Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Oral Cancer 1085

ORAL CANCER

SOL SILVERMAN Jr, DDS

history & physical

■squamous cell carcinoma accounts for >90% of oral cancers

■95% occur beyond age of 40; men 2:1 over women

■increased risk with tobacco and alcohol usage

■can occur on any mucosal site; tongue most common

■may appear as white, red, red-white, ulcer and lump

■often firm to indurated

■pain varies from minimal to severe, depending upon stage

■palpable lymph nodes in neck or size >3 cm indicates advanced

disease

■overall 5-year survival rate approximates 50%

tests

■incisional biopsy to confirm diagnosis

■MRI and PET scan for staging

■fine needle aspiration biopsy for suspected nodes

differential diagnosis

■leukoplakia, lichen planus, inflammatory disease, acute/chronic

trauma, infection

■disappearance rules out cancer

management

■refer to oncologist for staging and treatment options

■analgesics if necessary

specific therapy

■surgery and/or radiation depends upon tumor type, location, stage

■surgery can cause functional defects

■radiation can cause changes in salivary flow, taste, blood supply

(necrosis), mucositis

■chemotherapy is adjunctive (can cause severe mucositis)

■pretreatment dental care including hygiene and topical fluoride use

follow-up

■high recurrence rate; routine visits

■about 20% will develop second head and neck primary cancers

■treatment for complications