Chapter 53 Oral Cavity Cancer

The oral cavity extends from the mucosal surface of the lips to the junction of the hard and soft palate. It does not include the soft palate, uvula or tonsils, which form part of the oropharynx. Oral cavity cancer is the eighth most common cancer worldwide, with an estimated 350 000 cases arising annually. There is considerable geographical variation in the incidence of oral cancers worldwide, reflecting differing lifestyles and risk factor exposure. Oral cancer is one of the most common cancers in India, with an age-adjusted incidence rate of 20 per 100 000. In Europe, there is significant variation reflecting the varying cultures and lifestyles, especially between eastern and western Europe. The majority of oral cancers do not originate from a preexisting lesion. The management of premalignant lesions is challenging, not least because of an inconsistency with nomenclature internationally but also because the natural history of these lesions remains unclear.

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Weblinks

Journal articles

https://www.hindawi.com/journals/jce/2012/701932/ (free)

Oral cavity cancer incidence varies worldwide and reflects the varied exposure of populations to predisposing risk factors. In contrast to more western populations, oral cavity cancer accounts for 30% of all cancers in India. This review paper by Ken Russell Coelhoprovides a synopsis of the incidence of oral cancer in India. He details the various cancer registries on which this information is based and provides projections for future disease incidence. Additionally, he outlines some of the challenges faced and makes recommendations on how future research might help with early detection and prevention of oral cavity cancer.

https://onlinelibrary.wiley.com/doi/full/10.1111/jop.12339/ (paid)

The management of potentially malignant oral lesions is challenging, not least because they represent a heterogeneous group and therefore varying rates of malignant transformation. There is a paucity of randomised evidence informing this. Warnakulasuriya and Ariyawardana, in this systematic review, highlight not only the range of malignant transformation rates in the studied population but also the clinical risk factors for this.

https://www.nejm.org/doi/full/10.1056/nejmoa1506007/ (free)

Management of the neck in early-stage (N0) oral cavity cancer remains controversial. The key decision centres on the need or otherwise for an elective neck dissection to manage potentially occult cervical metastases. This seminal study performed by the Neck and Neck Disease Management Group at the Tata Memorial Centre in Mumbai, India, provides students and clinicians with prospective randomised evidence on overall and disease-free survival in patients undergoing elective versus therapeutic neck dissections.

https://www.sciencedirect.com/science/article/abs/pii/S0959804915008229?via%3Dihub/ (paid)

As for the previous article, management of the N0 neck, namely when and how to electively treat, has been debated extensively. Controversy remains regarding the indications for an elective neck dissection. Sentinel lymph node biopsy (SLNB) is a staging technique that may help inform that decision. Schilling et al. present the findings of the largest multicentre prospective trial investigating the reliability and safety of SLNB in detecting occult nodal metastases in T1 to T2 oral cavity cancer.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888839/ (free)

This randomised trial corroborates and, indeed, complements the findings of the D’Cruz (Tata Memorial Centre in Mumbai, India) article as outlined above. The authors highlight the benefits for patients of an up-front neck dissection in the setting of early oral cavity cancer. They analyse the outcomes for a western population where patient characteristics, risk factors and staging investigations may differ from those for an Asian population. Ultimately, this trial demonstrates the disease-free and overall survival benefits of an elective neck dissection.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/1097-0142%28197206%2929%3A6%3C1446%3A%3AAID-CNCR2820290604%3E3.0.CO%3B2-C/ (free)

Over time, neck dissections for the management of head and neck cancers have become less radical and more targeted towards the levels appropriate for specific anatomical subsites. This seminal paper by Lindberg, based on work at the M. D. Anderson Hospital and Tumor Institute, Houston, TX, USA, served to highlight the pattern of lymphatic spread from specific sites, therefore enabling surgeons to change from a radical neck dissection to a more bespoke, yet oncologically safe, conservative procedure.

https://www.sciencedirect.com/science/article/abs/pii/S0002961005805549?via%3Dihub/ (paid)

This retrospective review by Jatin Shah of 1081 patients at the Memorial Sloan-Kettering Cancer Center, New York, NY, USA, who underwent radical neck dissection for cancers of the head and neck supports the findings of the Lindberg study. It is safe to say that this study played a significant role in establishing the fact that a supraomohyoid dissection of levels I–III is appropriate for most oral cavity cancers.

https://www.sciencedirect.com/science/article/abs/pii/S1368837511001667?via%3Dihub/ (paid)

In patients with locoregionally advanced cancer, the benefit conferred by adjuvant chemo-radiotherapy is well supported in the literature. Adverse pathological factors determine the need for adjuvant therapy. This review paper, complied by a panel of radiation oncology experts, outlines not only the indications for therapy but also appropriate regimens and their effect on survival.

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