Treatment improvement and better patient care: which is the most important one in oral cavity cancer?
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Treatment improvement and better patient care: which is the most important one in oral cavity cancer? Francesca De Felice1*, Daniela Musio1, Valentina Terenzi2, Valentino Valentini2, Andrea Cassoni2, Mario Tombolini3, Marco De Vincentiis3 and Vincenzo Tombolini1,4
Abstract Due to substantial improvement in diagnosis and treatment of oral cavity cancer, a better understanding of the patient care needs to be revised. We reviewed literature related to OCC and discussed current general management approaches and related long-term radiation toxicities to emphasize the multidisciplinary team involvement. New technical modalities and patient quality of life parameters should be an integral and paramount state in the clinical evaluation to significantly contribute to reduce secondary side effects. Keywords: Treatment, Oral cavity, Cancer, Head and neck, Radiotherapy, Surgery, Patient care, Quality of life
Introduction Oral cavity cancer (OCC) accounts for approximately 28% of all head and neck malignancies. In 2014 there will be estimated 11.920 new patients diagnosed in United States and 2.070 deaths [1]. It is associated with tobacco smoking and alcohol abuse. Most cases occur in males, at a rate of 2:1 relative to female, although this trend is dropping, linked to the increase of tobacco use in women [2]. Over the past 20 years, there has been an increment in the incidence of oral cavity cancer in younger non-smokers and non-drinkers. Recent studies emphasize, in these emerging cancer patient populations, the role of Human Papilloma Virus (HPV) infection, especially types 16 – known as a high oncogenic causative agent in cervical cancer [3,4]. The oral cavity consists of various anatomic sites: upper and lower lips, gingiva-buccal sulcus, buccal mucosa, upper and lower gingiva, alveolar ridge, hard palate, floor of mouth and anterior 2/3 of the mobile tongue. These areas have a rich lymphatic drainage and primary regional node dissemination is to levels I to III [5]. Diagnosis and management are established by clinical examination and imaging evaluation – CT and/or * Correspondence: [email protected] 1 Department of Radiotherapy, Policlinico Umberto I “Sapienza”, University of Rome, Viale Regina Elena 326, 00161 Rome, Italy Full list of author information is available at the end of the article
MRI from base of skull to clavicle should be routine to assess the loco-regional extent of the primary tumor; CT ad/or PET should be performed to estimate the presence of distant metastasis [6]. Tumors are conventionally staged according to the American Joint Committee on Cancer classification system (Table 1) [7]. Squamous cell carcinomas represent approximately 90% of OCC; although uncommon, various subtypes are described, such as basaloid squamous cell carcinoma, sarcomatoid carcinoma and verrucous squamous cell carcinoma. These histological variants are correlated with differences in prognosis – good prognosis for verrucous carcinoma, only. The remaining 10% is predominantly adenoidocystic carcinoma
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