Oral Cancer Risk and Detection

Transcription

1 Oral Cancer Risk and Detection Evan M. Graboyes, MD Assistant Professor Department of Otolaryngology-Head & Neck Surgery Cancer Control Program, Hollings Cancer Center Medical University of South Carolina

2 Disclosures/Financial Conflicts of Interest None

3 Learning Objectives 1. Understand prevalence of oral cancer 2. Identify risk and protective factors for oral cancer 3. Recognize clinical manifestations of oral cancer 4. Appreciate screening guidelines for oral cancer

4 What is Head and Neck Cancer Cancer arising from the lining inside the mouth and throat Oral cavity Pharynx Nasopharynx Oropharynx Hypopharynx Larynx Salivary Glands Major (Parotid, SMG) Minor (in UADT) Skin and Soft Tissue

5 What is Oral Cancer Oral cavity Oral tongue (anterior 2/3) Floor of mouth Hard palate Alveolus (mandible and maxilla) Buccal Retromolar trigone Lip Oropharynx Tonsils Base of tongue (post 1/3) Soft palate Uvula Posterior pharyngeal wall Cummings

6 Head and Neck Cancer: Histopathology 1. Squamous Cell Carcinoma 2. Salivary gland malignancies 1. Mucoepidermoid Carcinoma 2. Adenoid cystic carcinoma 3. Acinic Cell Carcinoma 3. Lymphoma 1. Non-Hodgkins 2. Hodgkins 4. Sarcoma 1. Osteosarcoma 2. Chondrosarcoma 3. Rhabdomyosarcoma 5. Melanoma Lydiatt et al. CA: A Journal for Clinicians 2017

7 Learning Objectives Understand prevalence of oral cancer

8 Oral Cancer Prevalence 6th most common cancer worldwide 630,000 new diagnoses annually 350,000 deaths/year 51,000 patients diagnosed/year in the US more than 10,000 deaths annually

9 Oral Cancer Prevalence HPV-positive OPC increased by 225% from per 100, per 100,000 HPV-negative cancers declined by 50% 2.0 per 100,000 to 1.0 per 100,000 Chaturvedi et al. JCO 2011

10 Oral Cancer Prevalence Chaturvedi et al. JCO 2011

11 Oral Cancer Prevalence Marur et al., Lancet Oncol. 2010

12 Oral Cancer Prevalence CDC

13 Learning Objectives Identify risk and protective factors for oral cancer

14 Oral Cancer Risk Factors Tobacco Google

15 Oral Cancer Risk Factors Alcohol Google

16 Oral Cancer Risk Factors Human Papillomavirus (HPV) 16 >>18 >>>>> other subtypes Google

17 Oral Cancer Risk Factors Human Papillomavirus (HPV) s proteins interact with tumor suppressor proteins in the cell to cause cancer Allen et al. Laryngoscope 2010

18 Oral Cancer Risk Factors Risk Factors for OPC High lifetime # of vaginal-sex partners High lifetime # of oral-sex partners Oral HPV-16 infection Oral infection with any other type of HPV HPV-16 L1 capsid seropositivity D Souza et al. NEJM 2007

19 Oral Cancer Prevention NCI

20 Oral Cancer Prevention NCI

21 Oral Cancer Prevention?? Merck

22 Oral Cancer Prevention NCI

23 Learning Objectives Recognize clinical manifestations of oral cancer

24 Clinical Manifestations of Oral Cancer SUBTLE DELAY IN DIAGNOSIS Sore/ulcer in mouth Poorly fitting dentures Loose teeth Sore throat Neck mass Ear pain Difficulty swallowing Change in voice Shortness of breath

25 Clinical Manifestations of Oral Cancer Oral Cavity: Oral Cancer

26 Clinical Manifestations of Oral Cancer Oral Cavity: Oral Cancer

27 Clinical Manifestations of Oral Cancer Oropharynx: Base of Tongue Cancer

28 Clinical Manifestations of Oral Cancer Oropharynx: Tonsil Cancer

29 Clinical Manifestations of Oral Cancer Pynnonen et al., OtoHNS. 2017

30 Clinical Manifestations of Oral Cancer Delay in diagnosis routinely > 2 months Up to 70% receive antibiotics prior to diagnosis Pynnonen et al., OtoHNS. 2017

31 Clinical Manifestations of Oral Cancer The face of tobacco/alcohol-related oral cancer year old caucasian males Google

32 Clinical Manifestations of Oral Cancer The new face of HPV-related oropharyngeal cancer year old caucasian males Google

33 Clinical Manifestations of Oral Cancer Marur et al., Lancet Oncol. 2010

34 Clinical Manifestations of Oral Cancer Young Male White Presents with a neck mass IT IS NOT INFECTIOUS! Deschler et al., OtoHNS 2015

35 Clinical Manifestations of Oral Cancer Young Female White? Dental trauma Li et al., OtoHNS 2013

36 Clinical Manifestations of Oral Cancer

37 Clinical Manifestations of Oral Cancer

38 Learning Objectives Appreciate screening guidelines for oral cancer

39 Oral Cancer Screening NCI

40 Oral Cancer Screening USPTF

41 Learning Objectives Understand prevalence of oral cancer Identify risk and protective factors for oral cancer Recognize clinical manifestations of oral cancer Appreciate screening guidelines for oral cancer

42 Thank You