Intraoral Cancer Research Articles

Trends in the incidence of histologically diagnosed intra-oral squamous cell carcinoma in Northern Ireland, 1975-89.

Studies in Britain point to a rise in the incidence of intra-oral cancer in the last 20 years, paralleling trends evident in other European countries. Cases of histologically-diagnosed primary intra-oral squamous cell carcinoma have been ascertained by reviewing the records of pathology departments in Northern Ireland. Trends in the incidence of the disease have been determined for the period 1975-89. There has been a significant increase in the incidence among men, rising from 1.78 to 3.14 per 100,000. In women over the same period the incidence rose from 0.87 to 1.19 per 100,000, but this change was not significant. These trends concur with recent findings from other countries.

An evaluation of functional outcome after surgery and radiotherapy for intraoral cancer

Two hundred and fifty five patients undergoing treatment for oral cancer were studied. Tumour site, classification and treatment modality were recorded and an assessment of their ability to swallow was made postoperatively. Patients were graded into one of three groups depending on dietary consistency. Pre- and postoperative dental examinations were made and patients were weighed pre- and postoperatively. Postoperative functional problems are outlined. The results indicated that 21 % of the sample reported difficulty with swallowing solid foods and 46% were limited to semi-solid or liquid diets postoperatively; 16% were unable to wear upper or lower dentures postoperatively and 15% of edentulous patients were able to wear an upper denture only; 65% of the patients who had surgery and radiotherapy were unable to regain their preoperative weight after 6 months. Patients with T1 tumours who did not progress to radiotherapy faired much better postoperatively and were more likely to return to normal diet and regain their preoperative weight.

Oral cancer: a comparative study between 1962-67 and 1980-84 in England and Wales

This study reveals that changes are occurring in the pattern of oral cancer. Despite decreases in the number of lip and salivary gland cases, intra-oral cancer is increasing. The number of new cases is rising, especially in females, and it is presenting at a younger age in males. Intra-oral cancer deaths have increased, with females showing a 40% rise. The mortality rate has deteriorated to 62%. It is possible that these increases could be attributed to continued lack of public awareness of the disease and a considerable rise in alcohol consumption per head of population in the UK.

The incidence and management of osteoradionecrosis following combined modality therapy for intraoral cancer

The incidence and management of osteoradionecrosis following combined modality therapy for intraoral cancer

Oral Cancer

In the U.S. oral cancer accounts for 2.1% of all cancers and 1% of cancer deaths. Two to three times as many males as females are affected. Blacks have more intra-oral cancer than whites, and their incidence and mortality rates have increased in recent years. The etiologic process very likely involves several factors. The major etiologic agents are tobacco (all types) and alcoholic beverages. Herpes simplex virus, human papilloma virus, and Candida have been implicated. Host factors include poor state of dentition, nutritional aberrations, cirrhosis of liver, lichen planus, and immunologic impairmant. Cellular changes include amplification of some oncogenes, alterations in antigen expression, production of gamma-glutamyl transpeptidase, and disturbance of keratin and involucrin production. Experimentally, cancer is readily produced on the hamster cheek pouch and rat oral mucosa. Unlike oral cancer in humans, most experimental lesions are exophytic, and they rarely metastasize.

Functional implications of major surgery for intraoral cancer

A group of 41 patients were questioned about functional problems and concern for appearance, experienced following major surgery for intraoral malignancy. Twenty-five per cent of the group reported significant difficulties. Spouses reported a higher incidence of problems. The effects of primary tumour site and type of reconstruction on functional outcome are discussed.

Psychological distress at follow-up after major surgery for intra-oral cancer

A cohort of patients who had received major intra-oral surgery, up to 10 yr (mean 3.5 yr) prior to this study were reviewed and assessed for evidence of current psychological disturbance. Forty-one per cent of patients were found to have significant levels of psychological distress comprising mood disorder, social dysfunction or both types of difficulty. Prevalence of clinical anxiety and depression per se was within the range 22–32%, but few patients were receiving any form of active therapy for these problems. Investigation of predictors revealed that females and younger people were more at risk to psychological distress. Tentative evidence for variability in psychological outcome in relation to tumour site is also reported. Results are discussed with reference to service provision needs and further research priorities.

Oral cancer in children under 15 years of age. A clinicopathological and virological study.

11 malignant tumours of the oral region in children under 15 years of age were diagnosed in Finland during the 20-year period from 1961 to 1980; the age adjusted annual incidence rate being 0.31 per 1,000,000 children. 5 cases were intraoral cancer and 5 cases malignant tumours of the major salivary glands. The formalin-fixed tumours were studied using the in situ DNA hybridization technique for Adenovirus, group II, Epstein-Barr and human papillomavirus, type 16. For the first time, evidence was provided for the presence of Epstein-Barr virus in a malignant salivary gland tumour, implicating a possible etiological role for this virus in salivary gland neoplasms.

Excision of selected intraoral cancers by use of sagittal inner table mandibulectomy.

The application of oral surgery osteotomy techniques, which are used in orthognathic surgery, to excision of squamous cell carcinomas in various oral cavity locations is described and illustrated in eight cases. These methods allow the full height of the inner table of the mandible to be removed as a margin for tumors which abut the lingual mucoperiosteum without radiologic evidence of bone erosion, while jaw continuity via the intact outer cortex is maintained. These techniques can also be used for marginal mandibulectomy and horizontal maxillectomy. Discussion includes criteria for selection of cases appropriate for such conservation surgery with respect to oncologic considerations, as well as complications encountered and their prevention.

A classic paper revisited--Polya and von Navratil (1902).

In 1902, Polya and von Navratil published a paper in German describing lymphatic drainage of buccal mucosa, alveolus, fauces, and lips. In addition, they discussed patterns of local tumor spread and metastasis to lymph nodes, on the basis of which they gave a rational plan for surgical treatment of buccal carcinoma with the aim of both cure and conservation of uninvolved tissues. Much of that paper was ignored in the English language literature and some of the contents have been misquoted. This has been to the great detriment of the surgical treatment of intraoral cancer in the English-speaking world, which has only recently accepted similar principles and practice to that described by Polya and von Navratil. This paper reviews their publication in an attempt to put their contribution into proper perspective.

Intra-oral squamous cell carcinoma in patients under 40 years of age. A report of 13 cases and review of the literature

The results of the treatment of 13 patients under the age of 40 presenting with primary intra-oral squamous cell carcinoma have been presented. 31% (four patients) survived 3 years from first presentation and all patients who died had recurrent disease within 12 months of surgery. These figures suggest that younger patients with intra-oral cancer have a prognosis similar to an older, more typical cohort.

Reconstructive surgery in the treatment of intraoral cancer

Patients with intraoral cancer present to various specialities. A series of 63 patients shows the importance of modern reconstructioe surgery for patients treated by tumour excision. The reasons why a variety of techniques must be available to the patient are discussed. The advantages and disadvantages of some of these methods of reconstruction are reviewed.

Post-operative radiotherapy in the management of advanced intra-oral cancers

Advanced tumours of the tongue and floor of the mouth have a poor prognosis when treated by surgery or radiotherapy alone. The results reported here suggest that combined surgery and radical post-operative radiotherapy greatly improve the outlook for such patients. When the oral cavity is irradiated, both parotids usually receive a radical dose resulting in xerostomia. In this study, shaped fields are used to spare the contralateral parotid, thus minimising the reduction in saliva production. Previously, radical surgery of oral tumours left the patient deformed. Plastic surgery techniques of reconstruction using radial free flaps give excellent cosmetic results. Radial free flaps have their own blood supply and tolerate a radical dose of radiotherapy.

Age-specific and age-standardised incidence rates for intraoral squamous cell carcinoma in blacks on the Witwatersrand, South Africa.

All new cases of intraoral squamous cell carcinoma which occurred in Blacks resident on the Witwatersrand during the 10-yr period 1971-80 were traced by examining the records of all the hospital pathology departments in this area. The population at risk at the mid-point of the study (1975) was calculated from the National Population Censuses of 1970 and 1980, and consisted of 1125960 men and 880269 women. Age-specific incidence rates and age-standardised incidence rates were calculated for each intraoral site for men and women. In the latter calculation a standard World population was used. All rates are expressed as average number of cases per 100000 population per annum. The age-specific incidence rates and age-standardised incidence rates (in brackets) for men and women respectively are: tongue, 1.43 and 0.26 (2.69 and 0.41); gingiva and alveolar ridge, 0.04 and 0.01 (0.07 and 0.01); floor of mouth, 0.87 and 0.22 (1.64 and 0.38); buccal mucosa, 0.05 and 0.04 (0.13 and 0.05); hard and soft palate, 0.34 and 0.05 (0.63 and 0.08). There appears to have been an increase in the incidence of intraoral cancer in Black South Africans since the first survey in 1953-55, which can probably be ascribed to the urbanization process. In Europe, North America and in other population groups in South Africa, the palate is least frequently affected. In contrast, in Black South Africans lesions of the palate are much more common, being less frequent only than tongue and floor of mouth lesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Shamma Usage and Oral Cancer in Saudi Arabia

ABSTRACT Between June 1981 and July 1984, 33 (49%) of 68 patients with intraoral cancer referred to the King Faisal Specialist Hospital admitted to using shamma, which is a mixture of tobacco, blac...

Malignant: Intra-oral cancer at the Massachusetts General Hospital: Squamous cell carcinoma of the floor of the mouth

Malignant: Intra-oral cancer at the Massachusetts General Hospital: Squamous cell carcinoma of the floor of the mouth

Surgical stents for the head and neck cancer patient.

Split-thickness skin graft reconstruction following intraoral cancer surgery maintains functional mobility within the oral cavity and gives excellent support for the final intraoral rehabilitative prosthesis. We describe the use of a dental material, called tissue conditioner, for skin graft immobilization as an alternative to the usual gauze bolus and thermoplastic materials following surgery in various intraoral anatomic sites.

Skin grafts in intraoral reconstruction. A new stenting method.

The results of skin graft reconstruction in intraoral cancer in 65 consecutive cases were uniformly good. There were only 11 wound complications and all resolved spontaneously without additional surgery. Skin grafts were used successfully in conjunction with coronal resections of the mandible, incontinuity modified neck dissections, and composite resections. Postoperative radiation therapy had no ill effects on the grafts or oral hygiene. A new stenting method with a dental tissue conditioner was employed. When used to immobilize intraoral skin grafts, it improved oral hygiene and patient deglutition, thereby hastening rehabilitation. The success of grafts performed with the new stent was equal to (if not better than) the success of grafts performed with the traditional stent.

The Chepstow feeding aid

A specially designed spoon or scoop has been developed to enable controlled amounts of semi-solid food to be accurately and easily inserted into the mouth. This device simplifies feeding following major surgery for intra-oral cancer. Its use and other possible applications are described.

Bipedicled cervical skin flap for repair after resection of oral cancer

A technique for immediate reconstruction after resection of intraoral cancer, using a bipedicled cervical skin flap, is reported. This procedure does not necessitate a split-thickness skin graft, and the neck wound may be closed by primary approximation.