Mouth Cancer

Question 1

What are the next steps once patient with worrying features in mouth is referred?

Answer 1

• biopsy (local anaesthetic in mouth but potentially general with oropharyngeal)
• imaging
• diagnosis
• treatment
  
  • oral/mouth: surgery +/- chemotherapy
  • oropharyngeal: chemotherapy
• follow up for 5 years

Question 2

What are worrying features for mouth cancer?

Answer 2

• painless ulcers
• high risk sites- floor of mouth/lateral tongue
• duration
• size
• bone involvement
• spread to draining lymph nodes
• perineural spread
• vascular invasion: only picked up on CT or MRI

Question 3

As a doctor what should you do if you see worrying features in the mouth?

Answer 3

• photograph/document in notes
• ask a dentist to eliminate trauma
• review within 2 weeks
• refer using urgent pathways - SIGN (for Scotland) or NICE (rest of UK)
  
  • oral/mouth to maxillofacial
  • oropharyngeal to ENT

Question 4

Is oral squamous cell carcinoma preventable?

Answer 4

Yes! Largely
Stop risk factors e.g. smoking and alcohol

early diagnosis associated with better outcomes

Question 5

When do ulcers and red/white patches require urgent referral for biopsy?

Answer 5

If they are presented for more than 3 weeks (particularly if ulcers aren’t sore)

If you don’t think the red/white patches are malignant but have the potential/potentially is malignant refer for sooner referral so patients seen to within 6 week period

If you think its malignant - urgent referral - patient seen within 2 week period