Detection of Oral Cancer with New Technology Identafi
Oral cancer most commonly involves:
- the front 2/3 of the tongue
- the lining of the cheeks and lips (the buccal mucosa)
- the floor of mouth under the tongue
- the roof of the mouth (hard palate)
- the gums (gingiva)
- the small area behind the wisdom teeth
- the minor salivary glands
Most oral cancers look very similar under the microscope and are called “squamous cell” carcinomas. These are malignant and tend to spread rapidly.
Squamous Cell Carcinoma is any malignant cancer that arises from epithelial cells. Carcinomas invade surrounding tissues and organs and may “metastasize”., or spread, to lymph nodes and other sites.Oral Cancer is often detected late in development, when the possibility of metastasis is much greater. Like most cancers, cancer of the lip and oral cavity is best treated when found early – when cure rates are greater than 80%.
Determination of the stage of cancer in the lip or oral cavity is important in order to plan the best course of treatment.
Metastasis is the spread of a disease from one organ or body part to another non-adjacent organ or body part. Only malignant tumor cells and infections have the capacity to metastasize. Cancer cells can “break away”, “leak”, or “spill” from a primary tumor, enter lymphatic and blood vessels, circulate through the bloodstream, and settle down to grow within normal tissues elsewhere in the body. Squamous epithelium is the tissue that lines the mouth, throat, tongue and tonsils. These tissue cells are irregularly shaped and very flat. Squamous epithelium also lines other body cavities and capillaries to reduce friction, as well as lining the lungs to facilitate gas exchange.
Stages of Oral Cancer
Stage I. The cancer is no more than 2 centimeters and has not spread to lymph nodes in the area
Stage II. The cancer is more than 2 centimeters but less than 4 centimeters and has not spread to lymph nodes in the area
Stage III. Either of the following may be true – the cancer is more than 4 centimeters; the cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer.
Stage IV. Any of the following may be true – the cancer has spread to tissues around the lip or oral cavity; the lymph nodes in the area may or may not contain cancer; the cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters.
Recurrent. The cancer has returned after it has been treated. It may come back in the lip and oral cavity or in another part of the body.
When found early, oral cancer patients have an 80 to 90 % survival rate. Unfortunately 40% of those diagnosed with oral cancer will die within five years because the majority of these cases will be discovered as a late stage malignancy. (see stage description in Oral Cancer section)
Oral cancer is particularly dangerous, because the patient may not notice it in its early stages. It can frequently prosper without producing pain or symptoms. As a result, Oral Cancer often goes undetected until it has already metastasized to another location.
Oral Cancer – Who does Oral Cancer Screening?
Dentists, Periodontists, Hygienists
Most oral cancer screenings are done by a Dentist or Hygienist
Periodontists routinely screen for oral cancer on all new patients
A routine “recall” exam usually includes a visual search for lesions and abnormal structures in the oral cavity
It is estimated that 60% of the patients visiting a dentist get screened at least once a year.
HOW IT WORKS
Identafi® Multi-Spectral, Oral Cancer Screening
The deep penetrating power of the Identafi® multiple wavelengths will enhance the early detection of mucosal abnormalities that may be cancerous.
The new Identafi® uses the Identafi® Multi-Spectral Fluorescence and Reflectance technology to enhance visualization of mucosal abnormalities such as oral cancer or premalignant dysplasia that may not be apparent to the naked eye. But unlike other fluorescence technologies and dye systems, the Identafi® is Multi-Spectral with three distinct color wavelengths, making it easier to distinguish lesion morphology and vasculature aiding the dental professional in determining next steps.
How It Works:
The Identafi® uses white, violet and amber wavelengths of light to excite oral tissue in distinct and unique ways. As a result, biochemical changes can be monitored with fluorescence, while morphological changes can be monitored with reflectance. The combined system of fluorescence and reflectance uses the body’s natural tissue properties as an adjunctive tool for oral mucosal examination. Conventional examination of tissue is performed using a highly concentrated White light.
Wearing reusable Identafi® filtered eyewear to enhance visual effects and allow transmission of reflected light, the health professional then switches to Violet for a second observation.
The clinician’s photosensitive glasses block the violet excitation light and allow the observance of the tissues natural fluorescence. Violet light enhances normal tissue’s natural fluorescence; however, suspicious tissue appears dark because of its loss of fluorescence.
When suspect abnormalities are present the selector is switched to Amber light, which enhances normal tissue’s reflectance properties so the clinician may directly observe the difference between normal and abnormal tissue’s vasculature. This independent view of vascular architecture may assist in the assessment of confounders when screening for oral cancer.
Studies indicate abnormal tissue has a diffuse vasculature, where normal tissue vasculature is clearly defined. The combination of all three Multi-Spectral wavelengths provides the clinician with more visual information, improved results over direct visual exam alone and increased confidence for recommending.
The Need for Early Detection is Available to All Front Line Clinicians
The Identafi® is intended for use by:
- Dentists and Hygenists
- Primary Care Practitioners
- Oral Surgeons
- ENT Head and Neck Surgeons to help identify diseased tissue around a clinically apparent lesion. The Identafi® can enhance the surgeon’s ability to choose biopsy sites and aid in determining the appropriate margin for surgical incision.
Ask us how we can do a oral cancer screening at Atrium Dental by calling 480-940-4321.