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Introduction – Cancers of the Mouth and Oropharynx

  • Saman Warnakulasuriya
  • John S. GreenspanEmail author
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Part of the Textbooks in Contemporary Dentistry book series (TECD)

Abstract

Recent decades have seen tremendous advances in our understanding of the etiology, biology, and molecular basis of oral cancer, as well as important clinical advances in the diagnosis and management of this disease. Our aim in launching this textbook is to present important achievements that have been made in these respective fields, to summarize the current evidence, and to identify future perspectives.

Recent decades have seen tremendous advances in our understanding of the etiology, biology, and molecular basis of oral cancer, as well as important clinical advances in the diagnosis and management of this disease. Our aim in launching this textbook is to present important achievements that have been made in these respective fields, to summarize the current evidence, and to identify future perspectives.

In 2018, an estimated 354,864 people were diagnosed with oral cancer and 92,887 with oropharyngeal cancer, making this the eighth leading cause of cancer worldwide. Oral squamous cell carcinoma (OSCC) is the most frequent malignant tumor of the oral cavity, encompassing more than 90% of all oral malignancies. Though this book primarily deals with oral cancer in depth, we have devoted sections of some chapters to present some key information on oropharyngeal cancers.

Since the 1970s, the incidence of oral cancer, particularly tongue cancer, has risen in many countries, and recent studies have also shown a steady rise in the oropharyngeal cancer trajectory in high-income countries, particularly in the USA. Despite the progress in therapy, the mortality and morbidity rates of patients with oral cancer have not improved except in a few countries with advanced cancer centers. In ► Chapter  2, we present these global epidemiological data that are of particular interest to public health specialists. We draw the readers’ attention to the importance of considering various anatomical subsites of lip, oral cavity, and oropharynx as illustrated in ◘ Figs. 1.1 and 1.2 and based on the ICD-10 classification of diseases (◘ Table 1.1) (► https://apps.who.int/classifications/apps/icd/icd10online2007/index.htm?kc00.htm+) when reviewing the literature. As discussed in this chapter, it is clear that distinct differences exist in the epidemiology of the disease among the five continents.
Fig. 1.1

Anatomy of the oral cavity. (Copyright license ©2012 Terese Winslow LLC, U.S. Govt. has certain rights). Note that the soft palate, uvula, and tonsil are parts of the oropharynx

Fig. 1.2

Anatomy of the pharynx. (Copyright license ©2012 Terese Winslow LLC, U.S. Govt. has certain rights)

Table 1.1

ICD-10 Classification C00.3–C14.8: Cancers of lip, oral cavity, and oropharynx

Lip and oral cavity

Oropharynx

C00.3 – Mucosa of upper lip

C01.9 – Base of tongue, NOS

C00.4 – Mucosa of lower lip

C02.4 – Lingual tonsil

C00.5 – Mucosa of lip, NOS

C05.1 – Soft palate, NOS

C00.6 – Commissure of lip

C05.2 – Uvula

C00.8 – Overlapping lesion of lip

C09.0 – Tonsillar fossa

C00.9 – Lip, NOS

C09.1 – Tonsillar pillar

C02.0 – Dorsal surface of tongue, NOS

C09.8 – Overlapping lesion of tonsil

C02.1 – Lateral border of tongue

C09.9 – Tonsil, NOS

C02.2 – Ventral surface of tongue, NOS

C10.2 – Lateral wall of oropharynx

C02.3 – Anterior 2/3 of tongue, NOS

C10.3 – Posterior wall of oropharynx

C02.8 – Overlapping lesion of tongue

C10.8 – Overlapping lesion of oropharynx

C02.9 – Tongue, NOS

C10.9 – Oropharynx, NOS

C03.0 – Upper gum

 

C03.1 – Lower gum

 

C03.9 – Gum, NOS

 

C04.0 – Anterior floor of the mouth

 

C04.1 – Lateral floor of the mouth

 

C04.8 – Overlapping lesion of the floor of the mouth

 

C04.9 – Floor of the mouth, NOS

 

C05.0 – Hard palate

 

C05.8 – Overlapping lesion of palate

 

C05.9 – Palate, NOS

 

C06.0 – Cheek mucosa

 

C06.1 – Vestibule of mouth

 

C06.2 – Retromolar area

 

C06.8 – Overlapping lesion of other and unspecified mouth

 

C06.9 – Mouth, NOS

 

C14.8 – Overlapping lesion of the lip, oral cavity, and pharynx

 

In ► Chapters  3 and  4, we review the major risk factors of oral cancer, namely, tobacco, alcohol, and areca nut, and the role of human papillomavirus in the etiology of oropharyngeal cancers. There is an extensive literature on this topic, and we present the evidence in a summary form that we hope can be easily assimilated by our readers. The controversial aspects of the etiology are presented separately in a later chapter.

In ► Chapters  5,  6, and  7 we present the clinicopathological aspects of the disease. Correct staging of the tumor is important in making treatment decisions, and ► Chapter  6 summarizes significant modifications for clinical and pathological staging of head and neck cancers extracted from the recently released eighth edition of the American Joint Committee on Cancer Staging Manual. In ► Chapters  8,  9,  10, and  11, we summarize current knowledge on investigations to detect oral and oropharyngeal cancer helpful to clinicians and head and neck pathologists managing diagnostic services in secondary care facilities. Molecular aspects of oral cancer are discussed in ► Chapter  14 to assist the reader in understanding new biomarkers that may in the future help in cancer diagnostics and directing therapy. The majority of oral cancers are still identified in late and in advanced clinical stages, and ► Chapter  15 is devoted to advance the importance of the early detection of the disease.

Since the publication of the World Health Organization classification of oral potentially malignant disorders (OPMDs) in 2007, there has been growth of research on this topic, with over 750 publications in the past decade. In ► Chapters  12 and  13, we present knowledge from diagnosis to the management of OPMDs and pertinent data from follow-up studies examining the evidence on their malignant transformation.

► Chapters  16,  17, and  18 deal with aspects of prevention of the disease and focus on controlling lifestyle risk factors and chemoprevention, including information on ongoing clinical trials and approaches to secondary prevention. The principles and application of screening to facilitate and improve early detection are covered in ► Chapter  16.

► Chapters  19,  20,  21,  22,  23,  24, and  25 are devoted to various primary treatment modalities and principles underlying surgical and radio-chemotherapy treatment and factors affecting survival. In ► Chapter  23, the controversies on de-intensification of treatment for HPV-associated cancers of the oropharynx are discussed. ► Chapters  27 and  28 focus on new advances in molecular therapies and immunotherapy and their role in the management of oral cancer through personalized medicine. After primary treatment, relapses or metastases are encountered often, and primary treatment can profoundly affect the functioning of the oral cavity complex. These aspects are less emphasized in standard textbooks, and ► Chapter  26 deals with supportive and palliative care for patients with oral cancer. Cancer biology is comprehensively covered in ► Chapter  29, and we hope this would be of interest to both clinicians and researchers to understand the evolution and clonal expansion of a malignant cell that leads to a squamous cell carcinoma. As a prelude to future perspectives, we have in ► Chapter  30 included a critique on cancer stem cells to broaden the readership on this topic.

The contributors to this textbook are well-known authorities in their respective fields, and this book has brought together their expertise to provide an all-encompassing synthesis of the current state of knowledge on oral cancer. The ultimate intent of the book is to have an appeal to a broad group of clinicians working in oral medicine, otolaryngology, oncology, maxillofacial pathology, and other aspects of head and neck cancer. We hope this textbook will particularly help surgical trainees, residents, and specialists to broaden their knowledge to comprehensively manage oral cancer patients that they encounter in routine practice.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Faculty of Dentistry, Oral & Craniofacial SciencesKing’s College LondonLondonUK
  2. 2.Department of Orofacial Sciences, Schools of Dentistry and MedicineUniversity of California San FranciscoSan FranciscoUSA

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