oral cancer diagnosis C D A J O U R N A L , V O L 4 9 , Nº 3
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Oral Cavity and Oropharyngeal Cancer: Etiology, Diagnosis and Staging Robert S. Julian, DDS, MD; Brian M. Woo, DDS, MD; and Eric C. Rabey, DDS
abstract Background: The objective of this review is to examine the etiology, screening, diagnosis and staging for oral cavity and oropharyngeal cancer. Types of studies reviewed: Textbooks, review articles and large institution databases and guidelines were used in this review as appropriate. Case studies and smaller retrospective studies applied in specific and more controversial areas. Current phase 3 clinical trials and their reports were used in reviewing very recent developments. Results: Smoking, alcohol, viruses and genetic predisposition are the main etiologic factors responsible for oral cavity and oropharyngeal cancer. Screening by dental health care professionals can save lives through early detection, and biopsy remains the mainstay of establishing a diagnosis. Oral cavity cancer staging includes depth of invasion and even a small tumor with doi > 5mm is considered T2. Oropharyngeal cancers are staged separately from cancer of the oral cavity and separated into (HPV) p16 positive and p16 negative given the drastically improved survival for the p16 positive group (70% five years versus 50% five years for p16 negative). Practical implications: Dental health care professionals should routinely perform oral cancer screening exams. Early detection is paramount but even advanced p16 positive oropharyngeal tumors of the soft palate or tonsillar pillar may be quite treatable given favorable responses to radiation and chemotherapy. Survival is greatly improved when oral cavity cancers are treated before cervical lymph node involvement. Key words: Oral cavity, oropharyngeal, carcinoma, NCCN, p16, depth of invasion, cervical lymphadenopathy
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