Transcript Update-oral-cancer-AR - Arkansas Cancer Coalition

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
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No financial disclosures
Consent for medical photography
Oral Cavity
Pharynx
Larynx
Anatomical Sites
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Mucosal lip
Buccal mucosa
Upper alveolar ridge
Lower alveolar ridge
Retromolar trigone
Oral tongue
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Tip
Lateral borders
Dorsum
Ventral (nonvillous)
FOM
Hard palate
Epidemiology
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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
Incidence and Mortality
National Cancer Institute. Bethesda, MD, based on November 2012 SEER data submission
Tongue
Gums & other mouth
Lip
Floor of mouth
Prognosis
Stage at Diagnosis
Localized
(confined to primary site)
Regional
(spread to regional lymph nodes)
Distant
(cancer has metastasized)
Unknown
Stage
Distribution
5-year
Survival
31%
82.7%
47%
59.2%
17%
36.3%
6%
49.3%
National Cancer Institute. Bethesda, MD, based on November 2012 SEER data submission
Tumor Size and Prognosis
Early diagnosis is critical to improve outcomes
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African-Americans
Head and neck cancer has a
disproportionate impact in AfricanAmericans.
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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%
Symptoms
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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
Risk Factors
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Tobacco
Alcohol
Poor oral hygiene
Ill-fitting dentures
Betel-Nut (Paan)
Exposure to radiation
Family history
HPV? ..not clearly related
Betel-Nut
Premalignant Lesions
Leukoplakia
Lichen Planus
Erythroplakia
Normal mucosa
Erythroleukoplakia
Moderate Dysplasia
The Evolution of Treatment in Head and
Neck Cancer
Treatment Options
• Radiation therapy + Brachytherapy
• Surgery +/- Radiation therapy