ORAL CANCER

James Nethery, M.D.

April 10th, 2000

Head & Neck Cancer:

Incidence –

· 67,000 New cases/year

· 55% are Squamous cell

· Male/female incidence 3:1

Sites & Distributions –

· Orophyarynx/ hypopharynx 15%

· Major salivary glands 7%

· Nasopharynx 4%

· Nose & paranasal sinuses 4%

· Unknown primary 2%

· Oral 40%

-Tongue, lip, oral cavity, floor of mouth,

minor salivary glands

· Larynx 25%

***Estimated cancer death caused by cigarette smoking in the United States (1998) was

Oral cavity 6,380

Larynx 3,475

***Tobacco use is responsible for 35% of all cancer related deaths.

***The estimated annual cost of smoking related medical care is 50 billion

***In 1999, American Cancer Society estimated 30,000 new cases of incidence of oral and pharyngeal cancer.

Methods of Smoking Cessation:

· Cold turkey

· Acupuncture

· Hypnotism

· Buddy system

· Five day plan

· Nicotine replacement

Head & Neck Cancer:

Patient Evaluation (current symptoms) –

· Non-healing ulcer

· Persistent bleeding

· Change in denture fit

· Ear and/or facial pain

· Mass in neck or soft tissue

History –

· Family history of cancer

· Other major medical problems

· Tobacco & alcohol use

· Medications

· Allergic reactions

Patient Examination –

· Palpation & inspection

· Mirror exam of pharynx

· Mirror exam of larynx

· Record size and location

Physical Examination –

· Document findings

· Nasopharyngolaryngoscopy

· General anesthesia exam

Clinical Malignant Changes:

· Ulceration

· Indurations

· Leukoplakia

· Bleeding

· Erythoplasia

· Cervical mass

· Weight loss

· Dysphasia

· Pain

***Leukoplakia – most frequent; incidence: most common on lateral tongue and buccal mucosa

***Erytholeukoplakia – read and white lesions; higher risk of malignant changes

Head & Neck Cancer Staging (TNM):

T – refers to primary tumor
N – refers to regional nodes
M – distant metastases
T1 – less than 2cm diameter
T2 – 2cm to 4cm diameter
T3 – greater than 4cm
T4 – invaded adjacent tissue
N1 – single node < 3cm
N2 – single node 3 to 6cm
N3 – single node > 6cm or bilateral nodes
M0 – no distant metastases
M1 – distant metastases

What is a biopsy?

· The removal and examination of a tissue sample from an area of suspected cancer

· A biopsy is the only definitive way to make a diagnosis of cancer

Examination and Diagnosis:

· Microscopic slides are made from the margins of the tissue mass

· Slides examined under a microscope

· Pathologist reports findings and conclusions

Types of Biopsies:

· Core needle biopsy – uses a large needle that is inserted into the tumor to withdraw cells for examination

· Fine needle biopsy – needle is inserted into the tumor and cells are aspirated for examination

· Endoscopic biopsy – use of a thin fiber-optic tube inserted into the body opening to remove tissue for examination

· Incisional biopsy – surgical incision and removal of segment of a large tumor

· Excisional biopsy – complete removal of the tumor mass

**Will a biopsy cause cancer to spread?

· In almost all cases, a biopsy will not cause cancer to spread

Treatment Objectives:

· Early detection

· Effective treatment plan

· Avoid unnecessary delays

· Eradication of all tumor

· Reconstructive surgery

Clinical Course of Head and Neck Cancer:

· Leokoplakia – white plaque

· Erythroplasia – velvety read area

· Spreads by invasion to:

o Surrounding structures

o Cervical lymph nodes

o Distant metastases

Less frequent soft tissue changes:

· Crusting on lip (90% lower lip)

· Pigmented lesions showing change (mole)

· Tissue growth out of extraction site

· Difficulty swallowing

· Enlargement of gingival tissues

Distant metastases of Head and Neck Cancers (most common):

Metastases occurs late:

· To lungs

· To liver

· To bone

Methods of Treating Cancer:

· Surgery

Advantages –

§ Fast

§ Margins checked by pathologist

Disadvantages –

§ Increased morbidity (pain)

§ Tissue defects

· Radiation

· Chemotherapy

· Immunotherapy

Oral Oncology (other options):

· Maxillofacial prosthesis

· Radiation stents and shields

· Tissue replacement implants

· Root form implants

Surgical Procedures:

· Maxillary resection – portion of the roof of the mouth is removed

· Mandibular resection – lower jaw removed

· Neck dissection – muscles in neck are removed

· Glossectomy – removal of the tongue

· Commando-composite resection – a combination of the neck dissection and glossectomy

· Orbital exenteration – removal of the eye, ear, and/or nose

Post Maxillectomy (indicators of care):

· Loss of speech

· Loss of mastication

· Loss of deglutition

· Exposure of nasal sinuses

· Exposure of pharyngeal mucosa

· Loss of dental-alveolar structures

 
Last modified: March 25, 2001 01:45 PM
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