Oral cancer treatment
Oral cavity cancers account for 30% of head and neck cancers and represent a significant challenge to clinicians. Treatment requires multidisciplinary expertise and is complicated by the complex role that the oral cavity plays in speech,mastication,and swallowing. Oral squamous carcinomas account for 90% of malignancies affecting the oral cavity, and will be the focus of this chapter.
Although discussion will be limited to the treatment ofsquamous cell cancers, oncologic principles outlined in this chap- ter can be applied to other malignancies affecting the oral cavity. Regardless ofadvances in diagnosis and treatment, mortality from oral cancer has not changed significantly in the past 50 years.
Approximately 50% of patients diagnosed with oral cancer will ultimately die of their disease.4,5 Early detection and appropriate treatment of cancers remain the most effective weapons against cancers of the oral cavity.Unfortunately public and professional awareness and knowledge of oral cancer is low. A recent editorial referred to oral cancer as “The Forgotten Disease.”
Incidence and mortality for oral cancer is nearly double that of cancer of the cervix (30,300 vs 13,500 and 8,000 vs 4,400, respectively); yet few adults can remember their last oral cancer examina- tion, whereas most women are aware of their last gynecologic examination and Pap smear.
Patient knowledge ofother cancers, such as skin,breast,and prostate, has increased in recent years because of public awareness campaigns. Only recently, however, has oral cancer begun to receive some of the same attention. The American Cancer Society recommends a cancer-related check-up,including examination for cancers ofthe oral cavity,every 3 years for asymptomatic men and women aged 20 to 39 years and yearly for men and women aged 40 years and older.
Although the oral cavity is readily accessible for examination, results ofa study by Holmes and colleagues questioned whether health care professionals were screening for asymptomatic cancers.
Additionally,smaller symptomatic cancers often went undetected in their study and were ultimately detected at a later stage. Interestingly all asymptomatic cancers were referred from dental practices, and the average clinical and pathologic stage of cancers referred from physician offices were statistically higher.
This is unfortunate since the population at high est risk for development of an oral cancer is four to six times more likely to seek care from a physician than a dentist.
Clearly there is a need for increasing the public’s awareness oforal cancer and improving screening for early oral cancers in order to improve outcomes regardless of treatment modality employed.