Oral cancer
Squamous cell carcinoma of the oral cavity and oropharynx arises along two distinct etiologic pathways, tobacco/alcohol-driven disease in older adults and HPV-driven oropharyngeal disease with a better prognosis, and is diagnosed by biopsy with p16 testing and staged before a surgery-or-chemoradiation decision.
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What this article covers
- Overview
Squamous cell carcinoma (SCC) of the oral cavity and oropharynx: the most common oral cancer, up to 90% of oral neoplasms, arising from the lip, tongue, floor of mouth, buccal mucosa, gingiva, hard…
- Epidemiology
Tobacco/alcohol-associated disease occurs in older patients and remains the dominant pattern for oral cavity (as opposed to oropharyngeal) cancer.
- Risk factors
Smoked and smokeless tobacco use: the most important risk factor for oral and oropharyngeal SCC.
- Pathophysiology
Two divergent carcinogenic pathways converge on squamous mucosa: chronic tobacco- and alcohol-induced field cancerization damages a wide mucosal area, producing genetic injury across which multiple…
- Clinical features
Non-healing oral ulcer: the hallmark presentation is a persistent ulcerated lesion with a central necrotic area and rolled, indurated borders, most commonly on the lateral or ventrolateral tongue.
- Differential diagnosis
Nasopharyngeal carcinoma: EBV-associated malignancy of the nasopharynx presenting with unilateral nasal obstruction, epistaxis, and eustachian tube obstruction causing otitis media with effusion…
- Diagnosis
Diagnosis is established by biopsy and histopathology of the lesion, confirming squamous cell carcinoma; no clinical criteria substitute for tissue confirmation.
- Management
First, tumor board discussion to select surgery versus radiation, weighing functional morbidity (appearance, speech) against radiation morbidity (mucositis, fatigue, taste alteration, xerostomia…
- Complications
Locoregional recurrence, the most common treatment failure, particularly with high-risk pathologic features that did not receive adjuvant chemoradiation.
- Prognosis
Early-stage disease carries 70% to 90% long-term survival, making stage at diagnosis the single most important prognostic factor.
- Prevention
Tobacco cessation counseling and cessation pharmacotherapy for every current tobacco user, since tobacco is the most important modifiable risk factor and its combination with alcohol synergistically raises risk.
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