Oral cancer natural history, complications and prognosis: Difference between revisions

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Revision as of 12:53, 10 September 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. The 5-year survival rate for oral cancer diagnosed early is 75% compared to 20% for oral cancer diagnosed late.

Natural History

Complications

Prognosis

The prognosis (chance of recovery) depends on the following:

The stage of the cancer.
The number and size of lymph nodes with cancer.
Whether the patient has HPV infection of the oropharynx.
Whether the patient has a history of smoking for more than ten pack years.

Early detection is important. The 5-year survival rate for oral cancer diagnosed early is 75% compared to 20% for oral cancer diagnosed late.^[1]Approximately half of people with oral cancer will live more than 5 years after they are diagnosed and treated. If the cancer is found early, before it has spread to other tissues, the cure rate is nearly 90%. More than half of oral cancers have spread when the cancer is detected. Most have spread to the throat or neck.^[2]With early detection and timely treatment, deaths from oral cancer could be dramatically reduced. The 5-year survival rate for those with localized disease at diagnosis is 83 percent compared with only 32 percent for those whose cancer has spread to other parts of the body.

People with oral cavity cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.A prognosis is the doctor’s best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.

The following are prognostic factors for squamous cell carcinoma (SCC). Grading is not a very useful prognostic factor as it does not indicate treatment response or survival.

Stage

The size of the tumour and extent to which the cancer has spread to the lymph nodes are the main prognostic factors. Larger and more extensive late-stage tumours have a poor prognosis.

Site

The prognosis also depends on whether the primary tumour is on the lips, tongue, gums or the lining of the mouth.

Resection margin

If the cancer extends to the outer margin of the tissue removed during surgery, it is called a positive resection margin. A negative resection margin indicates a good prognosis.

Tumour thickness

The thicker the tumour, the poorer the prognosis.

Vascular invasion

The prognosis is poor if the cancer has spread to the blood vessels, which may result in rapid and widespread metastases

References

Template:WH Template:WS

[1] "NIH oral cancer fact sheet".

[2] "National Library of Medicine prognosis of oral cancer".

[1]

[2]

@@ Line 16: / Line 16: @@
 The 5-year survival rate for those with localized disease at diagnosis is 83 percent compared with only 32 percent for those whose cancer has spread to other parts of the body.
-Early detection of oral cancer is often possible. Tissue changes in the mouth that might signal the beginnings of cancer often can be seen and felt easily.
+People with oral cavity cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.A prognosis is the doctor’s best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
-Prognosis depends on stage and overall health. Grading of the invasive front of the tumor is a very important prognostic parameter. 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]].
-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.
+The following are prognostic factors for squamous cell carcinoma (SCC). Grading is not a very useful prognostic factor as it does not indicate treatment response or survival.
-Early cancers (stage I and stage II) of the lip and [[oral cavity]] are highly curable by surgery or by radiation therapy, and the choice of treatment is dictated by the anticipated functional and cosmetic results of treatment and by the availability of the particular expertise required of the surgeon or radiation oncologist for the individual patient. The presence of a positive margin or a [[tumor]] depth of more than 5 mm significantly increases the risk of local recurrence and suggests that combined modality treatment may be beneficial.[8,9]
+*Stage
-Advanced cancers (stage III and stage IV) of the lip and oral cavity represent a wide spectrum of challenges for the surgeon and radiation oncologist. Except for patients with small T3 lesions and no regional lymph node and no distant metastases or who have no lymph nodes larger than 2 cm in diameter, for whom treatment by radiation therapy alone or surgery alone might be appropriate, most patients with stage III or stage IV tumors are candidates for treatment by a combination of surgery and radiation therapy. Furthermore, because local recurrence and/or distant metastases are common in this group of patients, they should be considered for clinical trials. Such trials evaluate the potential role of radiation modifiers or combination chemotherapy combined with surgery and/or radiation therapy.
+The size of the tumour and extent to which the cancer has spread to the lymph nodes are the main prognostic factors. Larger and more extensive late-stage tumours have a poor prognosis.
-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>
+*Site
+The prognosis also depends on whether the primary tumour is on the lips, tongue, gums or the lining of the mouth.
+*Resection margin
+If the cancer extends to the outer margin of the tissue removed during surgery, it is called a positive resection margin. A negative resection margin indicates a good prognosis.
+*Tumour thickness
+The thicker the tumour, the poorer the prognosis.
+*Vascular invasion
+The prognosis is poor if the cancer has spread to the blood vessels, which may result in rapid and widespread metastases
 ==References==