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