Oral cancer natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Oral cancer}} | {{Oral cancer}} | ||
{{CMG}};{{AE}}{{ | {{CMG}}; {{AE}} {{SSW}}; {{GRR}} {{Nat}} | ||
==Overview== | ==Overview== | ||
Depending on the extent of the tumor at the time of diagnosis, the [[prognosis]] may vary. | 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. | ||
== 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== | |||
* The [[prognosis]] depends on the following: | |||
** Stage of the cancer | |||
** Number and size of [[lymph nodes]] with [[cancer]] | |||
** [[HPV]] infection of the [[oropharynx]] | |||
** [[Smoking]] history more than a ten pack-year | |||
* [[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. | |||
== | == Complications == | ||
*Direct surgical complications include [[infection]], [[bleeding]], [[aspiration]], wound breakdown, flap loss, and [[fistula]]. | |||
*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== | ||
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
- The prognosis depends on the following:
- Stage of the cancer
- Number and size of lymph nodes with cancer
- HPV infection of the oropharynx
- Smoking history more than a ten pack-year
- 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:
- More than 50% oral cancers are diagnosed when they have spread to throat and neck.
Complications
- Direct surgical complications include infection, bleeding, aspiration, wound breakdown, flap loss, and fistula.
- Complications of chemotherapy includes the following:[1]
- Neurotoxicity- This complication is a side-effect of certain classes of drugs, such as the vinca alkaloids.
- Bleeding
- Complications of radiation therapy includes the following:[2]
- Complications common to both chemotherapy and radiation include the following:[3]
- 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 infection
- Nutritional compromise, such as 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 radiotherapy before age 9
References
- ↑ 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.
- ↑ 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.
- ↑ 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.