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__NOTOC__
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{{Oral cancer}}
{{Oral cancer}}
{{CMG}};{{AE}}{{Simrat}}
{{CMG}}; {{AE}} {{SSW}}; {{GRR}} {{Nat}}
==Overview==
==Overview==
==Natural History==
If left untreated, patients with oral cancer may progress to develop a non-healing [[ulcer]], which demonstrates growth over time. A [[Neck masses causes|neck mass]] may develop, which may cause a mass defect. Depending on the extent of the [[tumor]] at the time of [[diagnosis]], the [[prognosis]] may vary. The [[Survival rate|5-year survival rate]] for oral cancer that is diagnosed early is 75%, compared to 20% for late diagnosis. Complications of oral cancer include difficulty speaking, [[dysphagia]], [[weight loss]], [[bleeding]] and even death.
==Complications==
 
== Natural History ==
* Oral cancers usually present late, as they are usually painless and often ignored by the patient.
* Eventually they present as a non-healing [[ulcer]], which demonstrates growth over time.
* Due to the extensive [[lymphatic]] drainage of the [[oral cavity]], [[Lymph node|nodal]] [[metastases]] are common at the time of [[diagnosis]].
* A [[Neck masses causes|neck mass]] may be the presenting complaint.
*<nowiki/>Because of the difficulties with direct visualization, they may extend into the tongue or have clinical [[lymph node]] [[metastases]] <nowiki/>before the [[diagnosis]] is established.
* As the [[tumors]] enlarge, they may cause a [[mass]] effect, which can lead to [[Respiratory system|respiratory]] compromise when the patient presents late i<nowiki/>n their illness.[[Tongue cancer natural history, complications and prognosis#cite note-radio-1|[1]]]
 
==Prognosis==
==Prognosis==
The prognosis (chance of recovery) depends on the following:
* The [[prognosis]] depends on the following:
*The stage of the cancer.
** Stage of the cancer
*The number and size of lymph nodes with cancer.
** Number and size of [[lymph nodes]] with [[cancer]]
*Whether the patient has HPV infection of the oropharynx.
** [[HPV]] infection of the [[oropharynx]]
*Whether the patient has a history of smoking for more than ten pack years.
** [[Smoking]] history more than a ten pack-year


The rate of curability of cancers of the lip and oral cavity varies depending on the stage and specific site. Most patients present with early cancers of the lip, which are highly curable by surgery or by radiation therapy with cure rates of 90% to 100%. Small cancers of the retromolar trigone, hard palate, and upper gingiva are highly curable by either radiation therapy or surgery with survival rates of as much as 100%. Local control rates of as much as 90% can be achieved with either radiation therapy or surgery in small cancers of the anterior tongue, the floor of the mouth, and buccal mucosa.
* [[Survival rate|5-year survival rate]] for oral cancer:
** Diagnosed early - 75%
** Diagnosed late - 20%
** Localized disease at diagnosis - 83%
** Cancer spread to other parts of the body - 32%
* Cure rate:
** 90% - If [[cancer]] is found early and before it has spread to other [[Tissue (biology)|tissues]]
* More than 50% oral cancers are diagnosed when they have spread to throat and neck.  


Moderately advanced and advanced cancers of the lip also can be controlled effectively by surgery or radiation therapy or a combination of these. The choice of treatment is generally dictated by the anticipated functional and cosmetic results of the treatment. Moderately advanced lesions of the retromolar trigone without evidence of spread to cervical lymph nodes are usually curable and have shown local control rates of as much as 90%; such lesions of the hard palate, upper gingiva, and buccal mucosa have a local control rate of as much as 80%. In the absence of clinical evidence of spread to cervical lymph nodes, moderately advanced lesions of the floor of the mouth and anterior tongue are generally curable with survival rates of as much as 70% and 65%, respectively.
== Complications ==
*Direct surgical complications include [[infection]], [[bleeding]], [[aspiration]], wound breakdown, flap loss, and [[fistula]].


Patients with head and neck cancers have an increased chance of developing a second primary tumor of the upper aerodigestive tract. A study has shown that daily treatment of these patients with moderate doses of isotretinoin (13-cis-retinoic acid) for 1 year can significantly reduce the incidence of second tumors. No survival advantage has yet been demonstrated, however, in part due to recurrence and death from the primary malignancy. An additional trial has shown no benefit of retinyl palmitate or retinyl palmitate plus beta-carotene when compared to retinoic acid alone.<ref>{{Cite web | title = NIH prognosis of Oral cancer | url =http://www.cancer.gov/types/head-and-neck/hp/lip-mouth-treatment-pdq#section/_1 }}</ref>
*Complications of [[chemotherapy]] includes the following:<ref name="pmid9591859">{{cite journal| author=Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA| title=Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. | journal=Otolaryngol Head Neck Surg | year= 1998 | volume= 118 | issue= 5 | pages= 616-24 | pmid=9591859 | doi=10.1177/019459989811800509 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9591859  }}</ref>
**[[Neurotoxicity]]- This complication is a side-effect of certain classes of drugs, such as the [[Vinca alkaloids|vinca alkaloids.]]
**[[Bleeding]]
*Complications of [[radiation therapy]] includes the following:<ref name="pmid18707827">{{cite journal| author=Gomez DR, Zhung JE, Gomez J, Chan K, Wu AJ, Wolden SL et al.| title=Intensity-modulated radiotherapy in postoperative treatment of oral cavity cancers. | journal=Int J Radiat Oncol Biol Phys | year= 2009 | volume= 73 | issue= 4 | pages= 1096-103 | pmid=18707827 | doi=10.1016/j.ijrobp.2008.05.024 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18707827  }}</ref>
**[[Radiation]] [[caries]]
**[[Trismus]]
**[[Osteonecrosis]]
*Complications common to both [[chemotherapy]] and [[radiation]] include the following:<ref name="pmid19531406">{{cite journal| author=Oh HK, Chambers MS, Martin JW, Lim HJ, Park HJ| title=Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis. | journal=J Oral Maxillofac Surg | year= 2009 | volume= 67 | issue= 7 | pages= 1378-86 | pmid=19531406 | doi=10.1016/j.joms.2009.02.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19531406  }}</ref>
**[[Oral]] [[mucositis]]
**Chronic [[dysphagia]]
**[[Anemia]]
**Pharyngocutaneous [[fistula]]
**[[Aspiration]]
**[[Infections]] such as [[viral]], [[bacterial]], and [[fungal]] that results from [[myelosuppression]], [[xerostomia]], and damage to the mucosa from [[radiotherapy]] or [[chemotherapy]]
**[[Xerostomia]]
**Functional disabilities such as impaired ability to swallow, eat, taste and speak because of [[trismus]], [[dry mouth]], [[mucositis]], and i[[Infection|nfection]]
**Nutritional compromise, such as [[Malnutrition|poor nutrition]] from eating difficulties caused by dry mouth, [[mucositis]], [[dysphagia]], and [[loss of taste]].
**Abnormal [[dental]] development
***Altered [[tooth]] development, [[craniofacial]] growth, or [[skeletal]] development in children- secondary to high doses of [[chemotherapy]] and [[Radiation therapy|radiotherapy]] before age 9


==References==
==References==
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[[Category:Mature chapter]]
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Latest revision as of 12:50, 11 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2]; Grammar Reviewer: Natalie Harpenau, B.S.[3]

Overview

If left untreated, patients with oral cancer may progress to develop a non-healing ulcer, which demonstrates growth over time. A neck mass may develop, which may cause a mass defect. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. The 5-year survival rate for oral cancer that is diagnosed early is 75%, compared to 20% for late diagnosis. Complications of oral cancer include difficulty speaking, dysphagia, weight loss, bleeding and even death.

Natural History

  • Oral cancers usually present late, as they are usually painless and often ignored by the patient.
  • Eventually they present as a non-healing ulcer, which demonstrates growth over time.
  • Due to the extensive lymphatic drainage of the oral cavity, nodal metastases are common at the time of diagnosis.
  • A neck mass may be the presenting complaint.
  • Because of the difficulties with direct visualization, they may extend into the tongue or have clinical lymph node metastases before the diagnosis is established.
  • As the tumors enlarge, they may cause a mass effect, which can lead to respiratory compromise when the patient presents late in their illness.[1]

Prognosis

  • 5-year survival rate for oral cancer:
    • Diagnosed early - 75%
    • Diagnosed late - 20%
    • Localized disease at diagnosis - 83%
    • Cancer spread to other parts of the body - 32%
  • Cure rate:
    • 90% - If cancer is found early and before it has spread to other tissues
  • More than 50% oral cancers are diagnosed when they have spread to throat and neck.

Complications

References

  1. ↑ Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA (1998). "Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients". Otolaryngol Head Neck Surg. 118 (5): 616–24. doi:10.1177/019459989811800509. PMID 9591859.
  2. ↑ Gomez DR, Zhung JE, Gomez J, Chan K, Wu AJ, Wolden SL; et al. (2009). "Intensity-modulated radiotherapy in postoperative treatment of oral cavity cancers". Int J Radiat Oncol Biol Phys. 73 (4): 1096–103. doi:10.1016/j.ijrobp.2008.05.024. PMID 18707827.
  3. ↑ Oh HK, Chambers MS, Martin JW, Lim HJ, Park HJ (2009). "Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis". J Oral Maxillofac Surg. 67 (7): 1378–86. doi:10.1016/j.joms.2009.02.008. PMID 19531406.


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