Mouth cancer - Diagnosing mouth cancer

If you have symptoms of mouth cancer, your GP will carry out a physical examination and ask about your symptoms.

If mouth cancer is suspected, you will be referred to hospital for further tests or to speak to a specialist head and neck surgeon.

Biopsy

It may be necessary to remove a small sample of affected tissue to check for the presence of cancerous cells. This procedure is known as a biopsy.

There are three main methods used to carry out a biopsy in cases of suspected mouth cancer.

Punch biopsy

A punch biopsy may be used if the suspected affected area of tissue is in an easily accessible place, such as your tongue or the inside of your mouth.

The area is first injected with a local anaesthetic to numb it. The doctor will then cut away a small section of affected tissue and remove it with tweezers.

The procedure is not painful, but can feel a little uncomfortable.

Fine needle aspiration (FNA)

A fine needle aspiration (FNA) is a type of biopsy used if it is suspected a swelling in your neck is the result of mouth cancer.

Your neck is numbed and a needle is used to draw out a small sample of tissue and fluids from the lump. The sample is then checked for cancerous cells.

FNA is not painful but it can be uncomfortable and cause bruising.

Panendoscopy

A panendoscope is used if the suspected tissue is at the back of your throat or inside one of your nasal cavities.

This is a long thin tube with a camera and a light which is guided through the nose, then used to remove a small section of tissue for the biopsy.

The panendoscope can also check whether cancer has spread from your mouth to further down your throat, such as your larynx (voice box), oesophagus (gullet) or trachea (windpipe).

Further tests

If the biopsy confirms cancer you will need further tests to check what stage it has reached.

If the cancer is diagnosed late it can have spread from your mouth into the lymphatic system – a series of glands throughout your body which produce many of the specialised cells needed by your immune system.

Once the cancer reaches the lymphatic system, it is capable of spreading to any other part of your body, including your bones, blood and organs.

However, it's uncommon for mouth cancer to spread further than the lymph nodes near your mouth, although in some cases it may also spread to surrounding bones, such as the jaw bone, and in some cases your lungs.

Therefore, the tests will examine your lymph nodes, bones and the tissue near the site of your initial tumour to check for the presence of other tumours.

These tests may include:

Further biopsies on nearby lymph nodes may also be carried out.

Staging and grading

Once these tests have been completed it should be possible to tell what stage and grade your cancer is:

staging is a measure of how far the cancer has spread
the grade describes how aggressive the cancer is and how fast it is likely to spread in future

This will help determine whether you have:

early mouth cancer (usually curable)
intermediate mouth cancer (may be curable)
or advanced mouth cancer (not usually curable, but it is usually possible to slow the spread of the cancer and extend lifespan)

There are three grades of mouth cancer: low-grade (the slowest), moderate-grade and high-grade (the most aggressive).

Grading your cancer helps the doctor decide how quickly you need to be treated – read more about treating mouth cancer.