Oral cavity cancer

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.

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

References:^[1][2]

Epidemiological data refers to the US, unless otherwise specified.

• 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]

• Oral mucosal cancer: squamous cell carcinoma (most common); ulcerative or verrucous growth
• Salivary gland cancer: usually mucoepidermoid carcinoma (see Malignant tumors of the salivary glands)
• Tonsillar cancer: squamous cell carcinoma (most common, > 70%), lymphoma

References:^[1][5][6]

• Halitosis
• Pain (e.g., earache)
• Dysphagia
• Nonhealing ulcer on tonsils, lateral/ventral tongue, lower lip, and/or floor of the mouth
• Unusual bleeding in the mouth
• Facial swelling (e.g., around the jawbone), pain or paralysis of a part of the face → salivary gland tumor likely
• Lymphadenopathy: regional, lymphogenic metastasis occurs early ; distant metastases in lungs, liver, and bones emerge later

A second carcinoma often develops close to the primary lesion!

References:^[1][7]

• Biopsy and histopathology of the lesion
• Panendoscopy: assessment of tumor extent
• HPV testing
• Chest x-ray, axial CT: assess tumor spread in solid organs; screen for lymph node and bone metastases
• PET-CT

References:^[1][8]

• 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
  • Neck dissection

A patient with oral cavity carcinoma is at risk for airway obstruction. See “Airway management in head and neck cancer” before procedural sedation and/or airway manipulation.

• 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]