Tongue cancer natural history, complications and prognosis
Jump to navigation
Jump to search
|
Tongue cancer Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Tongue cancer natural history, complications and prognosis On the Web |
|
American Roentgen Ray Society Images of Tongue cancer natural history, complications and prognosis |
|
FDA on Tongue cancer natural history, complications and prognosis |
|
CDC on Tongue cancer natural history, complications and prognosis |
|
Tongue cancer natural history, complications and prognosis in the news |
|
Blogs on Tongue cancer natural history, complications and prognosis |
|
Risk calculators and risk factors for Tongue cancer natural history, complications and prognosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Mohammed Abdelwahed M.D[3] Roukoz A. Karam, M.D.[4]
Overview
If left untreated, patients with tongue cancer may progress to develop metastasis. Common complications of treatment of tongue cancer include neurotoxicity, bleeding, radiation caries, trismus, osteonecrosis, oral mucositis, chronic dysphagia, anemia, pharyngocutaneous fistula, aspiration, infections, xerostomia, taste alterations, nutritional compromise, and abnormal tooth development. Prognosis is generally good, and the five-year mortality rate of patients with stage I and II tongue cancer is approximately 89 and 95 percent respectively. The five- year disease specific survival rate of patients with stage III and IV cancers is 39 and 27 percent respectively.
Natural History
- Carcinomas of the tongue base are clinically silent until they deeply infiltrate the tongue musculature.
- Tongue 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 tongue, 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 metastases before the diagnosis is established.
- Tongue cancer often begins as a white patch, small lump, or sore on the tongue.
- Tongue cancer is often not diagnosed until it has grown and spread to other areas of the mouth, but if caught early it can be easily treatable.
- 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]
Complications
- Direct surgical complications include infection, bleeding, aspiration, wound breakdown, flap loss, and fistula.
- Complications of chemotherapy includes the following:[2]
- 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:[3]
- Complications common to both chemotherapy and radiation include the following:[4]
- 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.
Prognosis
- Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.
- The five-year survival rate was 70% for patients with early oral cavity cancer.[5]
- Neck dissection was associated with an improved prognosis.
- A five-year relative survival for locally advanced oral cavity of 54.7%.[6]
Prognostic factors:
- Lymph node involvement is the single most important prognostic factor for outcome in oral cavity cancer[7]
- The number and size of positive lymph nodes
- The presence of extracapsular extension[8]
- The ratio of positive lymph nodes to total number of excised lymph nodes[9]
- In younger patients less than 40 years, tongue cancer is found to have a more aggressive course.[10]
Five-year survival
- The five-year mortality rate of patients with stage I and II cancers is 89 and 95 percent.[11]
- The five-year survival rate calculated from a population-based database is reported as 67 and 51 percent respectively.[12]
- The five-year disease specific survival rate of patients with stage III and IV cancers is 39 and 27 percent respectively.[13]
- Tongue cancer has been associated with a worse prognosis compared with other oral cavity subsites in some series.[14][15]
- The five year survival rate for individuals diagnosed with Stage I, II, III, and IV is shown below:
| Stage of the tongue cancer | Five-year survival rate |
|---|---|
|
71% |
|
59% |
|
47% |
|
37% |
- In 2011, approximately 25.69% of all oral cancer deaths were from tongue cancer. According to National Cancer Institute, from 2004-2008 the average age of death from tongue cancer was 66.
- Approximate age of diagnosis of tongue cancer and percentage of deaths from tongue cancer are shown below in this table:
| Age of diagnosis of tongue cancer | Percentage of deaths from tongue cancer |
|---|---|
|
0.1% |
|
1.1% |
|
3.9% |
|
15.4% |
|
24.8% |
|
23.8% |
|
20.3% |
|
10.7% |
References
- ↑ Halperin, Edward (2008). Perez and Brady's principles and practice of radiation oncology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 078176369X.
- ↑ 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.
- ↑ Luryi AL, Chen MM, Mehra S, Roman SA, Sosa JA, Judson BL (2015). "Treatment Factors Associated With Survival in Early-Stage Oral Cavity Cancer: Analysis of 6830 Cases From the National Cancer Data Base". JAMA Otolaryngol Head Neck Surg. 141 (7): 593–8. doi:10.1001/jamaoto.2015.0719. PMID 25974757.
- ↑ Liao CT, Chang JT, Wang HM, Ng SH, Hsueh C, Lee LY; et al. (2007). "Survival in squamous cell carcinoma of the oral cavity: differences between pT4 N0 and other stage IVA categories". Cancer. 110 (3): 564–71. doi:10.1002/cncr.22814. PMID 17577219.
- ↑ Shah JP, Cendon RA, Farr HW, Strong EW (1976). "Carcinoma of the oral cavity. factors affecting treatment failure at the primary site and neck". Am J Surg. 132 (4): 504–7. PMID 1015542.
- ↑ Fagan JJ, Collins B, Barnes L, D'Amico F, Myers EN, Johnson JT (1998). "Perineural invasion in squamous cell carcinoma of the head and neck". Arch Otolaryngol Head Neck Surg. 124 (6): 637–40. PMID 9639472.
- ↑ Gross ND, Patel SG, Carvalho AL, Chu PY, Kowalski LP, Boyle JO; et al. (2008). "Nomogram for deciding adjuvant treatment after surgery for oral cavity squamous cell carcinoma". Head Neck. 30 (10): 1352–60. doi:10.1002/hed.20879. PMID 18720518.
- ↑ T. O. Truitt, L. L. Gleich, G. P. Huntress & J. L. Gluckman (1999). "Surgical management of hard palate malignancies". Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 121 (5): 548–552. PMID 010547468. Unknown parameter
|month=ignored (help) - ↑ W. L. Jr Hicks, J. H. Jr North, T. R. Loree, S. Maamoun, A. Mullins, J. B. Orner, V. Y. Bakamjian & D. P. Shedd (1998). "Surgery as a single modality therapy for squamous cell carcinoma of the oral tongue". American journal of otolaryngology. 19 (1): 24–28. PMID 09470947. Unknown parameter
|month=ignored (help) - ↑ Kyle Rusthoven, Ari Ballonoff, David Raben & Changhu Chen (2008). "Poor prognosis in patients with stage I and II oral tongue squamous cell carcinoma". Cancer. 112 (2): 345–351. doi:10.1002/cncr.23183. PMID 018041071. Unknown parameter
|month=ignored (help) - ↑ Donald G. Sessions, Gershon J. Spector, Jason Lenox, Bruce Haughey, Clifford Chao & James Marks (2002). "Analysis of treatment results for oral tongue cancer". The Laryngoscope. 112 (4): 616–625. doi:10.1097/00005537-200204000-00005. PMID 012150512. Unknown parameter
|month=ignored (help) - ↑ M. J. Zelefsky, L. B. Harrison, D. E. Fass, J. Armstrong, R. H. Spiro, J. P. Shah & E. W. Strong (1990). "Postoperative radiotherapy for oral cavity cancers: impact of anatomic subsite on treatment outcome". Head & neck. 12 (6): 470–475. PMID 02258285. Unknown parameter
|month=ignored (help) - ↑ R. Bryan Bell, Deepak Kademani, Louis Homer, Eric J. Dierks & Bryce E. Potter (2007). "Tongue cancer: Is there a difference in survival compared with other subsites in the oral cavity?". Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 65 (2): 229–236. doi:10.1016/j.joms.2005.11.094. PMID 017236926. Unknown parameter
|month=ignored (help)