Advertisement

General Principles and Management Guidelines in Oral Cancer

  • Krishnakumar ThankappanEmail author
  • Moni Abraham Kuriakose
Chapter

Abstract

Clinicians have multiple options at every step in the comprehensive care of oral cancer from diagnosis, treatment, reconstruction, and rehabilitation and surveillance. To guide the clinicians to choose a specific management option, there exist several well-defined guidelines. As with any guidelines, the management options change constantly with improved understanding of cancer and varies with individual patient needs. Therefore, these guidelines though can give a generalized recommendation; it needs to be constantly updated and tailored to an individual patient. This individualized treatment plan is best through a multidisciplinary tumor board or clinic, which is the cornerstone of optimal oncology practice. Though individual clinicians have to take responsibility in the care of a specific aspect treatment, the overall care plan is best developed by the multidisciplinary team. This should be made before initiation of treatment.

Keywords

Sentinel Node Biopsy Oral Cancer Neck Dissection National Comprehensive Cancer Network National Comprehensive Cancer Network 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Ang KK, Trotti A, Brown BW, Garden AS, Foote RL, Morrison WH, et al. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001;51:571–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Balasubramanian D, Thankappan K, Battoo AJ, Rajapurkar M, Kuriakose MA, Iyer S. Isolated skip nodal metastasis is rare in T1 and T2 oral tongue squamous cell carcinoma. Otolaryngol Head Neck Surg. 2012;147(2):275–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (#9501). Head Neck. 2005;27:843–50.CrossRefPubMedGoogle Scholar
  4. 4.
    Brown JS, Lewis-Jones H. Evidence for imaging the mandible in the management of oral squamous cell carcinoma: a review. Br J Oral Maxillofac Surg. 2001;39(6):411–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Brown JS, Lowe D, Kalavrezos N, D’Souza J, Magennis P, Woolgar J. Patterns of invasion and routes of tumor entry into the mandible by oral squamous cell carcinoma. Head Neck. 2002;24(4):370–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Byers RM, Weber RS, Andrews T, McGill D, Kare R, Wolf P. Frequency and therapeutic implications of “skip metastases” in the neck from squamous carcinoma of the oral tongue. Head Neck. 1997;19(1):14–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Capote-Moreno A, Naval L, Muñoz-Guerra MF, Sastre J, Rodríguez-Campo FJ. Prognostic factors influencing contralateral neck lymph node metastases in oral and oropharyngeal carcinoma. J Oral Maxillofac Surg. 2010;68(2):268–75.CrossRefPubMedGoogle Scholar
  8. 8.
    Cheng A, Schmidt BL. Management of the N0 neck in oral squamous cell carcinoma. Oral Maxillofac Surg Clin North Am. 2008;20(3):477–97.CrossRefPubMedGoogle Scholar
  9. 9.
    Chu A, Fletcher GH. Incidence and causes of failures to control by irradiation the primary lesions in squamous cell carcinomas of the anterior two-thirds of the tongue and floor of mouth. Am J Roentgenol Radium Ther Nucl Med. 1973;117(3):502–8.CrossRefPubMedGoogle Scholar
  10. 10.
    D’Cruz AK, et al. Elective versus therapeutic neck dissection in node-negative oral cancer. N Engl J Med. 2015;373(6):521–9.CrossRefPubMedGoogle Scholar
  11. 11.
    DCruz A, Chaukar D, Gupta T, editors. General principles and outline of management in evidence based management of cancers in India. Guidelines for head and neck cancers. Mumbai: Published by Tata Memorial Centre; 2012.Google Scholar
  12. 12.
    de Bondt RBJ, Nelemans PJ, Hofman PAM, Casselman JW, Kremer B, van Engelshoven JMA, Beets-Tan RGH. Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol. 2007;64(2):266–72.CrossRefPubMedGoogle Scholar
  13. 13.
    Diagnosis and management of head and neck cancer. Guideline No. 90 ISBN 9781905813001 November 2006. www.sign.ac.uk/guidelines/.
  14. 14.
    Dunsky KA, Wehrmann DJ, Osman MM, Thornberry BM, Varvares MA. PET-CT and the detection of the asymptomatic recurrence or second primary lesions in the treated head and neck cancer patient. Laryngoscope. 2013;123(9):2161–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Edge SE, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2009.Google Scholar
  16. 16.
    Elsheikh MN, Mahfouz ME, Elsheikh E. Level IIb lymph nodes metastasis in elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma: a molecular-based study. Laryngoscope. 2005;115(9):1636–40.CrossRefPubMedGoogle Scholar
  17. 17.
    Ferlito A, Shaha AR, Rinaldo A, Pellitteri PK, Mondin V, Byers RM. “Skip metastases” from head and neck cancers. Acta Otolaryngol. 2002;122(7):788–91.CrossRefPubMedGoogle Scholar
  18. 18.
    Gao S, Li S, Yang X, Tang Q. 18FDG PET-CT for distant metastases in patients with recurrent head and neck cancer after definitive treatment. A meta-analysis. Oral Oncol. 2014;50(3):163–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Goerres GW, Schmid DT, Schuknecht B, Eyrich GK. Bone invasion in patients with oral cavity cancer: comparison of conventional CT with PET/CT and SPECT/CT. Radiology. 2005;237:281–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Govers TM, et al. Sentinel node biopsy for squamous cell carcinoma of the oral cavity and oropharynx: a diagnostic meta-analysis. Oral Oncol. 2013;49(8):726–32.CrossRefPubMedGoogle Scholar
  21. 21.
    Grégoire V, Lefebvre JL, Licitra L, Felip E, EHNS-ESMO-ESTRO Guidelines Working Group. Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v184–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Huang SH, Hwang D, Lockwood G, Goldstein DP, O’Sullivan B. Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: a meta-analysis of reported studies. Cancer. 2009;115(7):1489–97.CrossRefPubMedGoogle Scholar
  23. 23.
    Improving outcomes in head and neck cancers: evidence. Update May 2012 available from www.evidence.nhs.uk/topic/head-and-neck-cancers. Indian Council of Medical Research (ICMR). Guidelines for management of buccal mucosa cancer; 2010.
  24. 24.
    Inoue T, Inoue T, Teshima T, Murayama S, Shimizutani K, Fuchihata H, Furukawa S. Phase III trial of high and low dose rate interstitial radiotherapy for early oral tongue cancer. Int J Radiat Oncol Biol Phys. 1996;36(5):1201–4.CrossRefPubMedGoogle Scholar
  25. 25.
    Liao CT, Huang SF, Chen IH, Chang JT, Wang HM, Ng SH, et al. When does skin excision allow the achievement of an adequate local control rate in patients with squamous cell carcinoma involving the buccal mucosa? Ann Surg Oncol. 2008;15:2187–94.CrossRefPubMedGoogle Scholar
  26. 26.
    More Y, D’Cruz AK. Oral cancer: review of current management strategies. Natl Med J India. 2013;26(3):152–8.PubMedGoogle Scholar
  27. 27.
    Mukherji SK, Isaacs DL, Creager A, et al. CT detection of mandibular invasion by squamous cell carcinoma of the oral cavity. AJR Am J Roentgenol. 2001;177(1):237–43.CrossRefPubMedGoogle Scholar
  28. 28.
    Nair MK, Sankaranarayanan R, Padmanabhan TK. Evaluation of the role of radiotherapy in the management of carcinoma of the buccal mucosa. Cancer. 1988;61(7):1326–31.CrossRefPubMedGoogle Scholar
  29. 29.
    Newman H, Albooz H. The Scottish Intercollegiate Guidelines Network (SIGN) guideline for head and neck cancer: pointing in the right direction? Clin Oncol. 2008;20(9):664–5.CrossRefGoogle Scholar
  30. 30.
    Omura K. Current status of oral cancer treatment strategies: surgical treatments for oral squamous cell carcinoma. Int J Clin Oncol. 2014;19(3):423–30.CrossRefPubMedGoogle Scholar
  31. 31.
    Ota Y, Aoki T, Karakida K, Otsuru M, Kurabayashi H, Sasaki M, et al. Determination of deep surgical margin based on anatomical architecture for local control of squamous cell carcinoma of the buccal mucosa. Oral Oncol. 2009;45:605–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature. Head Neck. 2005;27(12):1080–91.CrossRefPubMedGoogle Scholar
  33. 33.
    Pernot M, Malissard L, Hoffstetter S, et al. The study of tumoral, radiobiological, and general health factors that influence results and complications in a series of 448 oral tongue carcinomas treated exclusively by irradiation. Int J Radiat Oncol Biol Phys. 1994;29:673–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Peters LJ, Goepfert H, Ang KK, Byers RM, Maor MH, Guillamondegui O, et al. Evaluation of the dose for postoperative radiation therapy of head and neck cancer: first report of a prospective randomized trial. Int J Radiat Oncol Biol Phys. 1993;26:3–11.CrossRefPubMedGoogle Scholar
  35. 35.
    Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Dunphy F, Eisele DW, Gilbert J, Gillison ML, Haddad RI, Haughey BH, Hicks Jr WL, Hitchcock YJ, Jimeno A, Kies MS, Lydiatt WM, Maghami E, Martins R, McCaffrey T, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rodriguez CP, Samant S, Schuller DE, Shah JP, Weber RS, Wolf GT, Worden F, Yom SS, McMillian NR, Hughes M. Head and neck cancers, version 2.2014. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2014;12(10):1454–87.PubMedGoogle Scholar
  36. 36.
    Rigual N, et al. Sentinel node biopsy in lieu of neck dissection for staging oral cancer. JAMA Otolaryngol Head Neck Surg. 2013;139(8):779–82.CrossRefPubMedGoogle Scholar
  37. 37.
    Sanabria A, et al. Comorbidity is a prognostic factor in elderly patients with head and neck cancer. Ann Surg Oncol. 2007;14(4):1449–57.CrossRefPubMedGoogle Scholar
  38. 38.
    Shah JP. Extent of surgical intervention in case of N0 neck in head and neck cancer patients. Eur Arch Otorhinolaryngol. 2004;261(6):293–4.CrossRefPubMedGoogle Scholar
  39. 39.
    Steinkamp HJ, Cornehl M, Hosten N, et al. Cervical lymphadenopathy: ratio of long- to short-axis diameter as a predictor of malignancy. Br J Radiol. 1995;68(807):266–70.CrossRefPubMedGoogle Scholar
  40. 40.
    Vidhyadharan S, Augustine I, Kudpaje AS, Iyer S, Thankappan K. Site-wise differences in adequacy of the surgical resection margins in head and neck cancers. Indian J Surg Oncol. 2014;5(3):227–31.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Weiss MH, Harrison LB, Isaacs RS. Use of decision tree analysis in planning a management strategy for the stage N0 neck. Arch Otolaryngol Head Neck Surg. 1994;120(7):699–702.CrossRefPubMedGoogle Scholar
  42. 42.
    Werner JA, et al. The sentinel node concept in head and neck cancer: solution for the controversies in the N0 neck? Head Neck. 2004;26(7):603–11.CrossRefPubMedGoogle Scholar
  43. 43.
    Woolgar JA. The topography of cervical lymph node metastases revisited: the histological findings in 526 sides of neck dissection from 439 previously untreated patients. Int J Oral Maxillofac Surg. 2007;36(3):219–25.CrossRefPubMedGoogle Scholar
  44. 44.
    Woolgar JA, Triantafyllou A. A histopathological appraisal of surgical margins in oral and oropharyngeal cancer resection specimens. Oral Oncol. 2005;41(10):1034–43.CrossRefPubMedGoogle Scholar
  45. 45.
    YamazakI H, Yoshida K, Yoshioka Y, et al. High dose rate brachytherapy for oral cancer. J Radiat Res. 2013;54(1):1–17. doi: 10.1093/jrr/rrs103.CrossRefPubMedGoogle Scholar
  46. 46.
    Yousem DM, Gad K, Tufano RP. Resectability issues with head and neck cancer. AJNR Am J Neuroradiol. 2006;27:2024–36.PubMedGoogle Scholar
  47. 47.
    Yousem DM, Hatabu H, Hurst RW, Seigerman HM, Montone KT, Weinstein GS, Hayden RE, Goldberg AN, Bigelow DC, Kotapka MJ. Carotid artery invasion by head and neck masses: prediction with MR imaging. Radiology. 1995;195(3):715–20.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Krishnakumar Thankappan
    • 1
    Email author
  • Moni Abraham Kuriakose
    • 2
  1. 1.Department of Head and Neck Surgery and OncologyAmrita Institute of Medical Sciences, Amrita UniversityKochiIndia
  2. 2.Department of Head and Neck, Plastic and Reconstructive Surgery, and Dental and Maxillofacial ProstheticsRoswell Park Cancer InstituteBuffaloUSA

Personalised recommendations