Oral Cancer Self-Check: Five Minutes in the Mirror Can Catch It Early

You brush your teeth every morning, probably without really looking at what is inside your mouth. A small sore appears, you take some medicine, it fades, and life goes on. Dr Smit A. Desai, a consultant oral cancer surgeon in Ahmedabad, says this ordinary pattern is where many cases of oral cancer begin to slip away.

Why a mirror, and why every morning?

Dr Desai's advice is simple. When you stand at the basin to brush, spend five minutes looking at your mouth. Check your tongue, the inside of both cheeks, your lips and the rest of the mouth.

He points to a properly published, long-term study from Kerala, which he says showed good results when people were caught early this way. In his view, a daily look gives you a real chance of noticing a change before it becomes serious. He also notes that in many countries a routine oral check-up every six months is common, while in India most people see a doctor only when something hurts.

He adds that the cause can be ordinary. A sharp tooth that keeps rubbing the same spot, or an ill-fitting denture, can irritate the lining of the mouth repeatedly, and that matters too.

What should you look for?

Dr Desai lists these as the typical signs that call for a visit to a specialist:

• White or red patches in the mouth
• A tongue that does not move as freely as before
• An ulcer that has lasted more than 21 days, does not change and does not hurt
• A lump that has been there for years but suddenly grows, or one that will not heal and has now started to pain
• Sudden weight loss
• Difficulty or hesitation while eating and drinking

The painless ulcer deserves special attention. Dr Desai explains that an ordinary mouth sore usually hurts. A cancerous ulcer that does not hurt is more likely to be at an early stage, but it is still cancer. If a cancerous ulcer is painful, he says, it is usually already at a more advanced stage. Waiting for pain before seeing a doctor means waiting too long.

What do the four stages mean?

Oral cancer has four stages, and stage 4 is further divided into 4A, 4B and 4C. Dr Desai describes stage 1 as an ulcer smaller than about 2 cm, with no lump or spread anywhere else. In stage 2 the size grows. The stage matters because treatment is decided by it.

He gives a rough timeline and stresses that the numbers are approximate. According to him, the move from stage 1 to stage 2 takes about six months, then about three more months to stage 3, and three more to stage 4. So a patient who arrives at stage 4 has typically been living with a small sore, a bit of medicine and a temporary relief for nine to twelve months.

If cancer is caught at stage 1, Dr Desai says the chance of cure is around 90 percent. He is equally clear that no doctor can promise 100 percent in cancer.

He also does not describe advanced disease as hopeless. Oral cancer, he says, is "not a gone case" even at a late stage. His centre operates up to stage 4B, and he has seen patients live well for several years after surgery. But recovery takes longer, and the outcome and quality of life are lower than when the cancer is found early.

Why do so many people arrive late?

Of ten patients Dr Desai sees in a day, about eight are at stage 4. He gives two main reasons: lack of awareness, and the stigma around the word cancer.

He also describes the months lost in between. Families first turn to neighbours, relatives and home remedies, then to powders, herbal preparations and visits to religious places for something to take. Some patients, he says, have been to as many as 15 such places before reaching him. He is respectful of every system of medicine, but he stresses that the window between stage 1 and stage 2 is short, and that those months are often spent on things that do not treat the disease.

His advice is to treat any ulcer that lasts beyond three weeks as a reason to see a specialist, however mild it feels.

Only a biopsy confirms cancer

Dr Desai is firm on this. The standard test is a biopsy, in which a small piece of tissue from the ulcer or lump is examined. Nothing else, he says, can confirm whether it is cancer.

He warns about products sold online and elsewhere: mouth rinses, iodine or other dyes, and scanning gadgets that claim to show whether a patch is cancerous. None of these, he says, gives a 100 percent answer. The real danger is a false negative. A person is told all is well, loses months, and the cancer moves on to the next stage unnoticed.

If you have a sore or patch that fits the description above, a doctor can examine it and decide whether a biopsy is needed.

Key takeaways

• Look at your tongue, cheeks, lips and mouth for five minutes each morning while brushing.
• White or red patches, a stiff tongue, a sore lasting over 21 days, a suddenly growing lump, weight loss and trouble eating all need a specialist's opinion.
• A painless ulcer should not be ignored. Pain, Dr Desai says, usually points to a later stage.
• Stage 1 means a small ulcer under about 2 cm. He puts the cure rate at around 90 percent when caught then, though nobody can guarantee an outcome.
• Only a biopsy confirms cancer. Rinses, dyes and scanners are not a substitute.
• Months spent on home remedies and other detours are months the cancer can advance.

Common questions

How often should I check my mouth for signs of oral cancer?

Dr Desai recommends a daily self-check in the mirror, about five minutes each morning while brushing. Look at your tongue, both cheeks, lips and the rest of your mouth. He also mentions a routine oral check-up every six months, as is common abroad.

How long can a mouth ulcer last before I should see a doctor?

Dr Desai says an ulcer that stays for more than 21 days, does not change and does not hurt should be examined by a specialist. Do not wait for it to become painful.

Does oral cancer always cause pain?

No. Dr Desai explains that early oral cancer often does not hurt, which is why people ignore it. A cancerous ulcer that is painful is usually at a more advanced stage.

Can a mouth rinse, dye or scanner tell me if I have oral cancer?

According to Dr Desai, no. Rinses, iodine dyes and scanning devices cannot give a 100 percent answer, and a false negative can cost precious time. A biopsy is the only test that confirms cancer.

Is stage 4 oral cancer hopeless?

Dr Desai says no. He describes oral cancer as not a lost case even at an advanced stage, and says some patients live well for years after surgery. Recovery takes longer, though, and results are better when the cancer is found early.