Types Of Oral Cancer: Most Common Type

Types Of Oral Cancer: Most Common Type

Briefly discuss the etiology, epidemiology, classification, and principles of treatment of oral cancer.

Answer.

Oral Cancer Epidemiology

• Squamous cell carcinoma represents about 90% of all oral cancer, for this reason, oral squamous cell carcinoma is often designated as “oral cancer.”
• On an average, oral squamous cell carcinoma represent about 3% of all cancer in males and about 2% of all cancer in females.
• The incidence of oral squamous cell carcinoma increases with age and most of the causes occur usually after the age of 40 years.

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Classification of Oral Cancer

Oral cancer of epithelial tissue origin:

• Basal cell carcinoma
• Squamous cell carcinoma
• Verrucous carcinoma
• Adenoid squamous cell carcinoma
• Malignant melanoma

Oral cancer of mesenchymal tissue origin:

Oral cancer of firous tissue

• Fibrosarcoma
• Malignant firous histiocystoma.

Oral cancer of adipose tissue

• Liposarcoma.

Oral cancer of vascular tissue

• Hemangiopericytoma
• Hemangioendothelioma
• Angiosarcoma.

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Oral cancer of lymphoid tissue

• Hodgkin’s lymphoma
• Non-Hodgkin’s lymphoma
• Burkitts lymphoma
• Leukemia.

Oral cancer of bone

• Osteosarcoma
• Ewing’s sarcoma.

Oral cancer of neural tissue

• Neurosarcoma
• Neurofirosarcoma
• Neuroblastoma.

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Oral cancer of muscle

• Leiomyosarcoma
• Malignant granular cell myoblastoma

Tumor of salivary gland

• Mucoepidermoid carcinoma
  Adenocarcinoma
  Acinic cell carcinoma.

Principle of Treatment of oral Cancer

Following are the principles oftreatment oforal cancer:

• If only primary is present which is mucosal with size less than 2 cm without nodal spread, then wide local excision with supra omohyoid block dissection of same side is done (N0); primary may also be treated with curative brachytherapy or external beam teletherapy.
  If nodes are histologically positive then radical neck dissection is done.
• Larger mucosal primary with similar features are also treated similarly, but postoperative radiotherapy or/and chemotherapy is added depending on grading of the tumor.
• In all these types of lesions, if there are positive mobile neck nodes which is confimed by FNAC, then radical neck dissection should be done.

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• If primary lesion extends into adjacent soft tissue with mandibular involvement then mandibular resection is needed.
  Part is reconstructed using plates or bone graft taken from iliac crest or opposite 11th rib. 2.4 mm reconstruction plate with pectoralis major myocutaneous flap (PMMF) or non-vascularized bone graft (iliac crest cancellous chips) or vascularized bone graft from fibula/iliac crest/ scapula are the present recommendations.
  Skin covering is done by split skin graft inside to mucosa or by appropriate flops depending on the need and feasibility of the donor area (PMMF/DP flp/forehead flap).
  Neck is addressed similarly. Postoperative EBRT and chemotherapy is needed either concurrent or sequential.

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• If primary is advanced then chemotherapy with EBRT is used.
  If lesion reduces in size and becomes operable it is then operated accordingly.
• In fixedd primary or secondary, radiotherapy with chemotherapy is used for palliation to relieve pain, fungation,sepsis.
• In advanced stage terminal events may be severe malnutrition, bleeding, sepsis, and bronchopneumonia.
  Posterior lesions has got poor prognosis than anterior lesions.
  Lip carries best prognosis depends on anatomical location, grading, lymph node status, soft tissue involvement and response of therapy.