Close

Oromandibular Cancer

Deciding on a Treatment Plan

Your doctors will typically use National Comprehensive Cancer Network® (NCCN®) Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers, as well as their own professional experience, to decide on the appropriate treatment course.16Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 9, 2016. To view the most recent and complete version of the guideline, go online to www.NCCN.org. If these guidelines are not followed, they will discuss it with you and explain why your situation might be special.

Before starting treatment, your doctor will make sure that the following steps are completed.

Pretreatment evaluation16Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 9, 2016. To view the most recent and complete version of the guideline, go online to www.NCCN.org.

  • A full history and physical examination, including a complete head and neck exam (mirror and fiberoptic exam if needed)
  • An evaluation by the members of a head and neck cancer team
  • A biopsy to confirm a diagnosis of cancer
  • Imaging of the lungs to check for spread, if needed
  • Imaging of the primary tumor and the neck with CT and/or MRI
  • Maybe a PET-CT for advanced cancers
  • A dental evaluation, with or without jaw X-rays, when necessary
  • Examination under anesthesia with endoscopy if necessary
  • Nutrition, swallowing and speech therapy when necessary
  • Pretreatment medical clearance and evaluation of medical conditions

Then, your doctor will recommend a course of treatment for you, depending on a number of factors. Depending on whether the cancer has spread or not, there are three general therapeutic options to consider:

Surgery is the recommended treatment when possible in almost all cases of oral cancer. Also, if a positive margin (rim of tissue around the tumor that should be normal tissue but has cancer cells in it) is found after removal of the cancer, all efforts should be made to re-resect and get to negative margins (rim of normal tissue around the tumor).

The treatment recommendations for oral cancers do not really vary by subsite, though there are certain subtle differences for lip cancer. The surgery your doctor recommends does vary depending on the location of the cancer as well as the stage. You should have an extensive discussion with your care team about different surgeries that might be required for your cancer.

Also, the reconstruction that your doctor recommends will change depending on what is removed.

Below are the recommended treatment options for oral cancer, depending on your T and N stages.16Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 9, 2016. To view the most recent and complete version of the guideline, go online to www.NCCN.org.

T1-2, N0 For cancers in this category, treatment options are:

  • Surgical removal of the cancer, with or without neck dissection, depending on location of the tumor and how thick the tumor is (preferred treatment)
  • Surgical removal of the cancer with or without a sentinel lymph node biopsy. A neck dissection may also be performed depending on the results of the biopsy.

The treatments above should then be followed by either no additional treatment, radiation alone, surgery again, or chemotherapy with radiation, depending on what is found in surgery.

  • Radiation alone as primary treatment is also an option. This may be followed by either no additional treatment or surgery, depending if there is left over disease from the initial radiation.
T3, N0 or

T1-3, N1-3 or

T4a, Any N

The initial treatment is surgical removal of the cancer with neck dissection(s). Then, either no additional treatment, radiation or chemotherapy and radiation will be recommended, depending on findings in the surgery. Certain factors that might guide what additional treatment is required will be features such as:

  • Positive margins (the presence of cancer cells at the edge of the resection that was performed)
  • Spread of cancer beyond the lymph nodes in the neck
  • T3 or T4 tumors based on pathologic evaluation
  • N2 or N3 disease in the neck lymph nodes
  • Cancerous lymph nodes in the lower part of the neck (Level IV), or toward the back portion of the side of the neck, behind the big neck muscle called the sternocleidomastoid (Level V)
  • Invasion into or around nerves
  • Tumor inside blood vessels

 

T4b, any N or

Unresectable neck disease or

Unfit for surgery

In cases that are very advanced, or in patients who are extremely sick, an extensive discussion with your doctors should be undertaken.

 

References

1 Petersen PE. Oral cancer prevention and control – The approach of the World Health Organization. Oral Oncol. 2008.

2 Ko YC, Huang YL, Lee CH, Chen MJ, Lin LM, Tsai CC. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. Nov 1995;24(10):450-453.

3 Shugars DC, Patton LL. Detecting, diagnosing, and preventing oral cancer. The Nurse Practitioner. Jun 1997;22(6):105,109-110,113-105 passim.

4 Neville BW, Day TA. Oral cancer and precancerous lesions. CA: a cancer journal for clinicians. Jul-Aug 2002;52(4):195-215.

5 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

6 Morton DL, Wen DR, Foshag LJ, Essner R, Cochran A. Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck. J Clin Oncol. 1993;11:1751-6.

7 Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, Petruzelli G, Gourin CG, Wong RJ, Ferris RL, El Naggar A, Ridge JA, Paniello RC, Owzar K, McCall L, Chepeha DB, Yarbrough WG, Myers JN. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol. 2010 Mar 10;28(8):1395-400.

8 Koch WM, Choti MA, Civelek AC, Eisele DW, Saunders JR. Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 1998;124:455–9.

9 Shoaib T, Soutar DS, MacDonald DG, Camilleri IG, Dunaway DJ, Gray HW, McCurrach GM, Bessent RG, MacLeod TIF, Robertson, AG. The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer. 2001;91:2077-2083.

10 Kademani D. Oral cancer. Mayo Clinic proceedings. Mayo Clinic. Jul 2007;82(7):878-887.

11 Funk GF, Karnell LH, Robinson RA, Zhen WK, Trask DK, Hoffman HT. Presentation, treatment, and outcome of oral cavity cancer: a National Cancer Data Base report. Head Neck. 2002 Feb;24(2):165-80.

12 Kraus FT, Perezmesa C. Verrucous carcinoma. Clinical and pathologic study of 105 cases involving oral cavity, larynx and genitalia. Cancer. Jan 1966;19(1):26-38.

13 Listl S, Jansen L, Stenzinger A, Freier K, Emrich K, et al. Survival of patients with oral cavity cancer in Germany. PLoS ONE.2013;8(1):e53415.

14 Anneroth G, Batsakis J, Luna M. Review of the literature and a recommended system of malignancy grading in oral squamous cell carcinomas. Scand J Dent Res. 1987;95;229-249.

15 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010.

16 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 9, 2016. To view the most recent and complete version of the guideline, go online to www.NCCN.org.

17 Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404.

18 Pradhan SA, Rajpal RM. Marginal mandibulectomy in the management of squamous cancer of the oral cavity. Indian J Cancer. 1987;24:167-171.

19 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 Dec;27(12):1080-91.

20 Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42,45-6.

21 Urist MM, O'Brien CJ, Soong SJ, Visscher DW, Maddox WA. Squamous cell carcinoma of the buccal mucosa: analysis of prognostic factors. Am J Surg. 1987 Oct;154(4):411-4.

22 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the head and neck. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.