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
Disclosures/Financial Conflicts of Interest None
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
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
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
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
Learning Objectives Understand prevalence of oral cancer
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
Oral Cancer Prevalence HPV-positive OPC increased by 225% from 1988-2004 0.8 per 100,000 2.6 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
Oral Cancer Prevalence Chaturvedi et al. JCO 2011
Oral Cancer Prevalence Marur et al., Lancet Oncol. 2010
Oral Cancer Prevalence CDC
Learning Objectives Identify risk and protective factors for oral cancer
Oral Cancer Risk Factors Tobacco Google
Oral Cancer Risk Factors Alcohol Google
Oral Cancer Risk Factors Human Papillomavirus (HPV) 16 >>18 >>>>> other subtypes Google
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
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
Oral Cancer Prevention NCI
Oral Cancer Prevention NCI
Oral Cancer Prevention?? Merck
Oral Cancer Prevention NCI
Learning Objectives Recognize clinical manifestations of oral cancer
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
Clinical Manifestations of Oral Cancer Oral Cavity: Oral Cancer
Clinical Manifestations of Oral Cancer Oral Cavity: Oral Cancer
Clinical Manifestations of Oral Cancer Oropharynx: Base of Tongue Cancer
Clinical Manifestations of Oral Cancer Oropharynx: Tonsil Cancer
Clinical Manifestations of Oral Cancer Pynnonen et al., OtoHNS. 2017
Clinical Manifestations of Oral Cancer Delay in diagnosis routinely > 2 months Up to 70% receive antibiotics prior to diagnosis Pynnonen et al., OtoHNS. 2017
Clinical Manifestations of Oral Cancer The face of tobacco/alcohol-related oral cancer 60-70 year old caucasian males Google
Clinical Manifestations of Oral Cancer The new face of HPV-related oropharyngeal cancer 40-50 year old caucasian males Google
Clinical Manifestations of Oral Cancer Marur et al., Lancet Oncol. 2010
Clinical Manifestations of Oral Cancer Young Male White Presents with a neck mass IT IS NOT INFECTIOUS! Deschler et al., OtoHNS 2015
Clinical Manifestations of Oral Cancer Young Female White? Dental trauma Li et al., OtoHNS 2013
Clinical Manifestations of Oral Cancer
Clinical Manifestations of Oral Cancer
Learning Objectives Appreciate screening guidelines for oral cancer
Oral Cancer Screening NCI
Oral Cancer Screening USPTF
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
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