Transoral Management of Oral Cancer with Variable Depth of Invasion

This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.

Head and neck cancers include mucosal squamous cell carcinomas of the oral cavity, paranasal sinuses, pharynx (oropharynx, hypopharynx) and larynx. Although a heterogeneous group, broad principles of management are essentially the same baring the nasopharynx which is distinct. There have been recent changes in the understanding of the biology of these cancers with the increasing role of HPV infection in oropharyngeal cancers and the recognition of new prognostic variables (depth of invasion and extranodal extension) both incorporated into the staging system. Patients are triaged according to treatment intention into curative or palliative, a decision based on clinical and imaging evaluation. Given the intensity and sequelae of treatment, multidisciplinary care is beneficial. Early stage (I and II) are treated with single modality, whereas advanced stage (III and IV) cancers require multimodality therapy. The general dictum is surgery as the primary modality for oral and sinonasal cancers while in pharyngeal and laryngeal cancers non-surgical approaches are preferred. There is some scope of salvage of recurrences, with surgery or re-radiotherapy. Those not suitable for salvage or those with metastatic disease are treated with chemotherapy. There is an emerging role of robotic surgery and immunotherapy in the management of these cancers.

Oral cancer is endemic and causes a great burden in Southern Asia. It is preferably treated by surgery with/without adjuvant radiotherapy (RT) or chemoradiation therapy, depending on the stage of the disease. Close or positive resection margin and cervical lymph node (LN) metastasis are important prognostic factors that have been presented to be related to undesirable locoregional recurrence and poor survival. Ultrasound (US) is a simple, noninvasive, time-saving, and inexpensive diagnostic modality. It can depict soft tissues very clearly without the risk of radiation exposure. Additionally, it is real-time and continuous image is demonstrated during the exam. Furthermore, the clinician can perform US-guided fine needle aspiration (FNA) or core needle biopsy (CNB) at the same time. US with/without US-guided FNA/CNB is reported to be of value in determining tumor thickness (TT), depth of invasion (DOI), and cervical LN metastasis, and in aiding the staging of oral cancer. DOI has a relevant prognostic value as reported in the eighth edition of the American Joint Committee on Cancer staging of oral cancer. In the present review, we describe the clinical applications of US in oral cancer management in different phases and potential applications in the future. In the pretreatment and surgical phase, US can be used to evaluate TT/DOI and surgical margins of oral cancer in vivo and ex vivo. The prediction of a malignant cervical LN (nodal metastasis) by the US-based prediction model can guide the necessity of FNA/CNB and elective neck dissection in clinical early-stage oral cancer. In the posttreatment surveillance phase, US with/without US-guided FNA or CNB is helpful in the detection of nodal persistence or LN recurrence, and can assess the possibility and extent of carotid artery stenosis after irradiation therapy. Both US elastography and US swallowing assessment are potentially helpful to the management of oral cancer.

Health care system is the establishment of institutions, people and wealth that deliver health care services to meet the health needs of target residents. There is a broad variation of health systems on all sides of the world, with as numerous histories and organizational structures as there are nations. However common elements in almost all health systems are public health measures and primary healthcare. To assess the awareness of rural population in Dharmapuri district of Tamil Nadu in India about the medical facilities available for oral cancer treatment in their area. Questions on medical facilities available in the management of oral cancer and awareness of oral cancer were prepared to survey the residents of the Dharmapuri district, Tamilnadu, India. The survey instrument employed was a self-administered questionnaire comprising 15 questions and the responses were recorded. 83% are not aware of hospital in Dharmapuri district for oral cancer. 56% of people say oral cancer is caused by tobacco chewing, 24% of people says oral cancer is caused by smoking and 18 % of people say oral cancer is caused by using snuff and 6 % by other factors. The people in the rural parts are not aware of medical facilities available in management of oral cancer .They are moderately aware about the causative factors of oral cancer and people require the specialized units for a proper treatment.

EXECUTIVE SUMMARY Oral cancer is the term described as cancers occurring in the mouthparts that include lips, cheeks, sinuses, tongue, hard and soft palate, or the base of the mouth extending up to the oropharynx. Globally, oral cancer ranks 17th among all types of cancer in terms of both incidence and mortality. India has the largest number of oral cancer cases in the world, and this constitutes more than one-third of the total global burden. In India, oral cancer ranks as the second most common cancer, and is the number one cancer among males. In India, around 130,000 new cases and >75,000 deaths were reported only in the year 2020, with an expected doubling of incidence by 2040. This burden of oral cancer is further complicated by the late-stage diagnosis and low survival rates. In India, the majority of oral cancer cases are reported in the advanced stages, and hence, the chances of cure are very low. This report provides an insight into oral cancer as a public health problem in India, along with etiology and strategies to diagnose, treat, and prevent it while providing recommendations to improve upon the availability and delivery of treatment for oral cancer. The predominant risk factor for developing oral cancer is tobacco consumption. The continual use of tobacco in both smoking and smokeless forms is a major contributor to tumor development in the oral cavity. Other risk factors such as alcohol, diet and nutrition, oral thrush, dental problems, chronic irritation from sharp teeth or ill-fitting dentures, and human papillomavirus (HPV) infection also contribute to the burden. Further, social, cultural, and psychological factors too play an important role in developing oral cancer. Oral potentially malignant disorders (OPMDs) are a diverse group of conditions that are the precursors of oral cancer. It is important to recognize that a patient diagnosed with an OPMD has an increased risk of developing oral cancer compared to a person with a healthy mucosa. Lesions such as Erythroplakia, Erythroleukoplakia, Leukoplakia, Proliferative verrucous leukoplakia, Submucous fibrosis, Palatal lesions associated with reverse smoking, oral lichenoid lesions, oral lichen planus, smokeless tobacco keratosis, and more are the common OPMDs seen in the country. Oral cancer screenings, which are conducted to identify any clinical premalignant phase (accessible to visual inspection), are usually done on a mass scale and shows a decreased burden of advanced oral cancer incident cases and deaths as compared to no screening. Among the screening strategies, it is suggested that high-risk screening is cost-effective compared to mass screening at periodic intervals. Oral cancer screening methods vary across healthcare settings, each with its advantages and limitations. While visual inspection remains a fundamental tool, adjunctive technologies are sometimes used in dental clinics; community outreach programs and telemedicine extend accessibility to screening. The Ministry of Health and Family Welfare, Government of India, has prepared a universal and objective operational framework for cancer screening and management that aims to promote, coordinate, and conduct research to better understand, detect, diagnose, and treat cancer. The framework makes it mandatory to perform screening of oral, cervix, and breast cancer for males and females above the age of 30. Concerning oral cancer treatment, several modalities are available; however, the cure depends on the cancer stage when diagnosed and the delay in starting treatment. Primary surgery is the preferred modality of treatment for a vast majority of operable oral cancers. Radiotherapy is an alternate for early-stage oral cancers with comparable control rates to surgery. Typically, the primary treatment for oral cancer is surgery. The primary goal of surgical resection is to ensure complete removal of the tumor tissue. However, the potential negative impacts on appearance and functionality due to the extent of the disease and the necessary surgical removal stress the importance of using less invasive surgical methods. The National Cancer Grid Management Guidelines for early-stage cancer recommends surgical local excision with a minimum of 1 cm gross margin, accompanied by appropriate neck dissection and suitable reconstruction. For advanced stages, surgery is preferred, along with adjuvant radiotherapy or chemotherapy. Oral cancer in its entirety imposes a significant fiscal burden on a national, institutional, family, and individual level. Funding of cancer care in India is a complex mixture of state and government accountabilities, with the government shouldering most of the responsibility. Oral cancer as such, has not been given a separate budget in India, but it is covered under various facilities of the government, schemes, and programs for cancer. This report entails the Task Force Committee recommendation for screening, diagnosis, prevention, and management of oral cancer, along with research, policy, and advocacy recommendations to address this immense public health problem in the country.

Diagnostic accuracy of magnetic resonance imaging in detecting depth of invasion of tongue cancers

Background:Oral cancer awareness among junior and seniors' dental undergraduate students may have an impact on the early detection and prevention of oral cancer.Aims and Objectives:To assess oral cancer awareness, knowledge and attitude among undergraduate dental students in government and private colleges in Saudi Arabia.Material and Methods:A cross-sectional survey was undertaken to assess oral cancer knowledge, awareness and attitude among undergraduate dental students in government and private colleges in Saudi Arabia. All junior and senior students enrolled during the 2020– 2021 academic year, were eligible to participate (n=189).Results:The study shows that dental Students at private and government colleges in Saudi Arabia are generally knowledgeable regarding Knowledge, awareness, attitude and management of oral cancer. There was no significant difference between knowledge, awareness, attitude, and management of oral cancer between students in either private and government colleges. Results shows that 99 (88.9%) of dental students in government colleges considered human papilloma virus as a risk factor, higher than dental students in private colleges 48 (73.3%). My results indicated that dental students considered (87%) tobacco, and alcohol (83.6%) as main risk to oral cancer, whereas, 100 (53%) identified limited consumption of fruit and vegetables and 124 (65.6%) considered old age as risk factor for oral cancer.Conclusion:The variation in correct answers indicate to need to reinforce the undergraduate dental curriculum with regards to oral cancer education; particularly in its prevention and early detection. Revision of knowledge senior students in oral cancer is highly recommended.

Introduction Oral cancer is the eighth most common cancer in the world and associated with a high rate of morbidity and mortality. Appropriate and early diagnosis of the condition is associated with improved patient outcomes, and an improvement in five-year survival rates.Aims We aim to ascertain if dental and medical students have similar amounts of self-confidence in the understanding and management of oral cancer within a large UK university.Methods We invited 65 final-year dental students and 101 final-year medical students to undertake our study, with 50 dental students and 59 medical students opting to participate.Results We found final-year dental students to feel significantly more confident in their understanding and management of oral cancer when compared to their medical counterparts.Conclusions Medical students may benefit from additional teaching on oral cancer. Additionally, they should be encouraged to briefly screen the oral cavity of individuals who are at high-risk of the disease.

Artificial intelligence (AI)-driven large language models, such as Chat Generative Pre-Trained Transformer (ChatGPT)-4 Plus, are increasingly used for patient education and clinical decision support in oral oncology, although their accuracy in oral cancer (OC) management remains uncertain. This study evaluates the accuracy of ChatGPT-4 Plus responses to clinically relevant questions regarding OC diagnosis, treatment, recovery, and prevention. A cross-sectional study assessed 65 clinically relevant OC-related questions using a paid ChatGPT-4 Plus subscription without modifications. Three oral medicine specialists and one radiation oncologist rated accuracy on a four-point scoring system. Interrater reliability was measured with the intraclass correlation coefficient (ICC), and chi-square tests were used for comparisons. Among 65 questions, 63% of responses were Score 1, with none rated as Score 4. Score 1 was most frequent in Recovery (72%), followed by Treatment (62%), Prevention (60%), and Diagnosis (55%). Scores 2 and 3 responses were highest in Diagnosis (45%). Recovery had significantly higher Score 1 responses than Diagnosis (p < 0.05), while other comparisons were not significant. ICC ranged from 0.85 to 0.93. ChatGPT-4 Plus provided accurate responses to clinically relevant OC-related questions, particularly regarding recovery. However, diagnostic inconsistencies highlight the need for clinician oversight before integrating AI into practice.

Can Artificial Intelligence (AI) assist in the diagnosis of oral mucosal lesions and/or oral cancer?

Current management of oral cancer: A multidisciplinary approach

Oral cancer is amenable to early detection but remains a prominent cause of mortality in the Asia Pacific region. This study aimed to identify barriers to early detection and management of oral cancer in the Asia Pacific region. A mixed-methods approach was employed triangulating findings from a survey and focus groups. The survey was conducted among seven representative members of the Asia Pacific Oral Cancer Network (APOCNET) across six countries. Focus groups were conducted to gain deeper insights into the findings of the survey. The identified barriers were a lack of national cancer control strategies and cancer registries and the limited availability of trained health care professionals. Overcoming these challenges in the Asia Pacific region where resources are scarce will require collaborative partnerships in data collection and novel approaches for continuous professional training including eLearning. Further, to overcome the lack of trained health care professionals, innovative approaches to the management of oral potentially malignant lesions and oral cancer including telemedicine were suggested. The findings of this study should be taken into account when charting national cancer control plans for oral cancer and will form the basis for future collaborative studies in evaluating effective measures to improve oral cancer detection and management in low- and middle-income countries.

This study conducts a systematic bibliometric analysis of tongue cancer publications to identify key topics, hotspots, and research distribution. We analyzed tongue cancer publications in the Web of Science core collection database, assessing their quantity and quality. We investigated contributors, including countries, affiliations, journals, authors, and categories, within collaborative networks. Additionally, we synthesized key research findings using various analytical techniques, such as alluvial flow, burstness analysis, cluster analysis, co-occurrence network of associations, and network layer overlay. From 2000 to 2022, this bibliometric study covers 2205 articles and reviews across 617 journals, involving 72 countries, 2233 institutions, and 11,266 authors. It shows consistent growth, particularly in 2016. Key contributors include China (499 publications), Karolinska Institute (84 publications), Oral Oncology (144 publications), and Tuula Salo (47 publications). Other notable contributors are the USA (16,747 citations), the National Cancer Institute (NCI) (2597 citations), and the Memorial Sloan-Kettering Cancer Center (MSK) (2231 citations). Additionally, there are significant teams led by Tuula Salo and Dalianis. We have identified six primary clusters: #0 apoptosis, #1 depth of invasion, #2 radiotherapy, #3 hpv, #4 tongue cancer, #5 oral cancer. The top ten highly cited documents primarily pertain to epidemiology, prognostic indicators in early-stage oral tongue cancer, and HPV. Additionally, we observed 16 reference clusters, with depth of invasion (#3), young patients (#4), and tumor budding (#6) gaining prominence since 2012, indicating sustained research interests. This analysis emphasizes the increasing scholarly interest in tongue cancer research. The bibliometric evaluation highlights pivotal recent research themes such as HPV, depth of invasion, tumor budding, and surgical margins. The bibliometric analysis highlights the key topics and studies which have shaped the understanding and management of tongue cancer.

This editorial explores the important role that nurses play in bridging the gap in the prevention and management of oral cancer. Despite advances in medical science, oral cancer remains a significant global public health challenge, with high mortality rates due to late diagnosis and inadequate treatment. Nurses, with their multifaceted contributions, are indispensable in addressing this challenge. The editorial emphasizes the key role of nurses in patient education and awareness, early detection and screening, comprehensive patient care, supportive services, and advocacy. Nurses are frontline educators, advocates, caregivers, and collaborators in the fight against oral cancer. Through their expertise, compassion, and dedication, nurses have a significant impact on patient outcomes, reducing mortality rates, and promoting a healthier future for those affected by oral cancer. Recognizing and supporting the crucial role of nurses in the management of oral cancer is essential for advancing prevention, detection, and treatment efforts.

Oral cancers are the leading cause of cancer-related death in Indian men. Currently steps to contain the transmission and treatment of COVID-19 pandemic have crippled the entire health care system. With hospitals running short of resources, the oncological practice became standstill, especially during the initial phase. This is a retrospective study among patients who presented to our tertiary care hospital in early 3 months of COVID-19 era(ECE) with respect to pre-COVID-19 era(PCE). The study includes patients discussed in multidisciplinary tumor board(MDT)(421 in ECE Vs 31 in PCE) and those who underwent surgery(192 in ECE Vs 26 in PCE). The presentation and outcomes of oral carcinoma were compared between the two eras. There was a significant drop in the number of patients who presented during ECE. Though mean age and gender remained comparable between groups, there was a statistical difference in relation to demographic profile of patient (p value < 0.001). Among operated during ECE, 80% had a significantly advanced tumor stage (p value < 0.034) and advanced composite stage (p value < 0.049). Among patients discussed in MDT during ECE, 38.7% were deemed inoperable which is double the number when compared with PCE (p value < 0.009). Results of our study showed a higher incidence of advanced stage disease during ECE, with many patient turning inoperable. Thus, the survival of newly diagnosed oral carcinoma patients will be worser. In the management of oral cancer both early stage and advanced stage should have the same priority. Immediate resumption of safe oncology services is mandatory to curtail the current issues.