Lawrence Chow / ENT Doctor
Oral Cancer Diagnosis: A Comprehensive Guide to Key Examination Methods
Facing oral cancer, early diagnosis is the key to overcoming the disease. This article will detail a range of advanced examination methods, including nasal endoscopy, biopsy, fine needle aspiration cytology, microcytoscopy, X-ray, CT scan, magnetic resonance imaging (MRI), bone scan, and ultrasound or positron emission tomography (PET scan). These methods not only help doctors accurately assess the condition but also provide patients with the most suitable treatment plans. We will explain the principles, procedures, and applicable scenarios of these examinations one by one, helping you feel less confused when facing oral cancer.
Common diagnostic methods for oral cancer are briefly described as follows:
Nasal Endoscopy
The doctor will use a nasal endoscope to examine the patient’s oral cavity. The endoscope is equipped with a mirror and light, which reflects strong light into the patient’s mouth, allowing the doctor to clearly see any ulcers or masses in the patient’s oral cavity and throat.
Biopsy
The doctor will take a small amount of soft tissue from the suspected cancerous area and send it for laboratory testing. By examining these cell slices under a microscope, the presence of cancer cells can be determined.
Fine Needle Aspiration Cytology
The doctor uses a thin needle and syringe to extract cell samples from the mass in the patient’s oral cavity for testing. Fine needle aspiration cytology is a relatively simple and quick examination method, and the patient can leave immediately after the procedure.
Microcytoscopy
If a patient has precancerous cells and frequently undergoes biopsies, the doctor may recommend microcytoscopy as an alternative. The doctor applies a small amount of blue dye to the abnormal cells and then observes them under a microscope. This examination is painless, with only slight discomfort.
X-ray
X-rays of the face, neck, oral cavity, jaw, and lungs are taken to determine if the cancer cells have spread.
CT Scan and Magnetic Resonance Imaging (MRI or NMR)
CT scans or MRI can reveal details that X-rays or other examinations cannot. Both methods are quick and painless. However, patients with cardiac monitors, pacemakers, or any surgical clips cannot undergo MRI because the strong magnetic field can interfere with these devices.
Bone Scan
A bone scan can check if cancer cells have spread to the cheekbones near the oral cavity.
Ultrasound or Positron Emission Tomography (PET Scan)
Ultrasound or positron emission tomography (PET scan).
Before each examination, the ENT specialist will explain the reasons for the test, the procedure, and any potential risks to the patient. To accurately assess the patient’s condition and determine the appropriate treatment, the patient may need to undergo one or a combination of the above examinations.
For any ENT issues, please immediately contact ENT Head and Neck Surgery Centre for detailed evaluation by our ENT specialists (Tel: 3100 0555).
Source:
HK ENT Specialist Ltd.
ENT Head and Neck Surgery Centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Understanding Oral Cancer: Causes, Symptoms, and High-Risk Groups
What is Oral Cancer?
The oral cavity includes the lips, gums, tongue, floor of the mouth, hard and soft palate, uvula, tonsils, inner cheeks, pharynx, hypopharynx, salivary glands, and parotid glands. Cancerous cells can develop in any of these areas, forming oral cancer.
What Are the Causes and Symptoms of Oral Cancer?
Who is More Susceptible to Oral and Throat Cancer? How to Determine if Swollen Neck Lymph Nodes Signal Cancer?
What Causes Oral and Throat Cancer?
Like many cancers, the exact causes of oral and throat cancer are unclear. However, individuals who smoke or consume alcohol excessively have a higher risk. Pipe or cigar smokers also face increased risks of tongue and cheek cancers. In regions where betel nut chewing is common or diets lack fresh fruits and vegetables, the incidence of oral and throat cancers is similarly elevated.
Who is More Likely to Develop Oral and Throat Cancer?
- Smokers and heavy alcohol consumers
- Elderly males
- Individuals with diets low in fresh fruits and vegetables
- Note:Oral and throat cancers are not hereditary.
What Are the Symptoms of Oral and Throat Cancer?
- Ulcers or lumps in the mouth, throat, head, or neck
- Pain while eating or speaking
- Noisy breathing, slurred speech, or hoarseness
- Numbness in the mouth or lips
- Sudden loosening of teeth
- Persistent nasal congestion or nosebleeds
- Sore throat
- Ear pain
- Swelling or lumps in the mouth or neck
- Pain in the face or upper jaw
These are the most common symptoms of oral and throat cancer. Symptoms vary depending on the tumor’s location. For example, tongue cancer may cause slurred speech, while hypopharyngeal cancer can lead to hoarseness. Smokers and heavy drinkers may develop painless white or red patches in the mouth or on the tongue, which may bleed—a potential early sign of oral cancer.
Are Swollen Neck Lymph Nodes a Precursor to Oral Cancer?
It is not definitive. A thorough oral, throat, and neck examination is required for confirmation. While swollen neck lymph nodes are a common symptom of oral and throat cancers, they can also result from viral infections. The lymphatic system acts as the body’s defense against infections. Lymph nodes, distributed in the neck, armpits, and groin, produce white blood cells to combat pathogens. Swollen lymph nodes due to infections typically resolve with antibiotics. However, if a painless lump persists for 3–4 weeks, it may indicate cancer, as oral tumors often spread to neck lymph nodes.
How to Determine if Swollen Neck Lymph Nodes Signal Cancer?
Virus-related lymph node swelling usually subsides with antibiotics. If a painless lump persists for 3–4 weeks, seek immediate medical attention. The mouth and neck are interconnected, so oral tumors frequently metastasize to neck lymph nodes.
For any ear, nose, or throat concerns, contact ENT Head and Neck Surgery Centre for detailed evaluation by our ENT specialists (Tel: 3100 0555).
Source:
HK ENT Specialist Ltd.
ENT Head and Neck Surgery Centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Lip Cancer: Learn All About This “Silent Lip Killer”!
Case Study:
“Mr. Li, a 60-year-old long-term smoker, noticed a ‘recurrent small ulcer with scabbing’ on his lower lip over the past six months. Self-applied ointments were ineffective. The ulcer gradually enlarged, developing a cauliflower-like surface with mild pain and numbness. After examination, he was diagnosed with ‘lower lip squamous cell carcinoma.’ The treatment team formulated a plan involving surgical resection, radiotherapy, and lip reconstruction, successfully restoring his appearance and function.”
What is Lip Cancer?
Lip cancer (carcinoma of the lip) is a malignant tumor arising from the mucosa of the vermilion border. Over 90% are squamous cell carcinomas, while adenocarcinomas are rare. According to international cancer classification standards, lip cancer is distinct from oral cancer but is still categorized under head and neck tumors. It commonly occurs at the junction of the middle and outer third of the lower lip. The male-to-female incidence ratio is approximately 7:1, with peak prevalence between ages 50–70.
What Are the Symptoms of Lip Cancer?
Lip cancer progresses relatively slowly with late metastasis. However, delayed treatment can severely impact appearance and function. Common symptoms include:
- Early Stage:Small hard nodules, herpetic-like scabs, localized mucosal thickening, or leukoplakia, often mistaken for common ulcers or angular cheilitis.
- Progressive Stage:Ulcers expand into crater-like or cauliflower-shaped masses with bleeding, foul odor, and tingling, pain, or numbness around the lips or oral skin. Invasion of muscles or bones may cause difficulty opening the mouth or loose teeth.
- Late Stage:Metastasis to cervical lymph nodes or distant organs (lungs, liver, bones), posing life-threatening risks.
What Causes Lip Cancer?
The exact etiology remains unclear, but risk factors include:
- Chronic Irritation:Smoking, alcohol abuse, betel nut chewing, or foreign object biting causing repeated mucosal damage.
- UV Exposure:Outdoor workers with insufficient lip pigmentation face higher cancer risk due to prolonged sun exposure.
- Chemical Exposure:Long-term contact with substances like asphalt.
- Precancerous Lesions:Untreated leukoplakia, verrucous hyperplasia, or chronic ulcers.
- HPV Infection:Some cases correlate with human papillomavirus (HPV).
How is Lip Cancer Diagnosed?
- Physical examination of the lips and cervical lymph nodes, along with lifestyle inquiries (smoking, sun exposure).
- Biopsy of the lesion for pathological analysis to confirm cancer type and differentiation.
- CT/MRI to assess tumor depth and lymph node involvement.
- PET-CT to detect distant metastasis.
- TNM Staging:Based on tumor size (T), lymph node metastasis (N), and distant metastasis (M) to guide treatment planning.
What Are the Treatment Options for Lip Cancer?
- Surgery:Early cases undergo wide local excision (≥1 cm margins) with direct closure or local flaps. Advanced cases require neck lymph node dissection and possible partial jawbone resection, followed by reconstructive surgery using adjacent tissue or free flaps.
- Radiotherapy:External beam radiation for postoperative adjuvant therapy or inoperable patients, often using proton therapy for precision. Brachytherapy places radioactive sources directly on the lip to minimize tissue damage.
- Chemotherapy:For advanced or metastatic cases.
- Targeted & Immunotherapy:Agents targeting specific mutations (e.g., EGFR) or PD-1/PD-L1 inhibitors to improve survival in advanced stages.
Early detection is critical for effective treatment. If a lip ulcer persists for over 2 weeks, immediately contact ENT Head and Neck Surgery Centre for detailed evaluation by our ENT specialists (Tel: 3100 0555).
Source:
HK ENT Specialist Ltd.
ENT Head and Neck Surgery Centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
Tonsillar Cancer: Understand the Symptoms and Causes to Identify and Treat it Early!
Case Study:
“Mr. Cheng, a 55-year-old with a long-term history of smoking and heavy alcohol use, recently sought medical attention due to persistent throat pain and difficulty swallowing. An oral examination revealed swelling and ulceration on one of his tonsils. A biopsy confirmed a diagnosis of tonsil cancer. Unfortunately, due to late detection, the cancer had already metastasized to the cervical lymph nodes, requiring a comprehensive treatment plan involving surgery, radiotherapy, and chemotherapy.”
What is Tonsil Cancer?
Tonsil cancer is a malignant tumor arising from the tonsillar tissue, predominantly classified as squamous cell carcinoma and categorized as a type of head and neck cancer. In Hong Kong, most patients are males over 45 years old. Tonsil cancer is staged into four phases, but early symptoms are often nonspecific, leading to delayed diagnosis. Many patients are diagnosed at advanced stages (III or IV) when the cancer has already spread to other body parts.
Common Symptoms and Complications
Early Symptoms:
- Throat discomfort or mild pain, often mistaken for pharyngitis.
- Unilateral tonsil enlargement, surface roughness or ulceration, sore throat, and difficulty opening the mouth.
Progressive Symptoms:
- Severe throat pain, accompanied by tinnitus or pain on the same side of the ear, unrelieved by medication.
- Dysphagia, hoarseness, and painless neck lumps (indicating cervical lymph node metastasis).
- Rapid weight loss and breathing difficulties (due to airway obstruction by the tumor).
Late-Stage Symptoms:
- Distant metastasis to organs like the lungs or liver, leading to organ failure.
Causes and Risk Factors
- HPV Infection: 70% of tonsil cancers are linked to HPV, particularly high-risk strains like HPV-16.
- Chronic Inflammation: Recurrent tonsillitis may trigger cellular mutations.
- Smoking and Alcohol: Synergistic damage to mucosal tissues by tobacco and alcohol.
- Environmental Exposure: Long-term contact with chemicals or radiation.
- Immunosuppression: Higher risk in HIV/AIDS patients or organ transplant recipients.
Diagnostic Methods
- Laryngoscopy: Visual examination of tonsil morphology and cervical lymph nodes.
- Biopsy: Tissue sampling for pathological analysis.
- CT/MRI Scans: Assess tumor size and invasion extent.
- PET-CT Scans: Detect systemic metastasis.
- HPV Testing: Determine viral involvement to guide treatment.
Treatment Options
Treatment depends on cancer staging, typically involving a multimodal approach:
Surgery:
- Early-stage tumors: Tonsillectomy with preservation of surrounding functions.
- Advanced cases: Extensive resection with cervical lymph node dissection.
Radiotherapy:
- Effective for radiation-sensitive tumors (e.g., HPV-positive cases), used alone or post-surgery.
- Advanced techniques like Intensity-Modulated Radiation Therapy (IMRT) minimize damage to healthy tissues.
Chemotherapy and Targeted Therapy:
- For advanced or recurrent cases, combined with targeted drugs.
- Immunotherapy (e.g., PD-1 inhibitors): Shows significant efficacy in metastatic or recurrent tonsil cancer.
By raising awareness and promoting early detection, the prognosis of tonsil cancer can be significantly improved. Regular check-ups and lifestyle modifications are critical for high-risk populations.
Early detection is critical for effective treatment. Please immediately contact ENT Head and Neck Surgery Centre for detailed evaluation by our ENT specialists (Tel: 3100 0555).
Source:
HK ENT Specialist Ltd.
ENT Head and Neck Surgery Centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Tongue Cancer: Don’t Let Ulcers Become a Crisis — A Comprehensive Guide to Early Detection, Prevention, and Treatment
Case Study:
“Mr. Gu, a 52-year-old with a 20-year smoking history and chronic alcohol use, noticed an ulcer on the right side of his tongue six months ago. Initially mistaken for a common mouth ulcer, it failed to heal despite repeated topical treatments. The ulcer gradually enlarged, accompanied by swallowing pain and speech difficulties. Medical evaluation confirmed ‘tongue cancer’ via biopsy, with CT scans revealing cervical lymph node metastasis. Treatment involved partial tongue resection, neck lymph node dissection, radiotherapy, and chemotherapy. His condition is now stable, but long-term follow-up is required.”
What is Tongue Cancer?
Tongue cancer, the most common type of oral cancer, originates from squamous epithelial cells on the tongue’s surface. It is categorized as:
- Anterior two-thirds tongue cancer (oral tongue cancer):More common, with noticeable early symptoms.
- Base-of-tongue cancer (oropharyngeal cancer):Often diagnosed at advanced stages due to its hidden location.
Tongue cancer is highly invasive and prone to metastasis (especially to cervical lymph nodes), but early detection significantly improves cure rates.
Symptoms of Tongue Cancer:
Early signs may mimic common ulcers. Warning signals include:
- Non-healing oral ulcers:Ulcers or red patches persisting over two weeks.
- Pain or numbness:Discomfort while eating, speaking, or localized numbness.
- Abnormal lumps:Thickened tongue texture, hard masses, or cauliflower-like growths.
- Difficulty swallowing:Common in advanced stages.
- Unexplained bleeding:Easily triggered by touching ulcers or lumps.
- Worsening bad breath:Caused by tumor necrosis or infection.
- Neck lumps:Indicative of lymph node metastasis.
- Voice changes:Hoarseness if the tumor invades the tongue base.
Risk Factors:
- Smoking and alcohol:Synergistically increase risk by over 15-fold.
- HPV infection:Particularly HPV16, linked to base-of-tongue cancer (rising in younger patients).
- Poor oral hygiene:Chronic periodontitis, sharp teeth, or ill-fitting dentures causing mucosal damage.
- Dietary habits:Consuming extremely hot, pickled, or betel nut products.
- Genetics:Family history of oral cancer.
Diagnosis Methods:
- Physical examination:Visual inspection and palpation of lesions.
- Oral endoscopy:Detailed examination of the tongue and throat.
- Biopsy:Pathological analysis of tissue samples.
- Imaging:
- CT/MRI:Assess tumor size, depth, and lymph node involvement.
- PET-CT:Detect systemic metastasis.
- HPV testing:Guides treatment and prognosis; HPV-related tumors often respond better to therapy.
Treatment Approaches:
- Early-stage (I-II):
- Surgery:Primary treatment with tumor excision and safe margins. Minimally invasive robotic surgery for base-of-tongue cancer.
- Radiotherapy:For small, superficial tumors or patients unsuitable for surgery.
- Advanced-stage (III-IV):
- Combined therapy:Surgery + radiotherapy ± chemotherapy.
- Targeted therapy:Anti-EGFR agents (e.g., cetuximab).
- Immunotherapy:PD-1 inhibitors for recurrent/metastatic cases.
- Functional and aesthetic reconstruction:
- Flap reconstruction:Uses autologous tissue (e.g., forearm flap) to repair defects.
- Speech and swallowing rehabilitation:Post-surgical training.
- Follow-up and recurrence prevention:
- Regular oral exams and imaging (every 3-6 months for the first two years).
- Smoking/alcohol cessation and oral hygiene maintenance.
- HPV vaccination (preventive measure).
Early detection is critical! Seek immediate medical attention if tongue ulcers persist beyond two weeks. For ENT concerns, contact ENT Head and Neck Surgery Centre or call 3100 0555 for specialized care.
Source:
HK ENT Specialist Ltd.
ENT Head and Neck Surgery Centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Nasopharyngeal Cancer: An Introduction to the Causes and Risk Factors
Nasopharyngeal cancer is a type of cancer that begins in cells in the nasopharynx. This is the area in the upper part of your throat and behind the nose. It is also known as NPC and is the most common type of head and neck cancer in Hong Kong. The cells will then start to grow into nearby lymph nodes in the rear of the mouth and continue to spread into other parts of the body.
Have you started to think about the causes of Nasopharyngeal cancer?
Have you asked yourself if there are risk factors for this disease?
Can Nasopharyngeal cancer be prevented?
If so, then read the following article.
Causes of Nasopharyngeal Cancer
Scientists are not sure what exactly causes nasopharyngeal cancer. However, the cancer has been strongly linked to the Epstein-Barr virus (EBV).
Other risks are living or working in a region with an increased incidence of nasopharyngeal cancer, chronic sinusitis, prolonged exposure to nitrous oxide gas, and family history.
Risk Factors
The risk factors for nasopharyngeal cancer are not widely understood and very few studies have been done in this area. Consequently, we know that nasopharyngeal cancer is more common in rural areas and that it is associated with Epstein-Barr virus infection. The risk for nasopharyngeal cancer goes up if eating a diet rich in salt-cured fish and meat. It may also be associated with smoking cigarettes and drinking alcohol although their link to the cancer is not clear. Some scientists believe that chemicals in these things further damage the DNA in cells.
Who is likely to get Nasopharyngeal cancer ?
- those with nasopharyngeal cancer are men (about 80%) in general;
- those who smoke or were exposed to second-hand smoke at a young age;
- those who drink a lot of alcohol;
- those with a family history of nasopharyngeal cancer;
- those with a weakened immune system due to HIV/AIDS, or other diseases, or medical treatments such as chemotherapy or transplant;
- those who have come in contact with EBV;
- those exposed to certain chemicals, such as arsenic or phenol;
- those who live in regions of China, Africa and South America.
Nasopharyngeal Cancer Symptoms
Symptoms of nasopharyngeal cancer may include:
- Lump in neck
- Blurry or double vision
- Ear infections that recur
- Face pain or numbness
- Headache
- Hearing loss, ringing in the ears, or a feeling of fullness in the ear
- Difficulty opening mouth
- Nosebleeds
- Stuffy nose
- Sore throat
As such symptoms are commonly found with many other diseases, it is suggested to see your ENT doctor for further diagnosis when you see the above symptoms.
Did you find the information useful? If so, continue reading our posts.
For details of our ENT services, diagnosis, and treatment, please consult our ENT specialist.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
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