Oral Cancer and Precancer: A Narrative Review on the Relevance of Early Diagnosis

Abstract

Oral cancer (OC) is an uncommon malignancy in Western countries, being one of the most common cancers in some high-risk areas of the world. It is a largely preventable cancer, since most of the different risk factors identified, such as tobacco use, alcohol consumption, and betel nut chewing, are behaviors that increase the likelihood of the disease. Given its high mortality, early diagnosis is of utmost importance. Prevention and the anticipation of diagnosis begin with identification of potentially malignant lesions of the oral mucosa and with local conditions promoting chronic inflammation. Therefore, every lesion must be recognized promptly and treated adequately. The clinical recognition and evaluation of oral mucosal lesions can detect up to 99% of oral cancers/premalignancies. As stated by the World Health Organization, any suspicious lesion that does not subside within two weeks from detection and removal of local causes of irritation must be biopsied. Surgical biopsy remains the gold standard for diagnosis of oral cancer. Adjunctive tools have been developed and studied to help clinicians in the diagnostic pathway, such as toluidine blue vital staining and autofluorescence imaging. In the near future other methods, i.e., identification of salivary markers of progression may help in reducing mortality due to oral cancer.

Keywords: oral cancer; oral health; oral healthcare; oral pathology; pre-malignancies; primary prevention; risk factors.

Figure 1

Female, 72 years—verrucous leukoplakia in the right buccal surface.

Figure 2

Male, 61 years—erythroplasic area in the posterior hard palate, revealed severe dysplasia and in-situ carcinoma in the histopathologic examination.

Figure 3

Male, 52 years—white reticular striae on the right cheek mucosa in a patient with oral lichen planus histopathologically confirmed.

Figure 4

Female, 53 years—multiple areas of erythroplakia with ulceration in the left buccal mucosa; diagnosis of invasive squamous cell carcinoma, originated in a chronic traumatic ulcer from self-biting.

Figure 5

Female, 25 years—area of leukoplakia in the right border of the tongue with histologically confirmed severe dysplasia.

Figure 6

Clinical flow-chart to guide the clinician in anticipating the diagnosis of oral cancer and other mucosal diseases and conditions.

Figure 7

Male, 72 years—wide corrugated leukoplakia of the left border of the tongue; the application of toluidine blue staining revealed several foci of suspect epithelial dysplasia or cancer.

Figure 8

Male, 80 years—Histologically confirmed T1 squamous carcinoma of the left border of the tongue, with loss of autofluorescence if inspected with use of a fluorescence imaging device.