Clinical Evaluation and Staging of Oral Cancer
The identification and evaluation of the patient with oral cavity cancer is an inherently multidisciplinary proposition. For most patients, the initial identification and evaluation of an oral lesion is undertaken by a primary healthcare giver—dentists, p
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Clinical Evaluation and Staging of Oral Cancer Christina Mimikos, Sudhir Nair, and David Cohan
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Introduction
The identification and evaluation of the patient with oral cavity cancer is an inherently multidisciplinary proposition. For most patients, the initial identification and evaluation of an oral lesion is undertaken by a primary healthcare giver—dentists, primary care physicians, oral surgeons, and general practitioners—before referal to a tertiary care center. Accurate diagnosis and staging at the initial visit is vital to appropriate decision-making and treatment planning. It is critical that the first examination of the oral cancer patient be comprehensive. Equally important is that the history taken is complete and elicits pertinent details that will give the oncologic care providers information relevant to the care of the patient. Initial evaluation of the oral cavity cancer patient will not only result in tumor staging but also determine most appropriate interventions and identify comorbidities that may influence treatment choices. Attempts should be made to identify the social support network of the patient has to facilitate consistent treatment and surveillance.
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History
All patient encounters should begin with a complete and detailed history, with particular emphasis on oncologic risk factors. Medical conditions, past surgical history, medications, allergies, and social as well as family history should be addressed during the consultation. Medical and cardiac clearance may be required for patients with underlying or uncontrolled pathology, and medical status should ideally be C. Mimikos (*) • D. Cohan Department of Head and Neck Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA e-mail: [email protected] S. Nair Tata Memorial Hospital, Mumbai, India © Springer International Publishing Switzerland 2017 M.A. Kuriakose (ed.), Contemporary Oral Oncology, DOI 10.1007/978-3-319-14917-2_1
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optimized prior to beginning treatment. Past surgical history can dictate or limit the extent of resection or reconstruction. Medications, including all supplements, should be reviewed so that the surgeon can anticipate possible related complications. An accurate social history is particularly important to the workup and treatment of oral cavity cancer. Smoking status and history, smokeless tobacco, betel nut use, alcohol use, illicit drug use, and occupational exposures should all be explored. Relevant information includes the duration and quantity of the patient’s substance use and current status. Patients should be counseled to discontinue any substance use prior to treatment and assisted with medications or support programs. Continued smoking or alcohol use, particularly during adjuvant radiation, is associated with poor overall and disease-free survival and predisposes to second primary malignancies [1–3]. Social history is also a valuable source of information regarding a patient’s ability and willingness to comply with and complete treatment. Many oral cancer
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