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DIAGNOSIS AND WORK-UP These can be summarised as follows: /uni25CF history and examination; /uni25CF biopsy; /uni25CF clinical and radiographic staging investigations; /uni25CF comorbidity and functional status; /uni25CF multidisciplinary team (MDT)/tumour boa...

EPIDEMIOLOGY There is considerable geographical variation in the incidence of oral cancers worldwide, reflecting di ff ering lifestyles and risk factor exposure. For clarity , and in keeping with the 11th revision of the International Classification of Disease...

Histological type The vast majority of OCSCCs are conventional squamous-type carcinomas, reflecting their cell of origin. Other less commonly encountered variants include papillary , adenosquamous, acan - tholytic, basaloid, spindle cell and verrucous carcino...

Imaging Contemporary cross-sectional imaging techniques are essen - tial in the management of head and neck cancer. They inform treatment decisions and prognosis. CT and/or MRI are the gold standard imaging modalities to stage a tumour of the oral cavity . P...

Immunotherapy Antitumour immunotherapy is based on the principle that tumours can sometimes escape immune response/checkpoints owing to adaptations in immune surveillance and the tumour microenvironment. Immunotherapy represents a change in the treatment parad...

Incidence There are approximately 350 /uni00A0 000 new cases of oral cavity cancer per year worldwide. The vast majority of these are squamous cell carcinomas (SCCs). In 2015, the estimated age-standardised ratio of oral cavity cancer was 5.8 in men and 2.3 ...

INTRODUCTION The oral cavity ( Figure 53.1 ) extends from the mucosal surface of the lips to the junction of the hard and soft palate. It does not include the soft palate, uvula or tonsils, which form part of the oropharynx. Oral cavity cancer is the eighth...

Learning objectives To understand: The epidemiology and aetiology of oral cancer • The cardinal features of malignant lesions of the oral • cavity (signs and symptoms) Learning objectives To understand: The epidemiology and aetiology of oral cancer • The cardi...

Lymphovascular invasion LVI represents the presence of tumour cells within an endothelium-lined space, irrespective of whether it is a vein or lymph channel. Lymphovascular invasion LVI represents the presence of tumour cells within an endothelium-lined spa...

M stage Routine assessment of the chest (as a minimum) for evidence of distant metastasis and/or synchronous lung primary tumours is the norm as part of staging prior to treatment. M0 denotes no distant metastases, whereas M1 signifi es distant metastases pr...

MANAGEMENT OF RECURRENT AND/OR METASTATIC DISEASE Patients with a low burden of disease or oligometastatic deposit(s) and a satisfactory performance status can be o ff ered salvage surgery and/or radiotherapy with curative intent. Patients with are eligible fo...

Metastases As outlined previously , HPV-negative cervical node metastases are associated with decreased overall and disease-specific survival. While skip metastases have been described, most OCSCC metastases occur in levels I and II of the neck. ENE occurs whe...

Molecular biology According to The Cancer Genome Atlas (TCGA), alterations in p53 (83%) and CDKN2A (57%) are the two most frequent genomic mutations noted in HPV-negative cancers of the head and neck (of which oral cancer is an example). This contrasts with H...

N stage The system for describing the anatomy of regional lymph node metastases has been well described previously and is outlined in Figure 53.3 . It divides the lateral neck nodes into five sepa - rate levels, based on their relationship to certain anatomica...

Neck lump Fine-needle aspiration cytology (FNAC) is the first-line biopsy for the investigation of neck lymphadenopathy . This technique carries a sensitivity of 89–98%. It will help in di ff erentiating between thyroid malignancy , oropharyngeal and oral cavi...

Oral cavity All sites in the oral cavity are examined under direct visual - isation. Table 53.4 details the signs and symptoms that are suggestive of a neoplastic process. Figure 53.4 demonstrates the wide clinical presentation of OCSCCs, which range from sm...

PATHOLOGY OF ORAL CANCERS The vast majority (>95%) of oral cavity cancers are squamous cell carcinomas (OCSCCs). The World Health Organization (WHO) tumour grading system, based on cellular di ff erentia - tion, is routinely used in pathological analysis and d...

Patient selection As outlined previously , patients’ comorbidities and functional status as well as their social circumstances play a significant role - in their ability to tolerate surgery and rehabilitation. The early involvement of an MDT including physicia...