VELscope Oral Cancer Screening System

If it’s caught early, oral cancer has an 80% survival rate. But too often it’s detected  late and patients end up losing part of their tongue, jaw, or their lives. The VELscope system consists of a light source and direct viewing handpiece that will be used during oral cancer and mucosal screenings as part of routine dental hygiene visits on all adult patients. Specifically, VELscope is an adjunctive screening device that utilizes a narrow band of high-energy blue light and specialized filter technology to help evaluate oral mucosa for abnormal areas of concern, such as potentially cancerous lesions that can be undetectable under white light.

This enables the treatment of cancerous lesions earlier in the disease process, This is significant because 50% of patients diagnosed with oral cancer are expected to die within 5 years. But, if caught early, 90% of oral cancer cases are survivable.

The American Cancer Society estimates that there will be nearly 31,000 new cases of oral cancer in the U.S. each year. It is also estimated that oral cancer kills one American every hour, 24 hours a day. Early screening, diagnosis and treatment for oral cancer can save lives. VELscope in particular can play a large part because it is simple, noninvasive, easy to incorporate into routine hygiene exams.

Called a Visually Enhanced Lesion Scope (VELScope), this simple, hand-held device emits a cone of blue light into the mouth that excites various molecules within our cells, causing them to absorb the light energy and re-emit it as visible fluorescence. Remove the light, and the fluorescence of the tissue is no longer visible.

Because changes in the natural fluorescence of healthy tissue generally reflect light-scattering biochemical or structural changes indicative of developing tumor cells, the VELScope allows dentists to shine a light onto a suspicious sore in the mouth, look through an attached eyepiece, and watch directly for changes in color. Normal oral tissue emits a pale green fluorescence, while potentially early tumor, or dysplastic, cells appear dark green to black. ”Looks alone can be deceiving,” said Rosin, referring to the common practice of diagnosing cancer based on the general appearance.

Using a special blue light, we are able to illuminate all tissues that we saw originally with white light. By comparing the two exams, dentists can identify areas that need to be biopsied. If there is an abnormality such as on the side of a tongue, the tissue will lose its ability to fluoresce the same way, so rather than looking green as it did before, it appears as a dark shadow.

Changes in the mouth that are undetectable by the naked eye become visible with the help of the VELScope, a fluorescence technology developed at the BC Cancer Agency, an agency of the Provincial Health Services Authority. The blue light directed by this hand-held, portable device helps dentists to define the borders of a cancerous lesion that are otherwise invisible under white light.

“You could compare it to the Pap smear screening for cervical cancer,” explains Dr. Miriam Rosin, senior scientist at the BC Cancer Agency and professor at Simon Fraser University. “Dentists are able to use the VELscope to determine who needs more evaluation through  biopsy which will be sent to an Oral Biopsy Service.”

Right now, 30-40% of  Oral Cancers are diagnosed in the late stages. Scientists are hoping this Velscope will help detect malignancies alot earlier, perhaps even before they develop into cancer. Dr. Miriam Rosin Sr., Scientist, says, “you really down the road want to catch, maybe 10 years before the cancers develop that’s going to save alot of agony for patients going through the process of the treatment. It also means we prevent the deaths that are due to this disease.” As a front-line device, the Velscope uses the same optical technology that’s been successful in detecting precancerous changes in the lung and cervix.

Dr. Calum MacCauley Sr., Scientist at  the BC Cancer Agency, says, “alot of these lesions are invisible to the human eye so without contrasting agent, you can’t seem them, so this makes the invisible visible. And that’s great for patients like Lena. Lena Pawlowich, Oral Cancer Patient, says,”That’s why I was quite amazed they told me they were going to do a biopsy, because something didn’t seem right and they were right.”

“The ability to detect the disease early means we can control the disease. The problem with oral cancer is it’s very aggressive cancer, if you catch it at a late state the prognosis and outcome is very poor,” says Dr. Miriam Rosin, Senior Scientist at the BC Cancer Agency.

Why do the cancerous tissues look different under the light?

That is because all tissues in our body naturally give off some radiation when exposed to light. But abnormal cells or cancer cells do this differently than healthy ones so that a computer can pick up this difference and translate the result, which is immediately available in the doctor’s office. This technology is really on the cutting edge of cancer detection. So far we know when used on the cervix, it can detect lesions as small as 1 millimeter and only a few cell layers thick.

What are the signs and symptoms of oral cancer?

In the early stages there can be no signs because there’s no discomfort or any obvious changes. The symptoms of oral cancer that you want to be on the watch for include:

· a mouth sore that doesn’t heal or bleeds easily
· a persistent white or red patch in the mouth
· lumps or thickening in mouth, throat, tongue
· difficulty with chewing or swallowing

Or in some cases nothing at all is visible – and that is why the Velscope is so important. Early detection is key to increasing the survival rate for these cancers.

Because there are so many benign tissue changes that occur normally in your mouth, and some things as simple as a bite on the inside of your cheek may mimic the look of a dangerous tissue change, it is important to have any sore or discolored area of your mouth, which does not heal within 14 days, looked at by a professional.

Other symptoms include; a lump or mass which can be felt inside the mouth or neck, pain or difficulty in swallowing, speaking, or chewing, any wart like masses, hoarseness which lasts for a long time, or any numbness in the oral/facial region. Other than the lips, the most common areas for oral cancer to develop are on the tongue and the floor of the mouth. Individuals that use chewing tobacco, are likely to have them develop in the sulcus between the lip or cheek and the soft tissue (gingiva) covering the lower jaw (mandible). In the US, cancers of the hard palate are uncommon, though not unknown. The base of the tongue at the back of the mouth, and on the pillars of the tonsils, are other sites where it is commonly found. If your dentist or doctor decides that an area is suspicious, the only way to know for sure is to do a biopsy of the area. This is not painful, is inexpensive, and takes little time. It is important to have a firm diagnosis as early as possible. It is possible that your general dentist or medical doctor, may refer you to a specialist to have the biopsy performed. This is not cause for alarm, but a normal part of referring that happens between doctors of different specialties.