From the Guidelines
Early biomarkers for oral cancer before it becomes invasive include leukoplakia, erythroplakia, and erythroleukoplakia, which should prompt immediate referral to an oral medicine specialist or oral surgeon for evaluation and possible biopsy. These potentially malignant disorders are crucial to identify as they can be treated successfully if detected early 1. Additional biomarkers include oral lichen planus, oral submucous fibrosis, and actinic cheilitis, particularly on the lower lip. Clinicians should also look for unexplained persistent ulcerations lasting more than two weeks, unexplained bleeding, sudden tooth mobility without periodontal disease, and persistent numbness or pain.
Key Biomarkers
- Leukoplakia (white patches)
- Erythroplakia (red patches)
- Erythroleukoplakia (mixed red and white patches)
- Oral lichen planus
- Oral submucous fibrosis
- Actinic cheilitis
- Unexplained persistent ulcerations
- Unexplained bleeding
- Sudden tooth mobility without periodontal disease
- Persistent numbness or pain
Detection Methods
Advanced detection methods include autofluorescence imaging (VELscope), toluidine blue vital staining, brush cytology, and salivary biomarkers testing for proteins like IL-8, IL-6, and TNF-alpha. Molecular markers such as DNA ploidy analysis, loss of heterozygosity, and p53 mutations can be assessed in specialized settings. Regular oral examinations every 6-12 months are recommended for high-risk individuals, such as tobacco users, heavy alcohol consumers, and those with previous oral cancer 1.
Importance of Early Detection
Early detection of these biomarkers is crucial as it allows for intervention before transformation to invasive carcinoma, significantly improving survival rates from below 50% for advanced disease to over 80% when caught early. The USPSTF found inadequate evidence that the oral screening examination accurately detects oral cancer, but the benefits of early treatment and detection are well-established in clinical practice 1.
From the Research
Early Biomarkers for Oral Cancer
The identification of biomarkers for oral cancer is crucial for early diagnosis and treatment. Several studies have investigated the potential of salivary biomarkers for detecting oral cancer [(2,3)].
- Salivary biomarkers, including cytokines (IL-8, IL-1b, TNF-α), defensin-1, P53, Cyfra 21-1, and tissue polypeptide-specific antigen, have been identified as potential markers for oral cancer 2.
- Other biomarkers, such as dual specificity phosphatase, spermidine/spermineN1-acetyltransferase, profilin, cofilin-1, and transferrin, have also been investigated 2.
- The use of saliva for early cancer detection is a promising approach due to its noninvasive sampling and easy collection methods [(2,3)].
Detection and Diagnosis of Oral Cancer
Oral cancer detection and diagnosis involve various methods, including clinical examination, biopsy, and screening tests [(4,5)].
- Clinical examination and biopsy are effective methods for detecting premalignant and early oral cancers 4.
- Screening tests, such as the Ora Test with toluidine blue and exfoliative cytology, can also be used to detect early oral cancer 4.
- Optical imaging systems, such as tissue-fluorescence imaging and optical coherence tomography, have been shown to be efficient in differentiating between benign and malignant lesions 5.
Importance of Early Diagnosis
Early diagnosis of oral cancer is critical for improving patient survival rates [(6,5)].
- Delayed diagnosis can result in poor patient outcomes, highlighting the need for increased public awareness and regular oral examinations [(6,5)].
- Certain characteristics, such as race, BMI, malnutrition, and anemia, have been associated with late-stage diagnosis 6.
- Increasing provider awareness of these factors can aid in detecting oral cancer at an early stage, improving overall patient mortality and curative outcomes 6.