Diagnosis
Oral cavity carcinoma
Carcinoma of the lip, tongue, floor of mouth, gums, palate.
Etiology
Tumors of the oral cavity [vir][u8v]
Squamous cell carcinoma (90%)
Lymphoma (Burkitt’s, B-cell)
Parotid Carcinoma
Salivary Gland Carcinoma: Mucoepidermoid carcinoma
Adenoid cystic carcinoma
Malignant Melanoma
Schwannoma
Epidermoid Carcinoma
Rhabdomyosarcoma
Angiosarcoma
Benign tumors: [shw]
Fibroma, Keratocystic odontogenic tumor, Ameloblastoma, Pleomorphic adenoma, Hemangioma, Central giant cell tumor, Papilloma, Fibrous dysplasia, Neurofibroma, Lymphangioma, Erythroplakia, Leukoplakia, Geographic tongue, Median rhomboid glossitis, Necrotizing sialometaplasia, Hairy tongue, Oral hairy leukoplakia, Oral candidiasis, Herpetic gingivostomatitis, Aphthous ulcers, Traumatic ulcers, Herpes labialis, Lipoma, Lingual thyroid, Mucocele, Ranula, Neurofibroma, Oral keratoacanthoma, Odontogenic tumors.
Pathophysiology
Chronic inflammation --> high cell turnover --> increased accumulation of mutations
If DNA-mutation in the tumor suppressor genes --> No control mechanisms
Uncontrolled growth of cancer
Risk factors [vup][mhi][ysr]
Tobacco smoke
Betel nut chewing
Alcohol
Sunlight exposure (cancer of the lip)
Human papillomavirus
Complications [shw]
Surgery: flap failure, wound dehiscence, nerve damage, vocal cord paralysis
Trismus
Dysarthria
Tracheostomy
Feeding tube
Dysphagia
Neutropenia
Depression
Epidemiology
Incidence per 100.000 [cbk][vir][fay][skw][vup][u8v]
Symptoms & findings
Symptoms
Erythroplakia, Leukoplakia, Lymphadenopathy, Trismus
Clinical findings
None listed.
Anamneses
Alcohol, Smoking, Sunlight exposure
Localized findings
Approach
Panendoscopy
Nasal endoscopy
Biopsy
CT collum
Treatment
Surgery: Resection with neck dissection if nodal positivity or based on tumor depth [vup][xa0]
Radiotherapy for locally advanced, unresectable disease
Chemotherapy combined with surgery and/or radiotherapy
Immunotherapy: Antibodies target specific genetic receptors on tumor cells
Palliation:
Palliative radiotherapy
Anticipatory medications aimed at symptom management at the end-of-life care
Differential diagnoses
Actinic keratosis, Aphthous stomatitis, Candidiasis, Hemangioma, Herpes simplex, Human papillomavirus, Keratoacanthoma, Leukoplakia, Lichen planus, Lipoma, Neurofibromatosis, Oral hairy leukoplakia
References
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[2] Sufiawati I, Piliang A, Yusuf AA, Dewi TS, Agustina H, Azhar Y, Idris A. Clinicopathological Characteristics of Oral Squamous Cell Carcinoma at the Central Referral and Teaching Hospital in West Java, Indonesia. Cancer Manag Res. 2024 Aug 21;16:1053-1061.
[3] Watters C, Brar S, Pepper T. Cancer of the Oral Mucosa. Updated 2024 Mar 15]: https://www.ncbi.nlm.nih.gov/books/NBK565867/
[4] Sexton GP, Hintze JM, Walsh P, Moriarty F, Lennon P, Fitzgerald CWR, O'Neill JP. Epidemiology and management of oral cavity squamous cell carcinoma in Ireland. Am J Otolaryngol. 2024 May-Jun;45(3):104235.
[5] Chamoli A, Gosavi AS, Shirwadkar UP, Wangdale KV, Behera SK, Kurrey NK, Kalia K, Mandoli A. Overview of oral cavity squamous cell carcinoma: Risk factors, mechanisms, and diagnostics. Oral Oncol. 2021 Oct;121:105451.
[6] Salehiniya, H., & Raei, M. (2020). Oral cavity and lip cancer in the world: An epidemiological review. Biomedical Research and Therapy, 7(8), 3898-3905.
[7] Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015 Mar 1;136(5):E359-86.
[8] Shiboski CH, Schmidt BL, Jordan RC. Tongue and tonsil carcinoma: increasing trends in the U.S. population ages 20-44 years. Cancer. 2005 May 1;103(9):1843-9.
[9] Schmidt Jensen J, Jakobsen KK, Mirian C, Christensen JT, Schneider K, Nahavandipour A, Wingstrand VL, Wessel I, Tvedskov JF, Frisch T, Christensen A, Specht L, Andersen E, Lelkaitis G, Grønhøj C, von Buchwald C. The Copenhagen Oral Cavity Squamous Cell Carcinoma database: protocol and report on establishing a comprehensive oral cavity cancer database. Clin Epidemiol. 2019 Aug 19;11:733-741.
[10] http://emedicine.medscape.com/article/1075729 (2014-01-02); [Medscape]