What to do when you suspect oral cancer?
Two week watch and wait
An injury to the oral mucosa, such as a traumatic mouth ulcer, needs treatment and should be reassessed for healing. If it fails to improve within two weeks refer for further investigation, usually including biopsy.
When to urgently refer
Any lesion, neck lump or other signs and symptoms that have persisted for more than two weeks without a definite cause should be immediately referred as a suspected malignancy.
For investigation of suspected oral cancer, refer to an an oral medicine specialist or oral and maxillofacial surgeon. For suspected oropharyngeal cancer, refer to the patient’s GP. The GP will usually make an onward referral to an ear, nose and throat (ENT) or head and neck surgeon.
Specialists – public
All Victorian patients eligible for public dental care should be referred to the Oral Medicine (Mucosal) Clinic at the Royal Dental Hospital of Melbourne. Non-eligible patients may also be seen in emergencies, so as not to delay diagnosis. For suspected malignancy, phone the clinic to coordinate emergency care.
Phone: (03) 9341 1120
Fax: (03) 9341 1048
Specialists – private
Find an oral medicine specialist who is a member of The Oral Medicine Academy of Australasia (OMAA) here.
Find an oral and maxillofacial surgeon who is a member of The Australian and New Zealand Association of Oral and Maxillofacial Surgeons (ANZAOMS) here.
Specialist assessment: what’s involved?
Specialist assessment includes a comprehensive oral examination, involving intra-oral examination with white dental light, extra-oral examination and palpation of the lymph nodes in the head and neck region. The specialist may also conduct adjunctive tests, such as blood tests, imaging or biopsy. Ideally, the first specialist appointment should occur within two weeks of the initial referral.
- Referral letter or form with relevant medical and family history, history of tobacco use and alcohol consumption if relevant, current medications and allergies
- Results of current clinical investigations e.g. imaging and pathology reports
- Results of relevant prior investigations e.g. chest x-rays or CT scans
- Photos of the lesion (shared securely via telehealth platforms such as HealthDirect)
- Clearly document why the patient is being referred, in the referral notes on your patient record system
The national optimal care pathway for head and neck cancer describes an integrated model of care that puts the patient’s needs first. There is a specific optimal care pathway for Aboriginal and Torres Strait Islander people (including this useful guide). It is important to note that these are cancer pathways, not clinical practice guidelines.
Effective communication is essential at every step. Explain to your patient (and their family or carer, if appropriate):
- why they are being referred
- who they are being referred to and how long they will have to wait
- what to expect from the appointment, including possible tests
- how to access support for physical or psychological symptoms, if needed
Give brief advice to help your patient with smoking or alcohol cessation if applicable, including referral to Quitline or DirectLine. If your patient goes on to be diagnosed with oral cancer or has questions about referral to specialist care, you could signpost them to these resources if you feel it is appropriate: Cancer Council Victoria’s information about head and neck cancer; the Guide to best cancer care (consumer version of the Optimal Care Pathway for head and neck cancers); and head and neck cancer support groups on the Head and Neck Australia website.
If your patient identifies as an Aboriginal or Torres Strait Islander person, help them access support from their local Aboriginal Community Controlled Health Organisation (ACCHO) or an Aboriginal Hospital Liaison Officer (if your service is based at a hospital). Aboriginal and Torres Strait Islander people may also find these resources from Cancer Council Victoria helpful.
If a general medical practitioner refers a patient for a second opinion, it is best practice to treat this as an urgent referral.
“Refer your patient if signs and symptoms have persisted for more than two weeks, even if you’re unsure if it is cancer. Don’t take a chance on their life.”