Skip to main content

Oral Cancer: Location, Staging, Surgical Management, and Outcomes

  • Chapter
  • First Online:
Targeting Oral Cancer

Abstract

Although substantial advances in adjuvant radiotherapy and chemotherapy for cancers of the oral cavity and neck have been made in recent years, surgery will be the preeminent approach for the treatment of the 46,000 new US patients in 2015 (Cancer Facts and Figure 2015). Squamous cell carcinoma is the predominate form of cancer that occurs in the head and neck (HNSCC) and is classified by location; it can occur in the oral cavity (mouth), nasal cavity or paranasal sinuses, nasopharynx (upper section of the throat), oropharynx (midsection of the throat), hypopharynx (lower part of the throat), and larynx (voice box). Despite the large number of new cases of HNSCC every year, the National Cancer Institute spent only ~$7 million of its nearly $3 billion FY2013 budget (0.002 %) on laryngeal and pharyngeal cancer research (http://fundedresearch.cancer.gov). Esophageal cancers (between the pharynx and the stomach), which are considered a digestive disease are also predominately SCCs, will register as additional 17,000 US patients this year. As nonsurgical approaches to treating HNSCC lag egregiously behind the progress realized in many other cancers, and funding for research is negligible, nearly all 46,000 new patients will face surgical intervention and the associate comorbidities. This chapter will focus specifically on the diagnosis, staging, surgical treatment, and expected outcomes of patient with oral cavity and neck cancers.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hoffman HT, Karnell LH, Funk GF, Robinson RA, Menck HR. The National Cancer Data Base report on cancer of the head and neck. Arch Otolaryngol Head Neck Surg. 1998;124(9):951–62.

    Article  PubMed  Google Scholar 

  2. Howlader N, Noone AM, Krapcho M, et al. SEER cancer statistics review, 1975–2011. Bethesda: National Cancer Institute; 2014 [Updated based on November 2013 SEER data submission, posted to the SEER web site April 2014. Accessed 30 Jan 2015]. http://seer.cancer.gov/archive/csr/1975_2011/#citation.

  3. American Cancer Society. Cancer facts & figures 2014. Atlanta: American Cancer Society; 2014.

    Google Scholar 

  4. International Agency for Research on Cancer. GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. Lyon, France: World Health Organization; 2012.

    Google Scholar 

  5. Mashberg A, Boffetta P, Winkelman R, Garfinkel L. Tobacco smoking, alcohol drinking, and cancer of the oral cavity and oropharynx among U.S. veterans. Cancer. 1993;72(4):1369–75. Epub 15 Aug 1993.

    Article  PubMed  Google Scholar 

  6. Johnson N. Tobacco use and oral cancer: a global perspective. J Dent Educ. 2001;65(4):328–39.

    PubMed  Google Scholar 

  7. Khan Z, Tonnies J, Muller S. Smokeless tobacco and oral cancer in South Asia: a systematic review with meta-analysis. J Cancer Epidemiol. 2014;2014:394696.

    PubMed Central  PubMed  Google Scholar 

  8. Krishna Rao SV, Mejia G, Roberts-Thomson K, Logan R. Epidemiology of oral cancer in Asia in the past decade--an update (2000-2012). Asian Pac J Cancer Prev. 2013;14(10):5567–77.

    Article  PubMed  Google Scholar 

  9. Saravanan K, Kodanda Ram M, Ganesh R. Molecular biology of oral sub mucous fibrosis. J Cancer Res Ther. 2013;9(2):179–80.

    Article  PubMed  Google Scholar 

  10. Scotto J, Kopf AW, Urbach F. Non-melanoma skin cancer among Caucasians in four areas of the United States. Cancer. 1974;34(4):1333–8.

    Article  PubMed  Google Scholar 

  11. Pogoda JM, Preston-Martin S. Solar radiation, lip protection, and lip cancer risk in Los Angeles County women (California, United States). Cancer Causes Control. 1996;7(4):458–63.

    Article  PubMed  Google Scholar 

  12. McLaughlin-Drubin ME, Munger K. Viruses associated with human cancer. Biochim Biophys Acta. 2008;1782(3):127–50.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Gillison ML, Broutian T, Pickard RK, Tong ZY, Xiao W, Kahle L, et al. Prevalence of oral HPV infection in the United States, 2009-2010. JAMA. 2012;307(7):693–703.

    Article  PubMed  Google Scholar 

  14. Gillison ML, Koch WM, Capone RB, Spafford M, Westra WH, Wu L, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000;92(9):709–20.

    Article  PubMed  Google Scholar 

  15. Psyrri A, Rampias T, Vermorken JB. The current and future impact of human papillomavirus on treatment of squamous cell carcinoma of the head and neck. Ann Oncol. 2014;25(11):2101–15.

    Article  PubMed  Google Scholar 

  16. Brown LM, Check DP, Devesa SS. Oral cavity and pharynx cancer incidence trends by subsite in the United States: changing gender patterns. J Oncol. 2012;2012:649498.

    PubMed Central  PubMed  Google Scholar 

  17. Bravi F, Bosetti C, Filomeno M, Levi F, Garavello W, Galimberti S, et al. Foods, nutrients and the risk of oral and pharyngeal cancer. Br J Cancer. 2013;109(11):2904–10.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Gallagher MP, Kelly PJ, Jardine M, Perkovic V, Cass A, Craig JC, et al. Long-term cancer risk of immunosuppressive regimens after kidney transplantation. J Am Soc Nephrol. 2010;21(5):852–8.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Kruse AL, Gratz KW. Oral carcinoma after hematopoietic stem cell transplantation--a new classification based on a literature review over 30 years. Head Neck Oncol. 2009;1:29.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Petti S. Pooled estimate of world leukoplakia prevalence: a systematic review. Oral Oncol. 2003;39(8):770–80.

    Article  PubMed  Google Scholar 

  21. Lodi G, Sardella A, Bez C, Demarosi F, Carrassi A. Interventions for treating oral leukoplakia. Cochrane Database Syst Rev. 2006;4:CD001829.

    Google Scholar 

  22. Villa A, Villa C, Abati S. Oral cancer and oral erythroplakia: an update and implication for clinicians. Aust Dent J. 2011;56(3):253–6.

    Article  PubMed  Google Scholar 

  23. Gorsky M, Epstein JB. Oral lichen planus: malignant transformation and human papilloma virus: a review of potential clinical implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(4):461–4.

    Article  PubMed  Google Scholar 

  24. Shah JP, Strong E, Spiro RH, Vikram B. Surgical grand rounds. Neck dissection: current status and future possibilities. Clin Bull. 1981;11(1):25–33.

    PubMed  Google Scholar 

  25. Lip and oral cavity. In: AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 29–40.

    Google Scholar 

  26. Moertel CG, Dockerty MB, Baggenstoss AH. Multiple primary malignant neoplasms. II. Tumors of different tissues or organs. Cancer. 1961;14:231–7.

    Article  PubMed  Google Scholar 

  27. Jones AS, Morar P, Phillips DE, Field JK, Husband D, Helliwell TR. Second primary tumors in patients with head and neck squamous cell carcinoma. Cancer. 1995;75(6):1343–53.

    Article  PubMed  Google Scholar 

  28. Haughey BH, Gates GA, Arfken CL, Harvey J. Meta-analysis of second malignant tumors in head and neck cancer: the case for an endoscopic screening protocol. Ann Otol Rhinol Laryngol. 1992;101(2 Pt 1):105–12.

    Article  PubMed  Google Scholar 

  29. Fleming Jr AJ, Smith Jr SP, Paul CM, Hall NC, Daly BT, Agrawal A, et al. Impact of [18F]-2-fluorodeoxyglucose-positron emission tomography/computed tomography on previously untreated head and neck cancer patients. Laryngoscope. 2007;117(7):1173–9.

    Article  PubMed  Google Scholar 

  30. Stuckensen T, Kovacs AF, Adams S, Baum RP. Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg. 2000;28(6):319–24.

    Article  PubMed  Google Scholar 

  31. Network NCC. NCCN clinical practice guidelines in oncology: head and neck cancers. Accessed at http://www.nccn.org on 30 Jan 2015: V.2.2014.

  32. Shaha AR, Spiro RH, Shah JP, Strong EW. Squamous carcinoma of the floor of the mouth. Am J Surg. 1984;148(4):455–9.

    Article  PubMed  Google Scholar 

  33. Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350(19):1937–44.

    Article  PubMed  Google Scholar 

  34. Urken ML, Buchbinder D, Weinberg H, Vickery C, Sheiner A, Parker R, et al. Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients. Laryngoscope. 1991;101(9):935–50.

    Article  PubMed  Google Scholar 

  35. Looser KG, Shah JP, Strong EW. The significance of “positive” margins in surgically resected epidermoid carcinomas. Head Neck Surg. 1978;1(2):107–11.

    Article  PubMed  Google Scholar 

  36. Renner GJ. Chapter 19: reconstruction of the lip. In: Baker SR, editor. Local flaps in facial reconstruction. 2nd ed. Philadelphia: Mosby; 2007. p. 475–524.

    Google Scholar 

  37. Mohit-Tabatabai MA, Sobel HJ, Rush BF, Mashberg A. Relation of thickness of floor of mouth stage I and II cancers to regional metastasis. Am J Surg. 1986;152(4):351–3.

    Article  PubMed  Google Scholar 

  38. Kligerman J, Lima RA, Soares JR, Prado L, Dias FL, Freitas EQ, et al. Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity. Am J Surg. 1994;168(5):391–4.

    Article  PubMed  Google Scholar 

  39. Rao RS, Deshmane VH, Parikh HK, Parikh DM, Sukthankar PS. Extent of lymph node dissection in T3/T4 cancer of the alveolo-buccal complex. Head Neck. 1995;17(3):199–203.

    Article  PubMed  Google Scholar 

  40. Yang Z, Deng R, Sun G, Huang X, Tang E. Cervical metastases from squamous cell carcinoma of hard palate and maxillary alveolus: a retrospective study of 10 years. Head Neck. 2014;36(7):969–75.

    Article  PubMed  Google Scholar 

  41. O’Brien CJ, Carter RL, Soo KC, Barr LC, Hamlyn PJ, Shaw HJ. Invasion of the mandible by squamous carcinomas of the oral cavity and oropharynx. Head Neck Surg. 1986;8(4):247–56.

    Article  PubMed  Google Scholar 

  42. Schusterman MA, Harris SW, Raymond AK, Goepfert H. Immediate free flap mandibular reconstruction: significance of adequate surgical margins. Head Neck. 1993;15(3):204–7.

    Article  PubMed  Google Scholar 

  43. Shah JP. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Am J Surg. 1990;160(4):405–9.

    Article  PubMed  Google Scholar 

  44. Lodder WL, Sewnaik A, den Bakker MA, Meeuwis CA, Kerrebijn JD. Selective neck dissection for N0 and N1 oral cavity and oropharyngeal cancer: are skip metastases a real danger? Clin Otolaryngol. 2008;33(5):450–7.

    Article  PubMed  Google Scholar 

  45. Cooper JS, Pajak TF, Forastiere A, Jacobs J, Fu KK, Ang KK, et al. Precisely defining high-risk operable head and neck tumors based on RTOG #85-03 and #88-24: targets for postoperative radiochemotherapy? Head Neck. 1998;20(7):588–94.

    Article  PubMed  Google Scholar 

  46. Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJ. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol. 2003;21(3):555–63.

    Article  PubMed  Google Scholar 

  47. Dwivedi RC, St Rose S, Chisholm EJ, Georgalas C, Bisase B, Amen F, et al. Evaluation of swallowing by Sydney Swallow Questionnaire (SSQ) in oral and oropharyngeal cancer patients treated with primary surgery. Dysphagia. 2012;27(4):491–7.

    Article  PubMed  Google Scholar 

  48. Jones KR, Lodge-Rigal RD, Reddick RL, Tudor GE, Shockley WW. Prognostic factors in the recurrence of stage I and II squamous cell cancer of the oral cavity. Arch Otolaryngol Head Neck Surg. 1992;118(5):483–5.

    Article  PubMed  Google Scholar 

  49. Day GL, Blot WJ. Second primary tumors in patients with oral cancer. Cancer. 1992;70(1):14–9.

    Article  PubMed  Google Scholar 

  50. Spiro RH, Guillamondegui Jr O, Paulino AF, Huvos AG. Pattern of invasion and margin assessment in patients with oral tongue cancer. Head Neck. 1999;21(5):408–13.

    Article  PubMed  Google Scholar 

  51. Genden EM, Ferlito A, Silver CE, Takes RP, Suarez C, Owen RP, et al. Contemporary management of cancer of the oral cavity. Eur Arch Otorhinolaryngol. 2010;267(7):1001–17.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Asakage T, Yokose T, Mukai K, Tsugane S, Tsubono Y, Asai M, et al. Tumor thickness predicts cervical metastasis in patients with stage I/II carcinoma of the tongue. Cancer. 1998;82(8):1443–8.

    Article  PubMed  Google Scholar 

  53. Woolgar JA, Rogers SN, Lowe D, Brown JS, Vaughan ED. Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread. Oral Oncol. 2003;39(2):130–7.

    Article  PubMed  Google Scholar 

  54. Munoz-Guerra MF, Marazuela EG, Fernandez-Contreras ME, Gamallo C. P-cadherin expression reduced in squamous cell carcinoma of the oral cavity: an indicator of poor prognosis. Cancer. 2005;103(5):960–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael Z. Chen MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Chen, M.Z., Mathog, R.H., Fribley, A.M., Yoo, G.H. (2016). Oral Cancer: Location, Staging, Surgical Management, and Outcomes. In: M. Fribley, A. (eds) Targeting Oral Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-27647-2_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27647-2_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27645-8

  • Online ISBN: 978-3-319-27647-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics