Essentials of Diagnosis
- Nonhealing ulcer, painful or bleeding lesion.
- Lump in oral cavity or oropharynx.
- Neck mass.
- Dysphagia, dysphonia, or otalgia.
- Weight loss.
- Mass on imaging in primary site or neck.
- Positive biopsy of lesion.
The oral cavity is bounded anteriorly by the vermilion border of the lip, superiorly by the hard-soft palate junction, laterally by the tonsillar pillars, and inferiorly by the circumvallate papillae of the tongue. Cancer of the oral cavity is classified by subsite: lip, oral tongue (anterior two thirds), buccal mucosa, floor of mouth, hard palate, upper and lower gingiva (alveolar ridges), and retromolar trigone. There is an estimated annual incidence of 23,110 new oral cavity cancers in the United States with approximately 5370 deaths per year. Men are affected 2–4 times more often than women for all racial and ethnic groups. The incidence of oral cancer increases with age, with median age at diagnosis of 62, although there is a trend of increasing incidence of tongue cancer among young people.
Tobacco use (both chewing and smoking), alcohol, and betel nut chewing are well-established causes of oral cavity cancer, and their carcinogenic effects are often synergistic. Other etiologic factors include poor oral hygiene and immunosuppression. The majority (90%) of cases of lip cancer are related to chronic sun exposure.
The oropharynx is posterior to the oral cavity and is bounded by the soft palate superiorly and hyoid inferiorly. Oropharyngeal subsites include the base of tongue (posterior third), palatine tonsil, soft palate, and posterior pharyngeal wall. These lesions are often silent in early stages and, consequently, frequently present at advanced stage. Cancer of the oropharynx occurs in an estimated 7570 patients in the United States each year, resulting in approximately 1340 deaths. Males are afflicted 3–5 times more frequently than females. Oropharyngeal cancer is frequently related to tobacco and alcohol use, although 30–50% of cases may be related to human papilloma virus (especially HPV-16), particularly in tonsil cancer.
Staging for both lip and oral cavity cancer is determined according to the 2010 American Joint Committee on Cancer (AJCC) TNM (tumor, node, metastasis) staging system (Table 23–1). AJCC staging for oropharyngeal cancer is shown in Table 23–2.
Table Graphic Jump Location Table 23–1. 2010 AJCC Staging: Lip and Oral Cavity. ||Download (.pdf)
Table 23–1. 2010 AJCC Staging: Lip and Oral Cavity.
|Primary Tumor (T)|
|TX:||Primary tumor cannot be assessed|
|T0:||No evidence of primary tumor|
|Tis:||Carcinoma in situ|
|T1:||Tumor ≤2 cm in greatest dimension|
|T2:||Tumor >2 cm, but not >4 cm, in greatest dimension|
|T3:||Tumor >4 cm in greatest dimension|
|T4a:||Moderately advanced local disease:|
- (Lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, ...