Risk Factors and Aggressiveness of Oral Cavity Carcinomas in Young Patients

Abstract

Over 37,000 people in the United States will be newly diagnosed with oral cancer this year. According to SEER, the median age at diagnosis was 62 years of age; 95% occur in patients over 45 years old. This study reviews one program's experiences with the younger patient diagnosed with oral cavity carcinomas. A retrospective chart review was performed for all OMFS patients under 45 y/o with oral cancer from July 1, 2006, to December 30, 2010. The patients that met the inclusion criteria had their risk factors reviewed, which included age, sex, smoking, smokeless tobacco, drinking, mouthwash, and HPV status. The aggressiveness of the tumor was also determined by stage at diagnosis, neural invasion, degree of differentiation, positive margins, adjuvant therapy given, and years living or years until expiration from the time of diagnosis. There were nine patients who met the inclusion criteria of being under 45 years of age with oral cavity carcinoma. There were 6 females and 3 males. The ages at diagnosis ranged from 16 to 44 years of age with a mean of 29. The stages ranged from 1 to 4 with the average being approximately 2. The most common primary tumor location was the tongue (5). The risk factors reviewed showed 3 patients with a positive smoking history, 1 patient with a betel nut history, and 3 patients with a history of mouthwash use (Scope and Listerine). There were 3 patients with a positive alcohol history, although the number of drinks only ranged from 1-3 drinks per week. The HPV status was negative in all 9 patients. In reviewing the aggressiveness of the tumors, 3 patients had perineural invasion, 2 patients with positive margins, 2 patients with adjunctive therapy, and 2 patients with poorly differentiated cells on histology. One patient died 16 months after onset of treatment, while one patient presented with distant metastasis at diagnosis. This review of one institution's experiences with oral cavity carcinoma in the younger population reiterates the rarity of such a phenomenon, as there have only been 9 cases in the past 5 years. In addition, these patients have little to no risk factors predisposing them to cancer of the oral cavity. All patients had a negative HPV status. These results are contrary to the notion that changing sexual mores and increased orogenital practices have contributed to oral cancer in the younger female population, although one must consider that the sample size in this study is small. Based on this study it appears that oral cavity carcinomas in the younger population are not associated with the traditional risk factors. Interestingly, 3 out of the 4 youngest patients had stage IV disease and the oldest patients had stage 1. We propose the idea that those cancers diagnosed at stages 1 were the classic carcinomas seen in >45 year olds, only identified early, whereas these “younger” carcinomas are somehow inherently different in a molecular level from their “older” counterparts. This is an important area of investigation because if these conclusions hold true, one could argue for more aggressive treatment in the younger population given that these cancers are more aggressive and younger patients have fewer comorbidities than their older counterparts.