Oral cancer

The term oral cancer includes all malignant tumors of the oral cavity and tongue, these are located in 80 to 90 % of the cases were squamous cell carcinomas. Other tumor types such as the light emanating from the seromucous mucosal glands adenocarcinoma are rare. Oral carcinomas belong to the class of head and neck tumors.

• 5.1 Surgical Therapy
• 5.2 Radiological therapy

Causes

Major risk factors for the occurrence of oral cavity cancer are chronic tobacco or alcohol, much less other factors. In chronic tobacco or alcohol in combination of both risk factors up to 30 -fold increased risk of disease is an up to 6-fold, yet. Also for the lip cancer is considered the contact of the lip with a cigarette, regardless of the total amount of tobacco smoked, as a major risk factor. Furthermore, the use of smokeless tobacco is a predisposing factor for the development of oral cavity cancer. In addition to the use of tobacco or alcohol can also be a one-sided diet, such as an excessive consumption of meat or fried food, increase the risk of development of carcinoma in the oral cavity.

Epidemiology

The carcinomas of the oral cavity occur after the 5th decade of life and have a peak between 60 and 70 years. Men are affected twice as often as women. The mortality of oral cavity cancer has geographical differences, in France it is, for example, four times as high as in Germany. The oral cancer is worldwide with 6 % of all cancers in 6th place. In men, it is the fifth most common in women and the 15 - most common cancer incidence (as of 2012). The five -year survival of patients diagnosed with oral cancer in Germany is about 55%.

Pathology

Formation

The development of an oral cavity carcinoma happens in the rarest of cases without precancerous lesions, which - depending on the probability of degeneracy - in optional ( low probability ) and obligate (probability ≥ 30 %) premalignant lesions are divided. An optional precancerous lesion of the oral cavity carcinoma is the leukoplakia and is found most commonly on the buccal mucosa and in the mouth. The obligatory precancerous lesions are generally less common than leukoplakia and often already degenerated at the time of diagnosis of malignant ( malignant). This includes, for example, Bowen disease (or Erythroplasia Queyrat ), they are often located on the gingiva or tongue base.

Localization

According to a study of the DOSAK ( German -Austrian- Swiss Association for tumors in the maxillo-facial area) are located about 45 % of all oral cancer floor of the mouth. The tumors on the tongue ( tongue cancer ) followed by approximately 20%. Other localizations, but much less frequently, in order of frequency gingiva, upper lip and buccal mucosa. The incidence of oral cancer arises often multifocal, which explains the high recurrence rate.

Morphology

The two forms of growth of oral cavity carcinoma differ prognostically from each other:

• Ulcerative Form: This growing inward ( endophytic ) form generally has a decay crater, the prognosis depends on the location, so it is better on the lip as, for example, floor of the mouth or on the tongue. Ulcerative form accounts for approximately 99%. Histologically, this is a geringgradig differentiated squamous cell carcinoma.
• Verrucous form: This growing outwards ( exophytic ) form accounts for approximately 1%. The tumor grows slowly and metastasizes later. In histology is highly differentiated squamous cell carcinoma.

Metastases

The tumors of the oral cavity and the anterior two thirds of the tongue metastasize almost never primarily via the blood ( hematogenous ), but via the lymph into the submandibular, submental rare in the lower-lying or on the neck lymph nodes. The frequency of lymphatic metastasis increases with tumor stage. It is in the diagnosis of the tumor about 30 to 40 % (T1 stage 10 to 15 % at the stage T4 with 55 to 75 %).

Tumors of the gingiva and the buccal mucosa have already metastases in the regional lymph nodes at diagnosis in a greater percentage. In Gingivatumoren can lymph nodes of the throat, be infested buccal mucosa tumors also parotideale lymph nodes.

Symptoms and diagnosis

The complaints are initially nonspecific. Initial symptoms of pain, bad breath and speech disability can be.

In all suspected cases, a biopsy should be performed. Further, a computed tomography or magnetic resonance imaging of the primary tumor and the locoregional lymph vessels should be performed in cases of suspected. Advantage of MRI is in tumors of the tongue and floor of the mouth of the good Weichgewebskontrast. If the infiltration of the bone to be clarified, MRI is less useful, here you have the bone scan or computed tomography in special bone window. In advanced cancer ( tumor stage T3 or from proven lymph node metastases) should be checked hematogenous metastasis of lung, liver and adrenal glands.

Therapy

Surgical treatment

Depending on the stage and extent of the tumor, a resection with a correspondingly high safety margin (approx. 1 cm ) are sufficient. With extensive findings may be necessary partial resection of the mandible. In several regions of the oral cavity is exceeded, then a combined resection of, for example, tongue, floor of mouth and palate should be performed. In lymph node metastases may be necessary depending on the stage to a selective radical neck dissection.

Radiological Therapy

For small tumors of the tongue and the hard palate the Radiotherapy alone can lead to a meaningful tumor control. For larger tumors offers a more aggressive approach in the form of a combination of surgical and radiological therapy.