Cancer of the mouth or Oral Cancer is one of the most common cancers diagnosed today. Despite this, it often gets less attention from public healthcare institutions than systemic malignancies like lung and colon cancer. However, if it is not detected and treated early, oral cancer can turn out to be a lethal condition. That is a reason early diagnosis is critical to improving treatment outcomes. It is thought that delayed diagnosis plays a role in the dismal oral cancer survival rate over five years. The existing standard for diagnosing and detecting this cancer relies on clinical assessment, biopsy study, and genetic analysis. Numerous advancements have been made in terms of technologies available to detect oral cancer at the initial stage, and this study looks to explore these innovative methods.

Background

Diagnosing oral cancer is frequently an obstacle due to the widespread unawareness of the symptoms, indicators, and risks correlated with it. Not until the 19th century did histotechnology and embedding wax in samples to sustain biological material for analysis become prevalent. By the commencement of the twenty-first century, American public healthcare institutions had declared frozen sections the default practice. French botanist Francois-Vincent Raspail was acclaimed for uncovering the chemical means for the examination of tissue and cells via a microscope.

In the last few decades, pathology has immensely flourished, providing a wealth of information regarding genetic abnormalities and their associated malignancies. During the past two decades, the incorporation of molecular techniques in clinical practice has accelerated. As pathology advances further, tools like brush cytology, telescopes, confocal microscopy, tumor markers, and microarray are being developed. Robotics, humanoid technology, lab-on-a-chip devices, nanodevices, and intelligent patient implants will also make it possible to open further exciting avenues of exploration.

Review

Conventional clinical examination can be difficult to diagnose potentially malignant disorders. These conditions require a microscopic examination of the cells and tissues for diagnosis. Unfortunately, there are few resources to prevent or treat oral cancer, and the prevalence of lesions in the oral cavity ranges from 50-60%. Despite this, the five-year survival rate has seen a slight improvement of 53-60%. Usually, an oral examination is used to screen for oral diseases and other precancerous lesions. In order to effectively identify and present hereditary diseases and cancers, it is necessary to analyze the unique genetic factors which control the pathologic processes in such diseases. It is imperative to understand the fundamentals behind these procedures and the molecular structures and cycles being evaluated in order to facilitate successful diagnostic testing, as is the case for older and more renowned diagnostic methods.

An oral cancer diagnosis at a public health institution is possible with the help of immunohistochemistry and other molecular methods in the lab. This condition is overlooked because of a lack of awareness and delayed detection by medical and dental professionals. It creates the first and second loss of time and between the diagnosis and start of treatment is known as the third loss of time. Educating medical and dental professionals and increasing self-awareness could help reduce the first and second losses of time.

Most oral cancers start out as pre-cancerous tumors. Such lesions, like leukoplakia, oral lichen planus, erythroplakia, and actinic cheilitis have an increased risk of progressing to cancer. Hence, a timely diagnosis and early treatment can increase the chances of survival in oral cancer patients. Cutting-edge diagnostics are now available for that purpose as follows:

Vital tissue staining

The combination of toluidine blue (TB) dye and Lugol’s iodine is an effective tool for diagnosing malignancies and other mouth abnormalities.

Vizilite Chemiluminescence

Recent studies suggest that Vizilite chemiluminescence is a great improvement to the traditional visual assessment method. An individual-use, disposable chemiluminescent light stick producing light at 430, 540, and 580 nm can be used to check for any changes in tissue and potentially detect early stages of oral cancer. Dysplastic or hyper keratinized lesions appear white in the light, while normal epithelium appears dark.

Brush Cytology

Dental clinics have made incredible use of brush cytology to discover Oral Premalignant and Malignant Lesions (OPMLs) in their early stages, as this method is budget-friendly, non-invasive, and safe. To collect cells from the mouth’s epithelium, a cytobrush is used and placed onto a glass slide before being stained by a special Papanicolaou test and observed under a sophisticated microscope.

VELscope

Now, with the VELscope handheld device, medical practitioners have a much simpler way to recognize early indicators of oral sickness. This technology helps them distinguish between harmless and dangerous cellular mutations, facilitating the discovery of several types of cancer, like those found in the skin, lungs, and cervix. Unfortunately, it is not equipped to decide which lumps are likely to lead to oral or mouth cancer, making it an unreliable way of detecting the disease.

Confocal Microscopy

Confocal microscopy has revolutionized cell biology studies by offering the advantages of optical sectioning and high-resolution imaging. It has been instrumental in helping to identify markers such as nuclear abnormalities in oral SCC (OSCC), distinguishing it from normal oral mucosa. However, for this instrument to become a dependable, non-invasive tool for early diagnosis of oral cancer, it must be further optimized.

Saliva-based diagnostics

Oral fluid or saliva has recently been recognized as a valuable source of diagnostic information for detecting Oral Squamous Cell Carcinoma (OSCC). This minimally invasive method is incredibly effective and would, in time, potentially provide the necessary knowledge for earlier and more accurate diagnosis. As of now, it is not widely available on the market. However, there is high hope that it soon will be since detecting OSCC in its early stages can vastly improve the patient’s prognosis. With that in mind, utilizing saliva for the identification of the disease has become an urgent goal to improve future treatments.

Tumor Markers and Biomarkers

To evaluate the prognosis of those affected by OSCC, diagnostic evaluations can be conducted that examine the cancer-suppressing capabilities, oncogenes, indicators of cell proliferation, angiogenic markers, and cell attachment molecules. These indicators are present in multiple cellular elements, including the bloodstream, body fluids, coverings, and cytoplasm, and are either generated by the host when presented with cancerous materials or secreted by cancerous cells.

PCR Based Diagnostics

PCR, a tool utilized in molecular biology, has been used to detect infectious diseases and inspect tumors associated with microorganisms. PCR is incredibly beneficial in aiding cancer research aiding to decipher the complicated pathology of neoplasia.

Autofluorescence Spectroscopy

Autofluorescence spectroscopy, another effective method for identifying oral cancer, is composed of an optical fiber with various diameters that produce a spectrum of excitation wavelengths and a spectrograph that records the fluorescent spectrum of the tissue and analyses it using a computer.

Fluorescence Photography

The non-invasive, rapid, and simple characteristics of fluorescence photography make it an effective technique for detection of oral cancer. Medical professionals can observe the progression of the disease and the growth of carcinomas through positive fluorescence staining, and often utilized for diagnosis of squamous cell carcinoma.

Optical Coherence Tomography

Optical Coherence Tomography (OCT) is a non-invasive imaging instrument used for oral cancer diagnosis. Although there are few indicators for oral cancer, EP layer thickness and the Standard Deviation (SD) of OCT signal intensity are two of them. As abnormal cells of the oral EP have varying sizes, shapes, and nucleus organization, they cause an increase in light scattering intensity and degree of spatial distribution fluctuations. OCT is an advantageous tool, as it offers a radiation-free and non-invasive process, which produces cross-sectional images of healthy or affected tissues.

Diagnostic Techniques – Outlook Chip Laboratory

It is widely accepted that microfluidics and micro-total-analysis systems (TAS) have a revolutionary impact on fields akin to the one that integrated silicon chips had on electronics, computers, and communications. Microfluidic devices offer a three-dimensional, physiological environment for handling living cells, usually a few micro-meters in size. These chips are saliva-friendly, require minimal operator training, and return quick and reliable diagnoses.

Nuclear Magnetic Resonance Microscopy

Nuclear Magnetic Resonance Microscopy (NMR) is an advanced diagnostic procedure enabling a pathologist to analyse the tissue’s cellular composition, search for mutations in genes governing development and activity, and recognize disease-related indicators. This ground-breaking technology permits individual cells in live tissue to be viewed in 3D without inflicting any damage.

Clinical Microbiology

Regarding clinical microbiology, tremendous progress is anticipated with the advent of chips that automatically extract DNA, RNA, and proteins/peptides, and organism ID chips and sequencing chips, enabling continuous observation of patient samples.

Cytogenetics

Mapping and sequencing new disease loci can be achieved through interphase cytogenetic fine-gene mapping, with the ability to follow patients who have such mutations over time. Modern oral diagnostic aids such as multispectral digital microscopes, time-resolved laser-induced fluorescence spectroscopy, spectroscopy of diffuse reflectance, terahertz imaging, hyperspectral imaging, confocal laser endomicroscopy, quantum dots and nanoparticles, bionic sensors, and diagnostic molecular pathology also provide more detailed information. The circulating tumour cells (CTCs) assay is a blood test that can count epithelial tumour cells, comparing the results to predefined patterns. Radiographic imaging to forecast a patient’s response to treatment is now becoming faster, with the FDA allowing it to be used as a prognostic and monitoring tool for patients with advanced breast cancer, taking significantly less time than the traditional two to three months.

A Dried Blood Spot

Blood sampling for testing is an uncomplicated and swift process that employs a dried blood spot (DBS) as the specimen. This process breaks down proteins into smaller components referred to as peptides, which are subsequently evaluated by a mass spectrometer for diagnostics. Additionally, DBS specimens can be utilized in both genetic testing and molecular diagnostic assessments. As an alternative to the classic optical screening colonoscopy, volumetric cine (VC) has made virtual colonoscopy possible by producing two- and three-dimensional images of the intestines through CT scan technology.

A dried blood spot (DBS) is used as the specimen for the test. The process involves breaking down proteins into smaller building blocks called peptides, which are subsequently measured by a mass spectrometer for diagnostic purposes. Taking a blood sample is easy and quick. DBS specimens may be used in genetic testing and molecular diagnostic assays. As an alternative to a traditional optical screening colonoscopy, CT scan technology allows for the performance of a virtual colonoscopy. Using the CT scan, Volumetric cine (VC) creates two- and three-dimensional images of the intestinal luminal surfaces.

Advanced Diagnostics in Dental Care – Way Forward

Skilled and well-trained dentists can identify oral cancer at its nascent stages, hindering the advancement of the sickness. Research conducted at public health institutions on histopathology implies that future diagnostic techniques, including molecular and macroscopic strategies, are essential for the detection of malignant oral lesions. If these pre-cancerous lesions are detected promptly, they can be managed efficiently before developing into full-blown cancer, thus facilitating personalized treatment right from the start. As a result, modern and future-oriented diagnostics will be fundamental to guaranteeing a timely diagnosis and consequent prompt treatment of premalignant lesions and oropharyngeal squamous cell carcinoma, which would further improve patient care and the general health of the public.

About International Institute of Innovation & Technology (I3TK)

I3TK, a clinical research organization based in New Town, Kolkata, West Bengal, India, is at the forefront of finding innovative solutions for health challenges faced by public healthcare institutions. With its focus on identifying the causes and solutions of communicable and non-communicable diseases, I3TK also provides top-notch medical care at its advanced diagnostic center. Patients can receive compassionate care from highly trained staff at affordable rates. Furthermore, I3TK offers medical testing at the most cost-effective fees. Equipped with experienced clinical personnel, modern equipment, and rigorous quality standards, I3TK can provide rapid and accurate results. Advanced computer technology and automated equipment, along with point-of-care devices for quick specimen testing in the ICUs and operating rooms, further enhance their service.