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Lip 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.18Pradhan SA, Rajpal RM. Marginal mandibulectomy in the management of squamous cancer of the oral cavity. Indian J Cancer. 1987;24:167-171.
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.18Pradhan SA, Rajpal RM. Marginal mandibulectomy in the management of squamous cancer of the oral cavity. Indian J Cancer. 1987;24:167-171.
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.18, Pradhan SA, Rajpal RM. Marginal mandibulectomy in the management of squamous cancer of the oral cavity. Indian J Cancer. 1987;24:167-171.19Baker SR, Krause CJ. Carcinoma of the lip. Laryngoscope. 1980 Jan;90(1):19-27.
Poor Differentiation The grade of lip cancer has been shown to be related to prognosis in some studies.14, 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):e53415.20Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42,45-6.
Spread into Local Structures Spread into large nerves, vessels, lymphatics or jawbones might make your prognosis worse.19, Baker SR, Krause CJ. Carcinoma of the lip. Laryngoscope. 1980 Jan;90(1):19-27.21Mccombe D, Macgill K, Ainslie J, Beresford J, Matthews J. Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979-88. Aust N Z J Surg. 2000;70(5):358-61.
Cancer of the Upper Lip and Commissure Cancers in this location often have worse outcomes than lower lip cancers.20Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42,45-6.
Recurrent Lip Cancer If the cancer comes back after treatment, it typically signifies a more aggressive cancer.20Maddox 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.

In general, for patients with cancer of the lip, studies have shown the following21Mccombe D, Macgill K, Ainslie J, Beresford J, Matthews J. Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979-88. Aust N Z J Surg. 2000;70(5):358-61.:

Estimated Disease-Specific Survival at Five Years Estimated Disease-Specific Survival at Ten Years
Lip Cancer Lip Cancer
Stage I 96% 90%
Stage II 83% 73%
Stage III 57% 56%
Stage IV 48% 40%

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.

References

1 Zitsch RP. Carcinoma of the lip. Otolaryngol Clin North America.1993;26;265-277.

2 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.

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

4 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.

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

6 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.

7 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.

8 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;28(8):1395-400.

9 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.

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

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

12 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.

13 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.

14 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.

15 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.

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

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 Baker SR, Krause CJ. Carcinoma of the lip. Laryngoscope. 1980 Jan;90(1):19-27.

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 Mccombe D, Macgill K, Ainslie J, Beresford J, Matthews J. Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979-88. Aust N Z J Surg. 2000;70(5):358-61.

22 De visscher JG, Van den elsaker K, Grond AJ, Van der wal JE, Van der waal I. Surgical treatment of squamous cell carcinoma of the lower lip: evaluation of long-term results and prognostic factors–a retrospective analysis of 184 patients. J Oral Maxillofac Surg. 1998;56(7):814-20.

23 De visscher JG, Botke G, Schakenraad JA, Van der waal I. A comparison of results after radiotherapy and surgery for stage I squamous cell carcinoma of the lower lip. Head Neck. 1999;21(6):526-30.

24 De visscher JG, Grond AJ, Botke G, Van der waal I. Results of radiotherapy for squamous cell carcinoma of the vermilion border of the lower lip. A retrospective analysis of 108 patients. Radiother Oncol. 1996;39(1):9-14.

25 Chone CT, Magalhes RS, Etchehebere E, Camargo E, Altemani A, Crespo AN. Predictive value of sentinel node biopsy in head and neck cancer. Acta Otolaryngol. 2008;128(8):920-4.

26 Hokkam E, Gomaa A, Rifaat M, et al. The Role of sentinel lymph-node biopsy in managing lip squamous cell carcinoma patients without clinical evidence of nodal metastasis. Gulf J Oncolog. 2013;1(14):57-62.

27 Sollamo EM, Ilmonen SK, Virolainen MS, Suominen SH. Sentinel lymph node biopsy in cN0 squamous cell carcinoma of the lip: A retrospective study. Head Neck. 2016;38 Suppl 1:E1375-80.

28 Nag S, Cano ER, Demanes DJ, Puthawala AA, Vikram B. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys. 2001;50(5):1190-8.

29 Mazeron JJ, Ardiet JM, Haie-méder C, et al. GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas. Radiother Oncol. 2009;91(2):150-6.

30 Babington S, Veness MJ, Cakir B, Gebski VJ, Morgan GJ. Squamous cell carcinoma of the lip: is there a role for adjuvant radiotherapy in improving local control following incomplete or inadequate excision?. ANZ J Surg. 2003;73(8):621-5.

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