GREENSBORO — Oral cancer is ready for its close-up.
A technology that uses dye and a special light to identify malignant tumors and precancerous lesions promises to help reduce the incidence of a cancer that has remained stubbornly common, and deadly, for decades.
Oral cancer includes cancers of the lips, tongue, cheek, floor of the mouth, hard and soft palates, sinuses and throat. The disease is detected in more than 30,000 Americans a year and kills about 8,000, more than melanoma or cervical cancer. Because it is seldom detected early, the five-year survival rate is only 57 percent.
The dye-and-light approach for detecting oral cancer was first used in the mid-1990s to detect cervical cancer. But recently, it has come into use to detect mouth tumors.
“Up to this point, for oral cancer, it could only be detectable visually, and once it’s visible, it’s pretty advanced,” said Dr. Laura Steinberg, a Greensboro dentist, among about a third of Guilford practitioners who use the technology.
“A common spot (for cancer to develop) is far, far back on the tongue, and if you have to remove the tongue, your quality of life is awful,” she added.
Another reason to emphasize early detection, Steinberg said, is that about 25 percent of people found to have the disease had none of the risk factors associated with it, such as age, smoking or drinking.
How does the system work? Steinberg and a patient, Larry Himes, demonstrated recently during Himes’ examination.
First, Himes rinsed his mouth for one minute with a raspberry-flavored 1 percent solution of acetic acid — essentially, diluted vinegar. This rinse dries the cells to reduce reflected glare and make any lesions more visible.
“That’ll keep you alert for the rest of the day,” Himes said after the rinse.
Then Steinberg lit a small glow stick, called a ViziLite Plus, that emits low-intensity light generated by the combination of two chemicals and used it to examine Himes’ mouth.
If the patient has no lesions, the light will be absorbed and the patient’s mouth will appear dark. Any abnormal growths will glow white.
If no lesions appear under the light, as was the case with Himes, the examination is over. But if a lesion appears, the dentist takes more steps.
First, she re-swabs the area with the acetic acid solution to keep the area glare-free. Then she swabs the abnormal-growth area with a special blue dye. If the lesion is likely cancerous or precancerous, the cells will turn blue.
Finally, the dentist re-swabs with the acetic acid solution. If the blue comes off the cells, the dentist may re-test within a few weeks or just have the patient return in six months as usual. But if the cells remain blue, the dentist would perform a biopsy or refer the patient to an oral surgeon who would perform the biopsy.
The dye works by detecting cells’ metabolic rate. The higher the rate, the more likely the cells are to be, or to become, cancerous. And the technique can detect lesions ranging from mildly abnormal precancerous cells up to the most advanced cancers.
The early part of the process can involve some false positive results — for example, when what looks like a lesion turns out to be trauma, a difference generally caught during a biopsy, Steinberg says. But in clinical trials, fewer than 1 percent of cases involving the blue dye have involved false negatives, or missed cancers, said Nikki Heubner, a representative for Zila Inc., which distributes the examination kits.
I think it’s going to become mainstream,” Steinberg said. “Women go to get a mammogram, they go to get a PAP smear, and I think (people are) going to get this. I feel like that’s where this will come once people see that we can detect things early.”
Contact Lex Alexander at
373-7088 or lalexander