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Palatomaxillary Cancer

Determining Your Prognosis

Your prognosis is a prediction of the outcome of your disease. What is the risk of succumbing to the cancer or the risk of its coming back? These are the big questions on most people’s minds after receiving a diagnosis of oral cancer. In general, doctors know there are several characteristics of the tumor that can tell you something about your chances of being cured.

The following aspects of the cancer may affect your prognosis.

Stage This is the most important factor that affects your chances of being cured.19Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer.2010.
Spread to Lymph Nodes This goes along with stage, but even without other factors, if there is spread to lymph nodes in the neck, it’s a worse chance of cure, especially if there is evidence of growth of cancer outside of the lymph node.20Lin HW, Bhattacharyya N. Survival impact of nodal disease in hard palate and maxillary alveolus cancer. Laryngoscope. 2009 Feb;119(2):312-5.
Tumor Margins The ability to completely remove the tumor can be a very important factor that will indicate whether you will be cured or not.21, Bhattacharyya N. Factors affecting survival in maxillary sinus cancer. J Oral Maxillofac Surg. 2003 Sep;61(9):1016-21.22Meng FY, Ko JY, Lou PJ, Wang CP, Yang TL, Chang CH, Chang YL, Chen TC. The determining risk factors for treatment outcomes in patients with squamous cell carcinoma of the hard palate. Ann Surg Oncol. 2012 Jun;19(6):2003-10. doi: 10.1245/s10434-011-2214-1. Epub 2012 Jan 20.
Spread into Local Structures Spread into large nerves, vessels, lymphatics or even the skin of the cheek might make your prognosis worse.23Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42,45-6.

It is very difficult to discuss prognosis without understanding all the details of your cancer, and this is a conversation you’re better off having in person with your doctor. To give you a percentage chance of cure is really difficult because cancer research looks at all sorts of different types of cancers and may include patients from long ago.

Palatomaxillary cancer can include cancer from a few different subsites.

For patients with cancer of gums and other locations in the mouth (excluding the tongue, lips and floor of mouth), studies have shown the following Estimated Disease-Specific survival rates24Piccirillo 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.:

Estimated Disease-Specific Survival at Five Years Estimated Disease-Specific Survival at Ten Years
Gum and Other Mouth Cancers Gum and Other Mouth Cancers
Stage I 81% 69%
Stage II 62% 49%
Stage III 45% 28%
Stage IV 40% 29%

Estimated Disease-Specific Survival is the percentage of people with a specific cancer who are alive at a given time point, such as five years after diagnosis. It excludes people who may have died from a disease other than their cancer. It is probably the best estimate we have in these large national databases as to the prognosis of a particular type of cancer at each stage.

In general, for patients with cancer of the oral cavity, studies have shown the following19Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer.2010.:

Estimated Disease-Specific Survival at Five Years Estimated Disease-Specific Survival at Ten Years
All Oral Cavity Cancers All Oral Cavity Cancers
Stage I 72% 59%
Stage II 58% 47%
Stage III 45% 36%
Stage IV 32% 27%
References

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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.

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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 Morris LG, Patel SG, Shah JP, Ganly I. High rates of regional failure in squamous cell carcinoma of the hard palate and maxillary alveolus. Head Neck. 2011 Jun;33(6):824-30.

18 Simental AA Jr, Johnson JT, Myers EN. Cervical metastasis from squamous cell carcinoma of the maxillary alveolus and hard palate. Laryngoscope. 2006 Sep;116(9):1682-4.

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

20 Lin HW, Bhattacharyya N. Survival impact of nodal disease in hard palate and maxillary alveolus cancer. Laryngoscope. 2009 Feb;119(2):312-5.

21 Bhattacharyya N. Factors affecting survival in maxillary sinus cancer. J Oral Maxillofac Surg. 2003 Sep;61(9):1016-21.

22 Meng FY, Ko JY, Lou PJ, Wang CP, Yang TL, Chang CH, Chang YL, Chen TC. The determining risk factors for treatment outcomes in patients with squamous cell carcinoma of the hard palate. Ann Surg Oncol. 2012 Jun;19(6):2003-10. doi: 10.1245/s10434-011-2214-1. Epub 2012 Jan 20.

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

24 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.