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Update on Cancer in Arkansas: Oral Cavity Cancer. Mauricio A. Moreno, M.D. Assistant Professor Department of Otolaryngology- Head and Neck Surgery University or Arkansas for Medical Sciences. Arkansas Cancer Coalition, March 2014. Disclosures. No financial disclosures - PowerPoint PPT Presentation
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Mauricio A. Moreno, M.D.
Assistant Professor
Department of Otolaryngology- Head and Neck Surgery
University or Arkansas for Medical Sciences
Mauricio A. Moreno, M.D.
Assistant Professor
Department of Otolaryngology- Head and Neck Surgery
University or Arkansas for Medical Sciences
Update on Cancer in Arkansas:Update on Cancer in Arkansas:Oral Cavity CancerOral Cavity Cancer
Update on Cancer in Arkansas:Update on Cancer in Arkansas:Oral Cavity CancerOral Cavity Cancer
Arkansas Cancer Coalition, March 2014Arkansas Cancer Coalition, March 2014
DisclosuresDisclosuresDisclosuresDisclosures
• No financial disclosuresNo financial disclosures
• Consent for medical photographyConsent for medical photography
Oral Cavity
Pharynx
Larynx
• Mucosal lip
• Buccal mucosa
• Upper alveolar ridge
• Lower alveolar ridge
• Retromolar trigone
• Oral tongue
- Tip
- Lateral borders
- Dorsum
- Ventral (nonvillous)
• FOM
• Hard palate
Anatomical Sites
• HNSCC is the 6th most prevalent cancer in US (3rd in developing countries).
• Oral cavity cancer represents 50% of all HNSCC.
• Lifetime Risk= 1.09%, of all men and women born today will develop cancer of the oral cavity pharynx during their lifetime.
• Currently, the median age for diagnosis is 62 years and for death is 67 years.
• 2010, in the US there were approximately 275,193 men and women alive with history of- or active disease.
• Mortality has decreased significantly in the last 3 decades
• Increasing incidence of tongue cancer in pts< 40y
Epidemiology
Incidence and Mortality
National Cancer Institute. Bethesda, MD, based on November 2012 SEER data submission
Tongue
Gums & other mouth
LipFloor of mouth
National Cancer Institute. Bethesda, MD, based on November 2012 SEER data submission
Prognosis
Stage at DiagnosisStage
Distribution 5-year Survival
Localized (confined to primary site)
31% 82.7%
Regional (spread to regional lymph nodes)
47% 59.2%
Distant (cancer has metastasized)
17% 36.3%
Unknown 6% 49.3%
Tumor Size and Prognosis
Early diagnosis is critical to improve outcomes
• Head and neck cancer has a disproportionate impact in African-Americans.
- 47-65% higher incidence
- Three times more likely to develop the disease before age 50
- 58-78% present with advanced disease (compared to 40-50% in whites)
- Twice the risk of developing distant metastasis after equivalent locoregional control is achieved
Overall Survival Whites 56%
African American 34%
African-Americans
• A sore in the mouth that does not heal (most common symptom)
• Pain in the mouth that doesn’t go away
• A white or red patch on the gums, tongue, tonsil, or lining of the mouth
• Trouble chewing or swallowing
• Trouble moving the jaw or tongue
• Numbness of the tongue or other area of the mouth
• Ill-fitting dentures
• Loosening of the teeth or pain around the teeth or jaw
• A lump or mass in the neck
Symptoms
• Tobacco
• Alcohol
• Poor oral hygiene
• Ill-fitting dentures
• Betel-Nut (Paan)
• Exposure to radiation
• Family history
• HPV? ..not clearly related
Risk Factors
Betel-NutBetel-Nut
Premalignant Lesions
LeukoplakiaLeukoplakia ErythroplakiaErythroplakia ErythroleukoplakiaErythroleukoplakia
Lichen PlanusLichen PlanusNormal mucosa Moderate Dysplasia
The Evolution of Treatment in Head and Neck Cancer
•Radiation therapy + Brachytherapy
•Surgery +/- Radiation therapy
Treatment Options