mauricio a. moreno, m.d. assistant professor department of otolaryngology- head and neck surgery...
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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
• 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
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%
• 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