oral cancer examination, oral cancer diagnosis
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Common Examination of Oral Cancer
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1. Imaging diagnosis
Radionuclide examination can provide information of tongue thyroid gland and bone metastasis of oral cancer, but it is rarely used in the diagnosis of oral cancer itself. Ultrasonography is also rarely used in oral cancer. X-ray plain film and tomography can provide more valuable information when oral cancer invades upper and lower jaws and nasal paranasal sinuses, but the location information of oral cancer, the scope of tumor invasion, especially the soft tissue around the primary focus, can not meet the needs of clinicians in diagnosis and treatment plan. CT makes up for the above requirements to a great extent, but CT should not be used as a routine examination method, and should be applied selectively on the basis of obtaining detailed medical history, physical examination and other examination materials.
The fibrous septum of the tongue presents a low-density plane on CT, which divides the tongue into two halves. Its displacement or disappearance can indicate that tongue tumor is benign or malignant. If its disappearance is accompanied by the deformation and disappearance of the contralateral tongue muscle, it suggests that tongue cancer has invaded the contralateral side, and the operator should consider total tongue resection.
The medial lingual muscle is located in the center, spherical, without fascia septum, and its muscle cord is irregular, so its density is uneven in CT. The extralingual muscle surrounds both sides and bottom of the internal lingual muscle, and its muscle cables are arranged in the same direction. On the supra-hyoid CT axial film, the genioglossus muscle clings to both sides of the lingual septum with fat densityIt is arranged in a band from the mental tubercle of mandible to the back and ends at the internal tongue muscle; The hyoid tongue muscle and styloid tongue muscle are arched around both sides of the posterior internal tongue muscle. Axial CT from hyoid body to hard palate can be performed in patients with tongue cancer or mouth floor cancer with limited tongue movement. If the deformation or disappearance of the extra-lingual muscle is found, the clinical judgment of tongue cancer invading extra-lingual muscle can be further confirmed.
Patients with oral cancer, especially those with lesions located at the back of the mouth, have limited mouth opening, that is, the distance between upper and lower incisors is less than 4 ~ 5cm after mouth opening, and those with numbness of tongue and lower lip should be examined by CT. The mandible, medial pterygoid plate, lateral pterygoid plate, medial pterygoid muscle, lateral pterygoid muscle, temporal muscle, masseter muscle and various fascia spaces formed by them can be clearly displayed on CT. The disappearance of these structures, especially the medial pterygoid muscles and pterygomandibular space, is often the direct evidence that oral cancer invades the masticatory space and causes difficulty in opening mouth.
A few oral cancers can invade along nerves, among which adenoid cystic carcinoma of hard palate is the most prominent. Although the hard palate block is not large, when there are symptoms of maxillary nerve invasion such as numbness of upper lip, if CT examination shows that the pterygopalatine fossa is enlarged, fat disappears, and sometimes the foramen round is enlarged and the root of pterygopalati is destroyed. If the tumor goes anterograde along the branches of trigeminal nerve, the enlargement of infraorbital neural tube and the tumor of orbital apex can also be seen. Therefore, when patients with oral cancer have symptoms of trigeminal nerve, especially the second maxillary nerve, CT examination of pterygopalatine fossa and its surroundings should be emphasized. In some cases, adenoid cystic carcinoma with many sieve-like structures can show sieve-like low-density areas on CT.
2. Cytology and biopsy
Exfoliative cytology is suitable for superficial asymptomatic precancerous lesions or early squamous cell carcinoma with unclear lesion range, and is suitable for screening examination. Then the positive and suspicious cases were further confirmed by biopsy. Some precancerous lesions can also be followed up by exfoliative cytology. This method is easy for patients to accept. However, 60% of the early oral squamous cell carcinoma cells directly penetrated the basement membrane and infiltrated downward, while the surface epithelium was normal, and the exfoliative cytology often showed negative results.
The diagnosis of oral squamous cell carcinoma usually adopts forceps or cut biopsy, because its surface mucosa has been broken or abnormal, and its position is superficial. Necrotic and keratinized tissues should be avoided, and tissues should be taken at the junction of tumor and surrounding normal tissues, so that the obtained materials have both tumor tissues and normal tissues. The forceps should be sharp, so as to avoid the tissue being squeezed and deformed, which will affect the pathological diagnosis. If the tissue is compressed and deformed, it should be taken separately. Fine needle aspiration cytology can be used for submucosal masses with intact mucosa.
Although the above biopsies rarely cause the proliferation and metastasis of tumor cells, local tumor growth acceleration can still be seen in cases with long treatment delay. Therefore, the shorter the interval between biopsy and clinical treatment, the better. Biopsy should be performed in a hospital where treatment is available.
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