New Technologies
New Technology - VELscope Oral Cancer Screening
| Figure 1. VELscope examination. The clinician shines the blue excitation light into the patient’s oral cavity and looks through the Handpiece. | |
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Figure 2. Illustration of VELscope’s principle of operation. |
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Figure 3. Representative examples of direct visualization under both white light and VELscope examination - photos courtesy of the British Columbia Oral Cancer Prevention Program. |
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No apparent lesion
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Normal fluorescence pattern |
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Visible leukoplakia
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Irregular, dark area visible under fluorescence visualization. Biopsy-confirmed severe dysplasia |
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| No apparent lesion | Irregular, dark area visible under fluorescence visualization. Biopsy-confirmed Carcinoma in Situ (CIS) |
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The following sections are from the Oral Cancer Foundation. We encourage you to visit their award winning, informative website and become a member of the Oral Cancer Foundation: www.oralcancerfoundation.org
Statistical Information
Every hour of every day in America someone dies of Oral Cancer. Oral Cancer is the sixth most common diagnosed form of cancer in the United States. Presently 30,000 patients are diagnosed annually with oral cancer. The 5-year survival rate is only 50%, accounting for 8,000 deaths each year. Oral Cancer risk factors include tobacco use, frequent and/or excessive alcohol consumption, a compromised immune system, past history of cancer, and the presence of the HPV virus. Recently however 25% of all newly diagnosed cases have been in patients under the age of forty with none of the known risk factors. Oral Cancer is one of the few cancers whose survival rate has not improved in the past 50 years. This is due primarily to the fact that during this time we have not changed the way we screen for this disease (a visual and manual examination of the oral cavity, head, and neck). Oral Squamous Cell Carcinomas (OSCC) make up over 90% of all oral cancers, and because of its appearance it has been difficult to differentiate from the other relatively benign lesions of the oral cavity. Early OSCC and potentially malignant lesions can appear as a white patch (leukoplakia, or as a reddened area (erythroplakia), or as a red and white (erythroleukoplakia) mucosal change under standard white light examination. However, these cellular changes are often non-detectable to the human eye (even with magnification eyewear) under standard lighting conditions. Often, when the lesion becomes visible, it has advanced to invasive stages. The high mortality rate is directly related to the lack of early detection of potentially malignant lesions. When diagnosis and treatment are performed at or before a Stage 1 carcinoma level, the survival rate is more than 90%. The cancers which have seen a major decline in the mortality rate have included colon, cervical, and prostate cancer and the primary reason is early detection and screening. We can make a difference in the oral cancer mortality rate.
Early screening, diagnosis, and treatment planning saves lives.
Risk Factors
Understanding the causative factors of cancer will contribute to prevention of the disease. Age is frequently named as a risk factor for oral cancer, as most of the time it occurs in those over the age of 40. The age of diagnosed patients may indicate a time component in the biochemical or biophysical processes of aging cells that allows malignant transformation, or perhaps, immune system competence diminishes with age. However, it is likely that the accumulative damage from other factors, such as tobacco use, are the real culprits. It may take several decades of smoking for instance, to precipitate the development of a cancer. Having said that, tobacco use in all its forms is number one on the list of risk factors. At least 75% of those diagnosed are tobacco users. When you combine tobacco with heavy use of alcohol, your risk is significantly increased, as the two act synergistically.Those who both smoke and drink, have a 15 times greater risk of developing oral cancer than others.
Tobacco and alcohol are essentially chemical factors, but they can also be considered lifestyle factors, since we have some control over them. Besides these, there are physical factors such as exposure to ultraviolet radiation. This is a causative agent in cancers of the lip, as well as other skin cancers. Cancer of the lip is one oral cancer whose numbers have declined in the last few decades. This is likely due to the increased awareness of the damaging effects of prolonged exposure to sunlight, and the use of sunscreens for protection. Another physical factor is exposure to x-rays. Radiographs regularly taken during examinations, and at the dental office, are safe, but remember that radiation exposure is accumulative over a lifetime. It has been implicated in several head and neck cancers. Biological factors include viruses and fungi, which have been found in association with oral cancers. The human papilloma virus, particularly HPV16 and 18, have been implicated in some oral cancers. HPV is a common, sexually transmitted virus, which infects about 40 million Americans. There are about 80 strains of HPV, most thought to be harmless. But 1% of those infected, have the HPV16 strain which is a causative agent in cervical cancer, and now is linked to oral cancer as well. There are other risk factors which have been associated with oral cancers, but have not yet been definitively shown to participate in their development. These include lichen planus, an inflammatory disease of the oral soft tissues. There are studies which indicate a diet low in fruits and vegetables could be a risk factor, and that conversely, one high in these foods may have a protective value against many types of cancer.
Signs & Symptoms
One of the real dangers of this cancer, is that in its early stages, it can go unnoticed. It can be painless, and little in the way of physical changes may be obvious. The good news is however, that your dentist or doctor can see or feel the precursor tissue changes, or the actual cancer while it is still very small, or in its earliest stages. It may appear as a white or red patch of tissue in the mouth, or a small indurated ulcer which looks like a common canker sore. Because there are so many benign tissue changes that occur normally in your mouth, and some things as simple as a bite on the inside of your cheek may mimic the look of a dangerous tissue change, it is important to have any sore or discolored area of your mouth, which does not heal within 14 days, looked at by a professional. Other symptoms include; a lump or mass which can be felt inside the mouth or neck, pain or difficulty in swallowing, speaking, or chewing, any wart like masses, hoarseness which lasts for a long time, or any numbness in the oral/facial region. Other than the lips, the most common areas for oral cancer to develop are on the tongue and the floor of the mouth. Individuals that use chewing tobacco, are likely to have them develop in the sulcus between the lip or cheek and the soft tissue (gingiva) covering the lower jaw (mandible). In the US, cancers of the hard palate are uncommon, though not unknown. The base of the tongue at the back of the mouth, and on the pillars of the tonsils, are other sites where it is commonly found. If your dentist or doctor decides that an area is suspicious, the only way to know for sure is to do a biopsy of the area. This is not painful, is inexpensive, and takes little time. It is important to have a firm diagnosis as early as possible. It is possible that your general dentist or medical doctor, may refer you to a specialist to have the biopsy performed. This is not cause for alarm, but a normal part of referring that happens between doctors of different specialties
Early Detection
Historically, it has been difficult to determine which abnormal tissues in the mouth are worthy of concern. The fact is, the average person routinely has conditions existing in their mouths that mimic the appearance of pre-cancerous changes, and very early cancers of the soft tissues. One study determined that the average dentist sees 3-5 patients a day who exhibit soft tissue abnormalities, most of which are benign in nature. Even the simplest things, such as a canker sore (herpes simplex), the wound left by accidentally biting the inside of your cheek, or sore spots from a poorly fitting prosthetic appliance or denture, all at first examination, share similarities with dangerous lesions. Some of these conditions cause physical discomfort, others are painless.