A history of tobacco use is the amount one risk factor for head and neck cancer in the Usa. Since the duration and quantity of tobacco use increases, so does the risk of developing intraoral cancer.
Alcohol is yet another major risk factor. Heavy consumption increases the risk of developing aerodigestive cancer by sixfold. Furthermore, the risk from concomitant tobacco and alcohol me is synergistic compared to either one alone. Other risk factors include dentures and poor dental hygiene. In countries with poor dental hygiene, these factors may play a larger etiologic role.
Squamous cell carcinomas can present as white patches, termed leukoplakia, or as an erythematous patch, known as erythroplakia. As a general rule, erythematous lesions have a greater risk of malignancy than leukoplakic lesions. The need to biopsy every leukoplakic area is controversial. Innovative squamous cell carcinomas are endophytic (ulcerated, deeply infiltrating). They may also be exophytic (projecting outward).
The tongue is the most common site of intraoral malignancy. In addition to alcohol and tobacco, Plummer Vinson syndrome is really a risk factor. Most lesions are on the anterolateral two thirds of the tongue. These tumors are usually painless and thus in many cases are neglected. The typical stage at presentation is T2 (2-4 cm). T1 tumors are given either wedge resection or radiation. T2 lesions require partial glossectomy and T3 tumors require total or subtotal glossectomy. T2 and T3 lesions are resected in combination with an elective neck dissection even if there are no palpable neck nodes (N0) due to the high-risk of occult nodal metastasis.
The floor of the mouth may be the second most typical site of intraoral cancer. Lesions are usually anterior and frequently present with a palpable submandibular node. 50 percent of patients present with stage III or IV disease due to the paucity of symptoms. The survival rate for stage I and II lesions is high (80-90%); advanced disease has a poorer prognosis (30-60%). An essential consideration in any form of treatment is the risk of submandibular duct stenosis with subsequent enlargement from the gland. If the occurs, referral to some specialist in this condition is warranted.
The 3rd most typical site of intraoral tumors is the lower alveolar gingiva. Eighty percent of these tumors occur on the lower alveolus. Lesions begin on the alveolar ridge and spread laterally. Nodal metastasis sometimes of presentation is typical. Cancer of the buccal mucosa is located primarily in tobacco chewers in the U.S. There is a higher incidence in India due to the custom of betel leaf chewing.
The tonsil is easily the most frequent site of squamous carcinoma in the oropharynx. Most tumors present late, as stage III or IV lesions. Hence, the prognosis is poor.
Just like cancer of the tongue, Plummer Vinson syndrome is a risk factor. Patients often present with advanced disease with dysphagia and clinically positive neck nodes. Extensive resections with free flap reconstruction are often required.
In cancer of the larynx, the vocal cords are participating in about 50% from the cases. This allows for relatively early detection due to hoarseness and respiratory symptoms. When the glottis is involved, radiotherapy is more successful at preserving speech than surgery. Advanced disease occurs more frequently with subglottic tumors and requires total laryngectomy with neck dissection.
Cancer from the nasopharynx is exclusive among neck and head tumors in its etiology. Chronic inflammation from the mucosa may be the main risk factor; chronic sinusitis, human papilloma virus and Epstein-Barr virus infections have been implicated. There is also in increased incidence among individuals from mainland China for unknown reasons. Tumors from the nasopharynx often present as locally advanced neck masses. The primary mode of treatment is radiation rather than surgery. Since most tumors present with nodal metastases, the neck also needs to be irradiated. In certain instances, chemotherapy is indicated.
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Note: This article was sent to us by: Keith Hayes at 02142011
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