Oral cancer natural history, complications and prognosis
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If left untreated, patients with oral cancer may progress to develop a non-healing ulcer, which demonstrates growth over time. A neck mass may develop, which may cause a mass defect. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. The 5-year survival rate for oral cancer that is diagnosed early is 75%, compared to 20% for late diagnosis. Complications of oral cancer include difficulty speaking, dysphagia, weight loss, bleeding and even death.
- Oral cancers usually present late, as they are usually painless and often ignored by the patient.
- Eventually they present as a non-healing ulcer, which demonstrates growth over time.
- Due to the extensive lymphatic drainage of the oral cavity, nodal metastases are common at the time of diagnosis.
- A neck mass may be the presenting complaint.
- Because of the difficulties with direct visualization, they may extend into the tongue or have clinical lymph node metastases before the diagnosis is established.
- As the tumors enlarge, they may cause a mass effect, which can lead to respiratory compromise when the patient presents late in their illness.
- The prognosis depends on the following:
- 5-year survival rate for oral cancer:
- Diagnosed early - 75%
- Diagnosed late - 20%
- Localized disease at diagnosis - 83%
- Cancer spread to other parts of the body - 32%
- Cure rate:
- More than 50% oral cancers are diagnosed when they have spread to throat and neck.
- Direct surgical complications include infection, bleeding, aspiration, wound breakdown, flap loss, and fistula.
- Complications of chemotherapy includes the following:
- Complications of radiation therapy includes the following:
- Complications common to both chemotherapy and radiation include the following:
- Oral mucositis
- Chronic dysphagia
- Pharyngocutaneous fistula
- Infections such as viral, bacterial, and fungal that results from myelosuppression, xerostomia, and damage to the mucosa from radiotherapy or chemotherapy
- Functional disabilities such as impaired ability to swallow, eat, taste and speak because of trismus, dry mouth, mucositis, and infection
- Nutritional compromise, such as poor nutrition from eating difficulties caused by dry mouth, mucositis, dysphagia, and loss of taste.
- Abnormal dental development
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- Gomez DR, Zhung JE, Gomez J, Chan K, Wu AJ, Wolden SL; et al. (2009). "Intensity-modulated radiotherapy in postoperative treatment of oral cavity cancers". Int J Radiat Oncol Biol Phys. 73 (4): 1096–103. doi:10.1016/j.ijrobp.2008.05.024. PMID 18707827.
- Oh HK, Chambers MS, Martin JW, Lim HJ, Park HJ (2009). "Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis". J Oral Maxillofac Surg. 67 (7): 1378–86. doi:10.1016/j.joms.2009.02.008. PMID 19531406.