Unveiling the Spectrum of Oral Cancer- Biopsy

Oral cancer is one of the most common cancers in the world: oral squamous cell carcinoma (OSCC) happens to be the most common form. Early detection and accurate diagnosis are vital factors in making treatment regimens more effective with lessened morbidity and better survival. Among the diagnostic tools available, biopsy and histopathological examination are considered the gold standard for confirming malignancy, grading dysplasia, and guiding the treatment.

To understand the spectrum of oral cancer by biopsy, the clinical presentations are recognized, appropriate biopsy technique selected, and findings interpreted from the histopathology. This enables dental professionals, oral surgeons, and oncologists to intervene as early as possible, thus resulting in better prognosis.

Recognizing the Clinical Spectrum of Oral Cancer
Oral cancer can present in a wide range of ways, from asymptomatic precancerous lesions to aggressive ulcerative masses with regional and distant metastases. Some of the key clinical presentations include:

Leukoplakia – White patches that cannot be scraped off and may indicate dysplastic or pre-malignant changes.
Erythroplakia – Red, velvety lesions with a higher risk of malignant transformation.
Non-Healing Ulcers – Those present more than two weeks especially if with indurated edges must be biopsied urgently.
Exophytic Growths – Nodular or verrucous proliferative lesions suggesting an invasive carcinoma
Induration and Fixation – Soft tissue becoming hard; more concerning on the tongue, floor of mouth or the buccal mucosa.
Pain or Paresthesia – Possible signs of nerve invasion.
High-risk areas for oral cancer include the lateral border of the tongue, floor of the mouth, retromolar region, and buccal mucosa—all these are exposed sites for the carcinogenic irritants like tobacco, alcohol, and betel quid.

The Role of Biopsy in Oral Cancer Diagnosis
Biopsy remains the most definitive diagnostic tool for oral cancer, providing critical histopathological insights that guide treatment. The selection of an appropriate biopsy technique depends on the lesion’s size, location, clinical suspicion, and accessibility.

Types of Biopsies in Oral Cancer Diagnosis
Incisional Biopsy – The most commonly used technique for large or suspicious lesions. A representative section of the lesion, including normal and abnormal tissue, is excised for analysis.
Excisional Biopsy – This is done for small, localized lesions where the lesion can be removed completely without loss of function.
Fine-Needle Aspiration Biopsy (FNAB) – It is used to determine the involvement of lymph nodes when metastasis is suspected.
Punch Biopsy – This is useful for lip or buccal mucosa lesions, in which a cylindrical core of tissue is obtained for examination.
Brush Biopsy – This is a non-invasive method of screening but lacks the diagnostic accuracy of conventional biopsies.
Sentinel Lymph Node Biopsy – A specialized procedure for assessing regional metastasis, especially in clinically negative necks.

Histopathological Spectrum of Oral Cancer
After biopsy, the tissue specimen is subjected to histopathological examination to assess cellular features, tumor differentiation, and depth of invasion. The important findings are as follows:

Dysplasia – It is graded as mild, moderate, or severe depending on architectural and cytological abnormalities.
Carcinoma in Situ (CIS) – Full-thickness epithelial dysplasia without basement membrane invasion.
Invasive squamous cell carcinoma. The criteria are the formation of keratin pearls, presence of cellular pleomorphism and high mitotic activity, but definitely invading past the basement membrane.
Verrucous carcinoma: A rather low-grade with locally invasive morphology. The characteristic presentation is more warty but still shows cytologically minimal atypia
p53 Ki-67 as well as many others cytokeratins should be applied and are useful when considering aggressiveness as well as possible progression from a biopsy.
Once oral cancer is diagnosed, staging and treatment planning occur.

The TNM classification system (Tumor size, Node involvement, Metastasis) determines the extent of the disease and guides therapeutic decisions, which may include:
Surgical Excision – First-line treatment for localized tumors with negative margins.
Radiotherapy and Chemotherapy – Used for advanced cases, nodal involvement, or palliative care.
Targeted and Immunotherapy – New treatments targeting molecular pathways to improve outcomes.
Conclusion
Biopsy is the cornerstone in unmasking the spectrum of oral cancer, which bridges clinical suspicion and definitive diagnosis. A comprehensive understanding of manifestations of oral cancer, combined with accurate biopsy techniques and histopathological interpretation, allows for early intervention and better patient prognosis. Dental professionals play a crucial role in identifying high-risk lesions, facilitating timely referrals, and contributing to comprehensive cancer care. By staying informed and vigilant, clinicians can significantly impact oral cancer detection and patient survival rates.