Given that mortality rates from OC/OP-SCC have been fairly stable, 27 it has been posited that earlier detection of oral cancers will improve prognosis. A 2015 systematic review and meta-analysis by Seoane et al. 28 found that a longer time interval from a patient’s first symptom to referral for diagnosis was a “risk factor for advanced stage and mortality of oral cancer.”
A number of adjuncts to the standard clinical examination have been developed and are intended to improve disease detection. These include oral brush cytology, toluidine blue staining, and light-based detection systems to increase the visibility of oral mucosal lesions or provide real-time data on suspicious mucosal lesions. 29 Diagnostic performance in clinical studies has been inconsistent because results vary according to study settings and the sample populations enrolled. 29 It is not yet clear whether these ancillary tests are helpful in triaging which patients need diagnostic or therapeutic follow-up, in part because there tests also cause false-positive results. Diagnostic adjuncts have been evaluated primarily in referral clinic settings or cancer centers and in patients at high baseline risk of disease. 29 Data from studies in general clinic settings and in patients at low baseline risk of disease are more limited and additional data are needed to characterize test performance in these populations and settings. 29
Doctors also describe oral and oropharyngeal cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. HPV-related oropharyngeal cancer does not have a grading system. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade can help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.