periodically, for example every 2 years, in accordance with local recommendations and referral pathways.
4) Which symptoms should prompt examination of the oral cavity?
Assessment should be prompted by symptoms such as persistent oral pain, ulcers that do not heal, changes in the colour or surface of the oral mucosa, swellings, unusual enlargement, paraesthesia affecting the oral or perioral region, and unexplained symptoms referred to the oral cavity.
5) How should examination of the oral cavity be performed?
The examination should be systematic and include inspection of the lips, buccal mucosa, gingivae, floor of the mouth, palate, tonsils and tongue, including its lateral borders and ventral surface. Suspicious areas should be palpated, and an extraoral examination of the head and neck should be performed, including assessment of the cervical lymph node chains.
6) What is leukoplakia?
Leukoplakia is a non-scrapable white plaque that cannot be classified as another disease. Before making this diagnosis, causes such as candidiasis, oral lichen planus and keratotic lesions caused by chronic trauma should be excluded. Definitive diagnosis is histopathological.
7) Which features increase the malignant risk of leukoplakia?
The risk is higher when the lesion persists over time, is located in high-risk areas such as the floor of the mouth, ventral surface of the tongue, hard palate or oropharynx, or has a non-homogeneous appearance with red areas, nodularity, an exophytic surface or a diameter greater than 2 cm.
8) What is erythroplakia?
Erythroplakia is a red patch or plaque of the oral mucosa, usually soft, that cannot be attributed to another cause. Although less common than leukoplakia, it has a greater malignant potential and should be regarded as a high-risk lesion.
9) Which lesions should be considered suspicious for malignancy?
Suspicious lesions include ulcers that fail to heal within 2–3 weeks without an obvious traumatic cause, indurated or infiltrative lesions, progressive swellings, submucosal masses, exophytic or ulceroproliferative lesions, persistent mucosal changes and unexplained cervical lymphadenopathy.
10) When is biopsy indicated?
Biopsy is indicated for lesions suspicious for malignancy or potentially premalignant lesions, such as leukoplakia or erythroplakia, after obvious benign causes have been excluded. In primary care, the usual step is to refer the patient for specialist assessment and histopathological confirmation.
11) What should be done following a diagnosis of a potentially malignant lesion or oral cancer?
Following histological diagnosis of a potentially malignant lesion or oral cancer, the patient should be referred to a hospital specialist service, preferably through a pathway appropriate to the severity and level of clinical suspicion, for staging, treatment and specialist follow-up.
