Oral cancer screening

WSAVA guideline

Key findings

• Histopathology is mandatory: "Benign and malignant conditions can appear very similar clinically, therefore histopathology is mandatory" (§1 Key Points). All oral lesions should be sampled regardless of appearance — a cat's eosinophilic granuloma was "diagnosed" as SCC without biopsy and suffered 5 years.
• "Epulis" is a misuse: an epulis is any gingival growth, which may include malignant tumours — the term must not be equated with benign.
• Benign look-alikes: gingival hyperplasia (Boxer predisposition; drug-induced with cyclosporine, phenobarbital, calcium channel blockers; excised tissue must be submitted to rule out neoplasia); peripheral odontogenic fibroma (formerly fibromatous epulis; cure requires extraction + periodontal debridement); acanthomatous ameloblastoma — benign but locally invasive, excision with 5–10 mm margins, up to 90% radiation control rate.
• Malignant frequencies as printed: dog — malignant melanoma 30–40% of malignant oral tumours (mean age 12 years), SCC 24–30% (mean 8 years), fibrosarcoma 17–25% (mean 8–9 years; Golden Retrievers over-represented, incl. histologically low-grade/clinically high-grade form); cat — SCC 64–75% (most common; mean 12.5 years), fibrosarcoma 12–22%; oral osteosarcoma ~2% of feline oral tumours; MCT ~6%.
• Melanoma behaviour: melanotic or amelanotic; spreads to local lymph nodes in 70% of cases and lungs in 66% — guarded to poor prognosis unless excised before metastasis.
• Imaging: dental radiographs may show bony destruction, proliferation or cyst-like change; bone proliferation displacing incisors is indicative of malignancy (SCC); CT of the head evaluates local extent and is ideally performed just before biopsy as it helps plan it.
• 3-questions client tool (GDC): (1) What is it? — biopsy under GA + histopathology; (2) How big is it? — head CT for local invasion; (3) Has it spread? — examine head/neck lymph nodes, lungs, abdominal organs (full-body CT ± abdominal ultrasound, MRI, lymph node sampling; PET-CT more sensitive but not widely available); only then can the optimal plan and prognosis be created.
• Owner warning signs (client tool): bad breath, difficulties eating, bleeding from mouth or nose, lump(s), swelling(s), ulcer(s), tissue colour change, any other change in the mouth or face → visit the vet immediately.
• Treatment landscape (client tool): surgery, radiation therapy, electrochemotherapy, immunotherapy, (metronomic) chemotherapy, photodynamic therapy, or multimodal combinations — "Most of the oral cancers, especially in dogs, can be cured, if diagnosed and treated early!"

Recommendations

• Biopsy (under GA) + histopathology every oral mass — benign and malignant lesions are clinically indistinguishable

  Expert consensus (Dental Guidelines Committee)

• Perform regular oral examinations; prompt and aggressive therapy offers the best chance of cure

  Expert consensus

• Image the lesion: dental radiographs of all masses; CT of the head for local extent, ideally before biopsy

  Expert consensus

• Search for metastasis in malignant tumours (lymph nodes, lungs, abdomen) before definitive planning

  Expert consensus

• Surgical excision is the treatment of choice for most oral tumours, margins by growth type/tissue planes (1–2 cm melanoma, 3 cm MCT, 5–10 mm ameloblastoma, 2–3 cm OSA)

  Expert consensus

• Do not equate "epulis" with benign; always submit gingivectomy tissue for histopathology

  Expert consensus

• Educate clients on warning signs and early-diagnosis curability; investigate any oral change promptly

  Expert consensus (GDC client handout)

• Refer early when biopsy, CT or oncologic therapy exceeds practice capability — delay caused 5 preventable years in a cited case

  Expert consensus

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