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Oral cancer awareness – early detection matters?

Professor Panayiotis Kyzas

PhD, FRCS (OMFS)

Consultant OMFS H&N Surgeon

Royal Blackburn Teaching Hospital / East Lancashire Hospitals Trust

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Royal Blackburn Teaching Hospital

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Edge Hill University

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Oral cancer

8^th commonest malignancy in UK

50% 5-year survival

Higher incidence and advanced stage in deprived areas

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Common risk factors...

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Not so common risk factors...

Oral lichen planus

Paan – Betel Quid – Khat – tobacco chewing

Chronic injury???

HPV – oropharyngeal cancer

Sun exposure – lower lip and facial skin cancer

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Why early detection matters???

5-year survival (oral cancer)

Early stage (I – II) 75% vs. 35% for stage III-IV

QoL and functional outcomes much better

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Early stage tongue tumor (T2N0)

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Early stage tongue tumor (T2N0)

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Advanced maxillary tumor

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Advanced mandibular tumor

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Advanced Oral cancer

Challenging surgery

Longer treatment times

Greater impact on quality of life

Worse survival

More costly to NHS

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GDPs are the gatekeepers

Great access and skills in the oral cavity

Routine examination of the mouth

Fantastic awareness of normal anatomy

Tell patients you are checking to rule out cancer at each check up

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TWW referral for oral cancer – The signs

Non – healing ulcer in the mouth

Tongue

FOM

Palate

Gums

A traumatic cause doesn’t exclude oral cancer

Smoothening a sharp tooth is vital

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TWW referral for oral cancer – The signs

Lump in the mouth - and/or the neck
Non-healing extraction socket

Leukoplakia
Erythroplakia / Erythroleukoplakia

Masses and ulcers in the tonsil / palate area

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TWW referral for oral cancer – The symptoms

EARACHE !!!!

Cardinal sign
Nerves’ anatomy
Once present and no cause identified, it should be considered suspicious, and cancer should be excluded

Unexplained numbness lip and tongue
Dysphagia/odynophagia/weight loss

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TWW referral for oral cancer

Combine signs and symptoms with history and social factors (smoking, alcohol)

Refer using TWW referral form

Add as much information as possible

Explain to the patient why is being referred

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TWW referral for oral cancer – the non-cancer ones

Mucocelles and polyps

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TWW referral for oral cancer – the non-cancer ones

Tori

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Referral

Tell patient you are referring to rule out cancer

Only 4% of referrals turn out to be cancer

Stress importance of attending

Give patient info leaflet

Referral form & patient info leaflet

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Follow up assurance

<12 hours Refer via online referral- 2 week wait
<24 hours check referral received
Follow up with patient:

Confirm appointment
Confirm patient attended
Record results

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Conclusion

Be alert for oral cancer at every consultation

If in doubt, refer or discuss with OMFS H&N consultant

Tell patients “you are referring to rule out cancer”

Use 2 week wait form & follow patient

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