Oral cancer has suddenly increased in cases with HPV infection in the younger generation. These lesions are found at the very back of the mouth, also known as oropharynx or OP. In order to extend the affected person’s life expectancy, early detection is a prerequisite. The American Dental Association and the Oral Cancer Foundation have a standardized protocol that can be completed in 5 minutes during opportunistic screening. OP comprises one-third of the tongue from its root, posterior wall of pharynx, tonsils and its folds.
Clues like changes in facial asymmetry, swelling, skin discoloration, temporal wastages, paralysis, weight loss, anorexia, and fatigue are gathered during recording history. In addition, other non-visual changes are also recorded.
It is advised to inform the patient about the procedures, establish rapport, win their confidence, and also educate the patient about malignancy, advantages of early detection, and risk reductions.
The patient’s face is then examined for signs of malignancy. Eye movement and visual activity are checked for the viability of the optic nerve and swellings. Nearby areas and blocks in tear ducts are also checked as they may indicate malignancy in the sinuses and palate.
Furthermore, any hearing deficiency is noted during conversations and the external ear is checked for telltale signs. Skin cancer starts at the top of the ear exposed to the sun. The canals and eardrums are also scrutinized after removing the wax if necessary.
Then, the external nose and the adjacent areas like the maxillary sinus and the temporomandibular joint are checked. The internal walls of the nose, sinuses, pharynx, and larynx can be examined together through a nasopharyngolaryngoscopy.
The oral cavity or OC consists of lips, its corners or commissures, the anterior two-thirds of the tongue, cheeks, gum, sulcus, and floor and roof of the mouth right up to tonsils. These are checked and any change in the dry mucous membrane and the area examined is noted. Lips, the vermilion boundary (between the skin and mucous membrane), frenum, and commissures are very important as both squamous and basal cells cancers originate here. Both the lips and tongue are checked in close and open conditions and in lateral movements and resting positions, respectively. Any deviation from the center is a sign of nerve paralysis.
The soft palate and beyond is oropharynx is checked in the usual manner, including its movement and symmetry of the uvula. The examination is carried out with the head tilted and the tongue suppressed so that the doctor can get a better look.
The neck is endowed with an abundance of lymph nodes, along the sides, middle, and supraclavicular space. Painless enlargements of lymph nodes are seldom signs of infections. Since these regions are not in the location of primary cancers, deduction of any painless nodes in patients above 40 years of age would call for a thorough reexamination.
