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Review
. 2008 Jun;54(6):870-5.

Screening for and diagnosis of oral premalignant lesions and oropharyngeal squamous cell carcinoma: role of primary care physicians

Joel B Epstein  1 , Meir Gorsky, Robert J Cabay, Terry Day, Wanda Gonsalves
Affiliations
Review

Screening for and diagnosis of oral premalignant lesions and oropharyngeal squamous cell carcinoma: role of primary care physicians

Joel B Epstein et al. Can Fam Physician. 2008 Jun.

Abstract
in English, French

OBJECTIVE; To describe the role that primary care physicians can play in early recognition of oral and oropharyngeal squamous cell carcinomas (OOSCCs) and to review the risk factors for OOSCCs, the nature of oral premalignant lesions, and the technique and aids for clinical examination.

Quality of evidence: MEDLINE and CANCERLIT literature searches were conducted using the following terms: oral cancer and risk factors, pre-malignant oral lesions, clinical evaluation of abnormal oral lesions, and cancer screening. Additional articles were identified from key references within articles. The articles contained level I, II, and III evidence and included controlled trials and systematic reviews.

Main message: Most OOSCCs are in advanced stages at diagnosis, and treatment does not improve survival rates. Early recognition and diagnosis of OOSCCs might improve patient survival and reduce treatment-related morbidity. Comprehensive head and neck examinations should be part of all medical and dental examinations. The head and neck should be inspected and palpated to evaluate for OOSCCs, particularly in high-risk patients and when symptoms are identified. A neck mass or mouth lesion combined with regional pain might suggest a malignant or premalignant process.

Conclusion: Primary care physicians are well suited to providing head and neck examinations, and to screening for the presence of suspicious oral lesions. Referral for biopsy might be indicated, depending on the experience of examining physicians.

OBJECTIF: Décrire le rôle éventuel du médecin de première ligne dans la détection des épithéliomas malpighiens spinocellulaires oraux et oro-pharyngés (ÉMSOO) et revoir les facteurs de risque associés, la nature des lésions orales précancéreuses, et les techniques et outils facilitant l’examen clinique.

QUALITÉ DES PREUVES: On a répertorié MEDLINE et CANCERLIT à l’aide des rubriques suivantes: oral cancer and risk factors, pre-malignant oral lesions, clinical evaluation of abnormal oral lesions, et oral cancer screening. Des articles additionnels ont été identifiés à partir des références-clés des articles. Les articles présentaient des preuves de niveaux I, II et III, et incluaient des essais randomisés et des revues systématiques.

PRINCIPAL MESSAGE: La plupart des ÉMSOO sont à un stade avancé au moment du diagnostic, et le traitement n’améliore pas le taux de survie. Une détection et un diagnostic précoces pourraient améliorer la survie et réduire la morbidité associée au traitement. Un examen minutieux de la tête et du cou devrait faire partie de tout examen médical ou dentaire. La tête et le cou devraient être inspectés et palpés à la recherche d’ÉMSOO, notamment chez les patients à risque élevé et en présence de symptômes suspects. Une tuméfaction cervicale ou une lésion orale accompagnée d’une douleur dans la région pourrait suggérer une lésion cancéreuse ou précancéreuse.

CONCLUSION: Le médecin de première ligne est bien placé pour faire l’examen de la tête et du cou, et pour détecter des lésions orales suspectes. Une biopsie pourra être demandée, selon l’expérience du médecin examinateur.

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Figures

Figure 1
Figure 1
Irregular leukoplakia (verrucous leukoplakia) with squamous cell carcinoma in the upper right vestibule where a mass can be seen, and dysplasia in the remaining leukoplakia
Figure 2
Figure 2
Asymptomatic red (erythroplakic) lesion involving the soft palate and tonsillar fossa, diagnosed as squamous cell carcinoma
Figure 3
Figure 3
Mixed red and white lesion on the floor of the mouth, a high-risk site for cancer
Figure 4
Figure 4
Oral, head, and neck examination
See this image and copyright information in PMC

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