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===Treatment of early cancers{stage I and stageII}===
===Treatment of early cancers{stage I and stageII}===
* Early cancers (stage I and stage II) of the lip, floor of the mouth, and retromolar trigone are highly curable by surgery or radiation therapy.  
* Stage I and II cancer of the lip, floor of the mouth, and retromolar trigone can be treated by surgery or radiation therapy.<ref name="pmid8417381">{{cite journal |vauthors=Browman GP, Wong G, Hodson I, Sathya J, Russell R, McAlpine L, Skingley P, Levine MN |title=Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer |journal=N. Engl. J. Med. |volume=328 |issue=3 |pages=159–63 |year=1993 |pmid=8417381 |doi=10.1056/NEJM199301213280302 |url=}}</ref>
* The choice of treatment is dictated by the anticipated functional and cosmetic results.
* The choice of treatment is decided based on functional and cosmetic results.
* Availability of the particular expertise required of the surgeon or radiation oncologist for the individual patient is also a factor in treatment choice.
* [[buccal]] mucosa carcinoma can be treated by radiation therapy.
* Early cancers of the [[buccal]] mucosa are equally curable by radiation therapy or by adequate [[excision]].
* T1 and T2 stage cancer of the anterior [[tongue]] may be treated radiation therapy alone.
* Patient factors and local expertise influence the choice of treatment.
* Radiation therapy has 85% cure rates in early lesions.
* Larger cancers require composite resection with reconstruction of the defect by pedicle flaps.
* Benefits of using radiation therapy over surgical resection are:
* Early [[lesions]] (T1 and T2) of the anterior [[tongue]] may be managed by surgery or by radiation therapy alone.
** Lesser chances of speech disabilty.
* Both modalities produce 70% to 85% cure rates in early lesions.
** Less chance of aspiration of liquids and solid.
* Moderate excisions of tongue, even hemiglossectomy, can often result in little speech disability provided the wound closure is such that the tongue is not bound down.
* Cancer involving upper gingiva or hard palate without bone involvement can be treated by radiation therapy alone.  
* If, however, the resection is more extensive, problems may include aspiration of liquids and solids and difficulty in swallowing in addition to speech difficulties.
* Patients who smoke while on radiation therapy appear to have lower response rates and shorter survival durations than those who do not; therefore, patients should be counseled to stop smoking before beginning radiation therapy.<ref name="pmid22135122">{{cite journal |vauthors=Peppone LJ, Mustian KM, Morrow GR, Dozier AM, Ossip DJ, Janelsins MC, Sprod LK, McIntosh S |title=The effect of cigarette smoking on cancer treatment-related side effects |journal=Oncologist |volume=16 |issue=12 |pages=1784–92 |year=2011 |pmid=22135122 |pmc=3248778 |doi=10.1634/theoncologist.2011-0169 |url=}}</ref>
* Occasionally, patients with tumor of the tongue require almost total glossectomy.
* Large lesions generally require combined surgical and radiation treatment.
* The control rates for larger lesions are about 30% to 40%.
* According to clinical and radiological evidence of involvement, cancers of the lower [[gingiva]] that are exophytic and amenable to adequate local excision may be excised to include portions of bone.
* More advanced lesions require segmental bone resection, hemimandibulectomy, or maxillectomy, depending on the extent of the lesion and its location.
* Early lesions of the upper gingiva or hard palate without bone involvement can be treated with equal effectiveness by surgery or by radiation therapy alone.
* Advanced infiltrative and ulcerating lesions should be treated by a combination of radiation therapy and surgery.
* Most primary cancers of the [[hard palate]] are of minor salivary gland origin.
* Primary squamous cell carcinoma of the hard palate is uncommon, and these [[tumors]] generally represent invasion of [[squamous cell carcinoma]] arising on the upper [[gingiva]], which is much more common.
* Management of squamous cell carcinoma of the upper [[gingiva]] and hard [[palate]] are usually considered together.
* Surgical treatment of cancer of the hard [[palate]] usually requires [[excision]] of underlying bone producing an opening into the antrum.
* This defect can be filled and covered with a dental prosthesis, which is a maneuver that restores satisfactory swallowing and speech.
* Patients who smoke while on radiation therapy appear to have lower response rates and shorter survival durations than those who do not; therefore, patients should be counseled to stop smoking before beginning radiation therapy.  
* Dental status evaluation should be performed prior to therapy to prevent late sequelae.


===Treatment of advanced cancers{stage III and stage IV}===
===Treatment of advanced cancers{stage III and stage IV}===
* Advanced cancers (stage III and stage IV) of the [[lip]], floor of the [[mouth]], and retromolar trigone represent a wide spectrum of challenges for the surgeon and radiation oncologists.
* Most patients with stage III or stage IV tumors are candidates for treatment by a combination of surgery and radiation therapy.
* Most patients with stage III or stage IV tumors are candidates for treatment by a combination of surgery and radiation therapy.
* Patients with small T3 lesions and no regional lymph nodes, and no distant [[metastases]] or patients who have no [[lymph nodes]] larger than 2 cm in diameter, for whom treatment by radiation therapy alone or surgery alone might be appropriate, are the exceptions.
* Patients with small T3 lesions and no regional lymph nodes, and no distant [[metastases]] or patients who have no [[lymph nodes]] larger than 2 cm in diameter, can be treated by radiation therapy alone.
* Because local recurrence and/or distant metastases are common in this group of patients, they should be considered for clinical trials that are evaluating the following:
* Because local recurrence and/or distant metastases are common in this group of patients, they should be considered for clinical trials that are evaluating the following:
**The potential role of radiation modifiers to improve local control or decrease [[morbidity]].
**The role of combinations of chemotherapy with surgery and/or radiation therapy both to improve local control and to decrease the frequency of distant metastases.


*The potential role of radiation modifiers to improve local control or decrease [[morbidity]].
===Complications of medical treatment===
*The role of combinations of chemotherapy with surgery and/or radiation therapy both to improve local control and to decrease the frequency of distant metastases.
*[[dry mouth]]  
 
*Difficulty [[swallowing]]
===Complications of treatment===
*[[weight loss]]
*Postoperative disfigurement of the face, [[head]] and [[neck]]
*Complications of radiation therapy include [[dry mouth]] and difficulty [[swallowing]]
*Other [[metastasis]] (spread) of the cancer
*Significant [[weight loss]]
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 14:10, 7 February 2018

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

Overview

The predominant therapy for oral cancer is surgical resection, radiation therapy or a combination of both. Adjunctive chemotherapy, radiation, chemoradiation may be required.

Medical Therapy

  • Depending on the site and extent of the primary tumor and the status of the lymph nodes, some general considerations for the treatment of lip and oral cavity cancer include the following:
    • Surgery alone
    • Radiation therapy alone
    • A combination of the above

Surgery

  • For lesions of the oral cavity, surgery must adequately encompass all of the gross as well as the presumed microscopic extent of the disease.[1]
    • If regional nodes are positive, cervical node dissection is usually done in continuity.
    • Surgeons ablate large posterior oral cavity tumors using reconstructive methods so that satisfactory functional results can be achieved.
    • Prosthodontic rehabilitation is important, particularly in early-stage cancers, to assure the best quality of life.

Radiation

  • External-beam radiation therapy (EBRT) or interstitial implantation can be administered to give radiation therapy for lip and oral cavity cancers.
    • These can be used alone, whereas combined use of both modalities produces better control and functional results at some sites.
  • Small superficial cancers are treated by local implantation using intraoral cone radiation therapy or by radiation using electrons.
  • Larger lesions are managed using EBRT to include the primary site and regional lymph nodes, even if they are not clinically involved.
  • interstitial radiation is used to supplement therapy to achieve adequate doses to treat large primary tumors and/or bulky nodal metastases.[2]
  • A review of published clinical results of radical radiation therapy for head and neck cancer suggests a significant loss of local control when the administration of radiation therapy was prolonged; therefore, lengthening of standard treatment schedules should be avoided whenever possible.[3]

Treatment of early cancers{stage I and stageII}

  • Stage I and II cancer of the lip, floor of the mouth, and retromolar trigone can be treated by surgery or radiation therapy.[4]
  • The choice of treatment is decided based on functional and cosmetic results.
  • buccal mucosa carcinoma can be treated by radiation therapy.
  • T1 and T2 stage cancer of the anterior tongue may be treated radiation therapy alone.
  • Radiation therapy has 85% cure rates in early lesions.
  • Benefits of using radiation therapy over surgical resection are:
    • Lesser chances of speech disabilty.
    • Less chance of aspiration of liquids and solid.
  • Cancer involving upper gingiva or hard palate without bone involvement can be treated by radiation therapy alone.
  • Patients who smoke while on radiation therapy appear to have lower response rates and shorter survival durations than those who do not; therefore, patients should be counseled to stop smoking before beginning radiation therapy.[5]

Treatment of advanced cancers{stage III and stage IV}

  • Most patients with stage III or stage IV tumors are candidates for treatment by a combination of surgery and radiation therapy.
  • Patients with small T3 lesions and no regional lymph nodes, and no distant metastases or patients who have no lymph nodes larger than 2 cm in diameter, can be treated by radiation therapy alone.
  • Because local recurrence and/or distant metastases are common in this group of patients, they should be considered for clinical trials that are evaluating the following:
    • The potential role of radiation modifiers to improve local control or decrease morbidity.
    • The role of combinations of chemotherapy with surgery and/or radiation therapy both to improve local control and to decrease the frequency of distant metastases.

Complications of medical treatment

References

  1. ↑ Neville BW, Day TA (2002). "Oral cancer and precancerous lesions". CA Cancer J Clin. 52 (4): 195–215. PMID 12139232.
  2. ↑ Bansberg SF, Olsen KD, Gaffey TA (1989). "High-grade carcinoma of the oral cavity". Otolaryngol Head Neck Surg. 100 (1): 41–8. doi:10.1177/019459988910000107. PMID 2466229.
  3. ↑ Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA (2009). "Future of cancer incidence in the United States: burdens upon an aging, changing nation". J. Clin. Oncol. 27 (17): 2758–65. doi:10.1200/JCO.2008.20.8983. PMID 19403886.
  4. ↑ Browman GP, Wong G, Hodson I, Sathya J, Russell R, McAlpine L, Skingley P, Levine MN (1993). "Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer". N. Engl. J. Med. 328 (3): 159–63. doi:10.1056/NEJM199301213280302. PMID 8417381.
  5. ↑ Peppone LJ, Mustian KM, Morrow GR, Dozier AM, Ossip DJ, Janelsins MC, Sprod LK, McIntosh S (2011). "The effect of cigarette smoking on cancer treatment-related side effects". Oncologist. 16 (12): 1784–92. doi:10.1634/theoncologist.2011-0169. PMC 3248778. PMID 22135122.


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