• Clinical science

Oral cavity cancer

Summary

Oral cavity cancers refer to malignant tumors of the oral mucosa, tonsils, and salivary glands. Predisposing factors include smoking, oral tobacco consumption, long term alcohol use, and human papilloma virus infection. Oral cavity cancers usually present in males, aged 55–60 years, with clinical features like pain, dysphagia, or a nonhealing ulcer on the tonsils, tongue, or oral mucosa. Clinically suspected cases are confirmed via histopathological examination of a biopsy specimen. Imaging and panendoscopy help determine the extent of the tumor and to rule out spread. Treatment depends upon the stage of the tumor and the extent of its spread, and may include surgical resection (usually with neck dissection), radiation therapy, and/or chemotherapy.

Epidemiology

  • Peak incidence: 55–60 years
  • Sex: > 2:1

References:[1][2]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Risk factors
    • Oral tobacco consumption (e.g., snuff, paan/betel quid), smoking
    • Long-term alcohol consumption
    • Poor oral hygiene, chronic mechanical irritation (e.g., badly positioned dentures)
    • Human papillomavirus, particularly HPV 16, 18, 31, and 33
    • Presence of precancerous lesions : leukoplakia , erythroplakia , erythroleukoplakia

References:[1][3][4]

Types of cancers in the oral cavity

References:[1][5][6]

Clinical features

A second carcinoma often develops close to the primary lesion!

References:[1][7]

Diagnostics

References:[1][8]

Treatment

  • Localized malignancy: surgical resection
  • Tumors with local spread : surgery (usually with neck dissection) + radiation therapy, with or without chemotherapy
  • Inoperable tumors: radiation therapy with adjuvant chemotherapy
  • Surgical procedures
    • Maxillectomy, mandibulectomy
    • Glossectomy (tongue removal; total, hemi or partial), laryngectomy
    • Radical neck dissection

Prognosis

  • Early diagnosis and treatment usually result in a good curative rate.
  • HPV-positive tumors have a good prognosis since they respond better to chemo- and/or radiotherapy.

References:[1]

  • 1. Sim CQ. Cancers of the Oral Mucosa. In: Elston DM. Cancers of the Oral Mucosa. New York, NY: WebMD. http://emedicine.medscape.com/article/1075729. Updated June 29, 2017. Accessed July 4, 2017.
  • 2. The American Cancer Society medical and editorial content team. What Are the Key Statistics About Oral Cavity and Oropharyngeal Cancers?. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.html. Updated January 6, 2017. Accessed February 16, 2017.
  • 3. Orbak R, Bayraktar C, Kavrut F, Gündogdu C. Poor oral hygiene and dental trauma as the precipitating factors of squamous cell carcinoma. Oral Oncol. 2005; 41(6): pp. 109–113. doi: 10.1016/j.ooe.2005.02.006.
  • 4. Kim SM. Human papilloma virus in oral cancer. J Korean Assoc Oral Maxillofac Surg. 2016; 42(6): pp. 327–336. doi: 10.5125/jkaoms.2016.42.6.327.
  • 5. Kokot N. Malignant Tonsil Tumor Surgery. In: Meyers AD. Malignant Tonsil Tumor Surgery. New York, NY: WebMD. http://emedicine.medscape.com/article/848034. Updated March 16, 2016. Accessed February 16, 2017.
  • 6. Boahene DKO, Olsen KD, Lewis JE, Pinheiro AD, Pankratz VS, Bagniewski SM. Mucoepidermoid carcinoma of the parotid gland. Arch Otolaryngol Head Neck Surg. 2004; 130(7): pp. 849–856. doi: 10.1001/archotol.130.7.849.
  • 7. van Zyl A, Bunn BK. Clinical features of oral cancer. SADJ. 2012; 67(10): pp. 566–569. pmid: 23957097.
  • 8. Gourin CG, Watts T, Williams HT, Patel VS, Bilodeau PA, Coleman TA. Identification of distant metastases with PET-CT in patients with suspected recurrent head and neck cancer. Laryngoscope. 2009; 119(4): pp. 703–706. doi: 10.1002/lary.20118.
  • The American Cancer Society medical and editorial content team. Treatment Options for Oral Cavity and Oropharyngeal Cancer by Stage. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/treating/by-stage.html. Updated March 2, 2017. Accessed July 4, 2017.
last updated 02/20/2019
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