- Oral cancer is the sixth commonest cancer in the world
- Accounts for 2-4 % of all malignant tumours in the western world
- Incidence is increasing in young people
- Particularly common in some parts of Asia
- Associated with other tumours of the aerodigestive tract
- In particular carcinoma of the :
- Larynx
- Bronchus
- Oesophagus
- 85% are squamous cell carcinomas
Risk factors
- Risk factors for oral cancer included
- Smoking
- Alcohol excess
- Syphilitic glossitis
- Sideropenic dysphagia
- Premalignant conditions included
- Leucoplakia
- Erythroplakia
- Chronic hyperplastic candidiasis
Clinical features
- Oral cancer produces symptoms early
- This allows the potential for early diagnosis and treatment
- Diagnosis is usually clinical
- Commonest sites with the mouth are
- Tongue
- Floor of the mouth
- Gingiva and alveolar ridge
- Buccal mucosa
- Hard palate
- Most tongue cancers occur on the lateral margin of the middle third
of the tongue
- Tumours in the floor of the mouth often have early bone involvement
- Present as exophytic growths or ulcers
- Pain is a late symptom
- Leucoplakia may be present
- 50% patients have lymph node metastases at presentation
Investigation
- Diagnosis can be confirmed by a biopsy under local anaesthetic
- FNA of palpable nodes is useful to confirm lymphatic spread
- CT is useful for assessing extent of nodal disease
Management
Resection
- Appropriateness and approach to surgery depends on
- Fitness of patient
- Site of tumour
- Stage of disease
- Previous irradiation
- Histological type
- Wide surgical resection is usually required
- Usually performed in association with dissection of lymphatic
drainage
- Resection often involves lip splitting or mandibulectomy
Reconstruction
- Primary reconstruction may be required
- Usually requires the use of free flaps
- Produces acceptable functional and cosmetic results
Radiotherapy
- Tumours are radiosensitive
- Osteonecrosis is a rare complication
- No longer necessary to remove teeth prior to radiotherapy
- Brachytherapy useful in the management of small tumors
Chemotherapy
- Tumours are relatively resistant to chemotherapy
Bibliography
Thoma A, Levis C, Young J E. Oromandibular
restruction after cancer resection. Clin Plast Surg 2005;
32: 361-375.
McCabe K J. Rubenstein D. Advances in head and neck
imaging. Otolaryngol Clin North Am 2005; 38:
307-319.
Patel K N. Shah J P. Neck dissection: past, present,
future. Surg Oncol Clin North Am 2005; 14:
461-477. |