Oral cancer natural history, complications and prognosis
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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]
Overview
If left untreated, patients with oral cancer may progress to develop non-healing ulcer which demonstrates growth over time. A neck mass may be 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 diagnosed early is 75% compared to 20% for oral cancer diagnosed late. Complication 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 oral tongue or have clinical lymph metastasesbefore 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 (chance of recovery) 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 ten pack years.
- 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
- 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.