Oral, Pharyngeal & Laryngeal Cancer Screening

Oral cavity and nasopharyngeal cancers are diseases in which malignant (cancer) cells form in the mouth and throat.

Oral cavity cancer usually forms in the squamous cells (thin, flat cells lining the inside of the oral cavity).

Oral cavity cancer forms in any of these tissues of the oral cavity:

• The lips.
• The front two thirds of the tongue.
• The gingiva (gums).
• The buccal mucosa (the lining of the inside of the cheeks).
• The floor (bottom) of the mouth under the tongue.
• The hard palate (the front of the roof of the mouth).
• The retromolar trigone (the small area behind the wisdom teeth).

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Anatomy of the oral cavity. The oral cavity includes the lips, hard palate (the bony front portion of the roof of the mouth), soft palate (the muscular back portion of the roof of the mouth), retromolar trigone (the area behind the wisdom teeth), front two-thirds of the tongue, gingiva (gums), buccal mucosa (the inner lining of the lips and cheeks), and floor of the mouth under the tongue.

Pharyngeal cancer forms in the tissues of the pharynx (throat), including the nasopharynx, oropharynx, and hypopharynx. This summary covers nasopharyngeal cancer, which forms in the tissue of the nasopharynx (the upper part of the throat behind the nose).

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Anatomy of the pharynx. The pharynx is a hollow, muscular tube inside the neck that starts behind the nose and opens into the larynx and esophagus. The three parts of the pharynx are the nasopharynx, oropharynx, and hypopharynx.

See the following PDQ summaries for more information about the prevention, diagnosis, and treatment of head and neck cancers, including oral cavity cancer and nasopharyngeal cancer:

• Oral Cavity, Oropharyngeal, Hypopharyngeal, and Laryngeal Cancers Prevention
• Lip and Oral Cavity Cancer Treatment
• Nasopharyngeal Cancer Treatment (Adult)

The number of new cases of oral cavity and nasopharyngeal cancers and the number of deaths from these cancers vary by sex and geographic region.

From 2009 to 2018, the number of new cases of oral cavity cancer in the United States slightly increased, mostly in non-Hispanic White patients.

Oral cavity cancer is more common in men than in women. Although oral cavity cancer may occur in adults of any age, it occurs most often in those aged 75 to 84 years.

France, Brazil, and parts of Asia have much higher rates of oral cavity cancer than most other countries.

Nasopharyngeal cancer is rare in the United States. It is more common in parts of Asia, the Arctic region, North Africa, and the Middle East.

Different factors increase or decrease the risk of oral cavity and nasopharyngeal cancers.

Anything that increases your chance of getting a disease is called a risk factor. Anything that decreases your chance of getting a disease is called a protective factor.

Being infected with Epstein-Barr virus (EBV) increases the risk of nasopharyngeal cancer.

For more information about risk factors and protective factors for oral cavity cancer, see the PDQ summaries on Oral Cavity, Oropharyngeal, Hypopharyngeal, and Laryngeal Cancers and Lip and Oral Cavity Cancer Treatment.

Tests are used to screen for different types of cancer when a person does not have symptoms.

Scientists study screening tests to find those with the fewest harms and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) helps a person live longer or decreases a person's chance of dying from the disease. For some types of cancer, the chance of recovery is better if the disease is found and treated at an early stage.

There are no standard or routine screening tests for oral cavity and nasopharyngeal cancers.

No studies have shown that screening for oral cavity cancer and nasopharyngeal cancer would lower the risk of dying from these diseases.

A dentist or medical doctor may check the oral cavity during a routine check-up. The exam will include looking for lesions, including areas of leukoplakia (an abnormal white patch of cells) and erythroplakia (an abnormal red patch of cells). Leukoplakia and erythroplakia lesions on the mucous membranes may become cancerous.

If lesions are seen in the mouth, the following procedures may be used to find abnormal tissue that might become oral cavity cancer:

• Toluidine blue stain: A procedure in which lesions in the mouth are coated with a blue dye. Areas that stain darker are more likely to be cancer or become cancer.
• Fluorescence staining: A procedure in which lesions in the mouth are viewed using a special light. After the patient uses a fluorescent mouth rinse, normal tissue looks different from abnormal tissue when seen under the light.
• Exfoliative cytology: A procedure to collect cells from the oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, or mouth. The cells are viewed under a microscope to find out if they are abnormal.
• Brush biopsy: The removal of cells using a brush that is designed to collect cells from all layers of a lesion. The cells are viewed under a microscope to find out if they are abnormal.

More than half of oral cancers have already spread to lymph nodes or other areas by the time they are found.

Epstein-Barr virus (EBV) has been linked to nasopharyngeal cancer. Screening for nasopharyngeal cancer using the EBV antibody test or EBV DNA test has been studied. These are laboratory tests used to check the blood for EBV antibodies or EBV DNA. If EBV antibodies or DNA are found in the blood more tests may be done to check for nasopharyngeal cancer. No studies have shown that screening would decrease the risk of dying from this disease.

Screening tests for oral cavity and nasopharyngeal cancers are being studied in clinical trials.

Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

The risks of screening for oral cavity and nasopharyngeal cancers include the following:

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Purpose of This Summary

This PDQ cancer information summary has current information about oral cavity and nasopharyngeal cancers screening. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

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The best way to cite this PDQ summary is:

PDQ® Screening and Prevention Editorial Board. PDQ Oral Cavity and Nasopharyngeal Cancers Screening. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/head-and-neck/patient/oral-screening-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389441]

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