Treatment of stage I and II (early) head and neck cancer: The oral cavity
- Neil D Gross, MD, FACS
Neil D Gross, MD, FACS
- Associate Professor
- Director of Clinical Research
- Head and Neck Surgery
- MD Anderson Cancer Center
- Nancy Y Lee, MD
Nancy Y Lee, MD
- Attending Physician
- Memorial Sloan-Kettering Cancer Center
- Scott Okuno, MD
Scott Okuno, MD
- Professor of Oncology
- Division of Medical Oncology
- Mayo Clinic
- Shyam SD Rao, MD, PhD
Shyam SD Rao, MD, PhD
- Assistant Professor of Radiation Oncology
- University of California Davis Comprehensive Cancer Center
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- David M Brizel, MD
David M Brizel, MD
- Section Editor — Radiation Therapy
- Leonard R Prosnitz Professor of Radiation Oncology
- Professor of Otolaryngology Head & Neck Surgery
- Duke University Cancer Institute
- Marshall R Posner, MD
Marshall R Posner, MD
- Section Editor — Cancer of the Head and Neck
- Professor of Gene and Cell Medicine
- The Tisch Cancer Institute
- Icahn School of Medicine at Mount Sinai
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Squamous cell carcinoma is the predominant malignancy that occurs in the oral cavity. Minor salivary gland cancers and sarcomas are less common.
The initial approach to squamous cell carcinoma of the oral cavity and the treatment of stage I and II (early) disease are discussed here. The management of locally advanced oral cavity cancer and the treatment of metastatic and recurrent cancers are discussed separately.
The oral cavity extends from the skin-vermilion junction of the lips to the junction of the hard and soft palate above, and to the line of circumvallate papilla of the tongue below. The anterior tonsillar pillars and glossotonsillar folds serve as the lateral boundaries between the oral cavity and oropharynx.
- Globocan http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=900 (Accessed on June 28, 2011).
- Moore S, Johnson N, Pierce A, Wilson D. The epidemiology of lip cancer: a review of global incidence and aetiology. Oral Dis 1999; 5:185.
- King GN, Healy CM, Glover MT, et al. Increased prevalence of dysplastic and malignant lip lesions in renal-transplant recipients. N Engl J Med 1995; 332:1052.
- Warnakulasuriya S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009; 45:309.
- Chen YK, Huang HC, Lin LM, Lin CC. Primary oral squamous cell carcinoma: an analysis of 703 cases in southern Taiwan. Oral Oncol 1999; 35:173.
- Castellsagué X, Alemany L, Quer M, et al. HPV Involvement in Head and Neck Cancers: Comprehensive Assessment of Biomarkers in 3680 Patients. J Natl Cancer Inst 2016; 108:djv403.
- Ndiaye C, Mena M, Alemany L, et al. HPV DNA, E6/E7 mRNA, and p16INK4a detection in head and neck cancers: a systematic review and meta-analysis. Lancet Oncol 2014; 15:1319.
- Lee LA, Huang CG, Tsao KC, et al. Human Papillomavirus Infections are Common and Predict Mortality in a Retrospective Cohort Study of Taiwanese Patients With Oral Cavity Cancer. Medicine (Baltimore) 2015; 94:e2069.
- Ridge JA, Lydiatt WM, Patel SG, et al. Lip and Oral Cavity. In: AJCC Cancer Staging Manual, 8th, Amin MB. (Ed), Springer, New York 2017. p.79.
- National Comprehensive Cancer Network (NCCN). NCCN Clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp (Accessed on February 27, 2016).
- Chung MK, Lee GJ, Choi N, et al. Comparative study of sentinel lymph node biopsy in clinically N0 oral tongue squamous cell carcinoma: Long-term oncologic outcomes between validation and application phases. Oral Oncol 2015; 51:914.
- Pedersen NJ, Jensen DH, Hedbäck N, et al. Staging of early lymph node metastases with the sentinel lymph node technique and predictive factors in T1/T2 oral cavity cancer: A retrospective single-center study. Head Neck 2016; 38 Suppl 1:E1033.
- Schilling C, Stoeckli SJ, Haerle SK, et al. Sentinel European Node Trial (SENT): 3-year results of sentinel node biopsy in oral cancer. Eur J Cancer 2015; 51:2777.
- Sykes AJ, Allan E, Irwin C. Squamous cell carcinoma of the lip: the role of electron treatment. Clin Oncol (R Coll Radiol) 1996; 8:384.
- 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; 39:9.
- Boudreaux BA, Rosenthal EL, Magnuson JS, et al. Robot-assisted surgery for upper aerodigestive tract neoplasms. Arch Otolaryngol Head Neck Surg 2009; 135:397.
- Eckel HE, Volling P, Pototschnig C, et al. Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma. Laryngoscope 1995; 105:53.
- Standards and minimum datasets for reporting cancers. Dataset for histopathological reports on head and neck carcinomas and salivary neoplasms. In: Royal College of Pathologists Guidelines, 2nd, Helliwell T, Woolgar JA (Eds), Royal College of Pathologists, London 2005.
- Bradley PJ, MacLennan K, Brakenhoff RH, Leemans CR. Status of primary tumour surgical margins in squamous head and neck cancer: prognostic implications. Curr Opin Otolaryngol Head Neck Surg 2007; 15:74.
- Koch WM, Stafford E, Baja G. Cancer of the oral cavity. In: Head and neck cancer: a multidisciplinary approach, 3rd, Harrison LB, Sessions RB, Hong WK (Eds), Lippincott Williams & Wilkins, Philadelphia 2009. p.250.
- McCombe D, MacGill K, Ainslie J, et al. Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979-88. Aust N Z J Surg 2000; 70:358.
- Zitsch RP 3rd, Park CW, Renner GJ, Rea JL. Outcome analysis for lip carcinoma. Otolaryngol Head Neck Surg 1995; 113:589.
- Lindqvist C, Teppo L. Is upper lip cancer "true" lip cancer? J Cancer Res Clin Oncol 1980; 97:187.
- Sharma PK, Sculler DE, Baker SR. Malignant lesions of the oral cavity. In: Otolaryngology Head and Neck Surgery, Cummings CC, Frederickson JM, Harker LA, et al (Eds), Mosby-Year Book, St. Louis 1998. Vol 1444.
- Zitsch RP 3rd. Carcinoma of the lip. Otolaryngol Clin North Am 1993; 26:265.
- Babington S, Veness MJ, Cakir B, et al. 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; 73:621.
- Coppit GL, Lin DT, Burkey BB. Current concepts in lip reconstruction. Curr Opin Otolaryngol Head Neck Surg 2004; 12:281.
- Hanasono MM, Langstein HN. Extended Karapandzic flaps for near-total and total lower lip defects. Plast Reconstr Surg 2011; 127:1199.
- Holmkvist KA, Roenigk RK. Squamous cell carcinoma of the lip treated with Mohs micrographic surgery: outcome at 5 years. J Am Acad Dermatol 1998; 38:960.
- Zide MF, Adnot J. Lower lip cancer: Mohs micrographic surgery and reconstruction as a multidisciplinary effort. J Oral Maxillofac Surg 1997; 55:818.
- Hicks WL Jr, Loree TR, Garcia RI, et al. Squamous cell carcinoma of the floor of mouth: a 20-year review. Head Neck 1997; 19:400.
- Sessions DG, Spector GJ, Lenox J, et al. Analysis of treatment results for floor-of-mouth cancer. Laryngoscope 2000; 110:1764.
- Matsumoto S, Takeda M, Shibuya H, Suzuki S. T1 and T2 squamous cell carcinomas of the floor of the mouth: results of brachytherapy mainly using 198Au grains. Int J Radiat Oncol Biol Phys 1996; 34:833.
- Rodgers LW Jr, Stringer SP, Mendenhall WM, et al. Management of squamous cell carcinoma of the floor of mouth. Head Neck 1993; 15:16.
- Fujita M, Hirokawa Y, Kashiwado K, et al. An analysis of mandibular bone complications in radiotherapy for T1 and T2 carcinoma of the oral tongue. Int J Radiat Oncol Biol Phys 1996; 34:333.
- Matsuura K, Hirokawa Y, Fujita M, et al. Treatment results of stage I and II oral tongue cancer with interstitial brachytherapy: maximum tumor thickness is prognostic of nodal metastasis. Int J Radiat Oncol Biol Phys 1998; 40:535.
- Hicks WL Jr, North JH Jr, Loree TR, et al. Surgery as a single modality therapy for squamous cell carcinoma of the oral tongue. Am J Otolaryngol 1998; 19:24.
- Rusthoven K, Ballonoff A, Raben D, Chen C. Poor prognosis in patients with stage I and II oral tongue squamous cell carcinoma. Cancer 2008; 112:345.
- Truitt TO, Gleich LL, Huntress GP, Gluckman JL. Surgical management of hard palate malignancies. Otolaryngol Head Neck Surg 1999; 121:548.
- Byers RM, Weber RS, Andrews T, et al. Frequency and therapeutic implications of "skip metastases" in the neck from squamous carcinoma of the oral tongue. Head Neck 1997; 19:14.
- Tsue TT, McCulloch TM, Girod DA, et al. Predictors of carcinomatous invasion of the mandible. Head Neck 1994; 16:116.
- Hao SP, Tsang NM, Chang KP, et al. Treatment of squamous cell carcinoma of the retromolar trigone. Laryngoscope 2006; 116:916.
- Cleary KR, Batsakis JG. Oral squamous cell carcinoma and the mandible. Ann Otol Rhinol Laryngol 1995; 104:977.
- Mendenhall WM, Morris CG, Amdur RJ, et al. Retromolar trigone squamous cell carcinoma treated with radiotherapy alone or combined with surgery. Cancer 2005; 103:2320.
- Byers RM, Newman R, Russell N, Yue A. Results of treatment for squamous carcinoma of the lower gum. Cancer 1981; 47:2236.
- Huang CJ, Chao KS, Tsai J, et al. Cancer of retromolar trigone: long-term radiation therapy outcome. Head Neck 2001; 23:758.
- Lo K, Fletcher GH, Byers RM, et al. Results of irradiation in the squamous cell carcinomas of the anterior faucial pillar-retromolar trigone. Int J Radiat Oncol Biol Phys 1987; 13:969.
- Lam KH, Lam LK, Ho CM, Wei WI. Mandibular invasion in carcinoma of the lower alveolus. Am J Otolaryngol 1999; 20:267.
- Nair MK, Sankaranarayanan R, Padmanabhan TK. Evaluation of the role of radiotherapy in the management of carcinoma of the buccal mucosa. Cancer 1988; 61:1326.
- Dixit S, Vyas RK, Toparani RB, et al. Surgery versus surgery and postoperative radiotherapy in squamous cell carcinoma of the buccal mucosa: a comparative study. Ann Surg Oncol 1998; 5:502.
- Diaz EM Jr, Holsinger FC, Zuniga ER, et al. Squamous cell carcinoma of the buccal mucosa: one institution's experience with 119 previously untreated patients. Head Neck 2003; 25:267.
- Iyer SG, Pradhan SA, Pai PS, Patil S. Surgical treatment outcomes of localized squamous carcinoma of buccal mucosa. Head Neck 2004; 26:897.
- Strome SE, To W, Strawderman M, et al. Squamous cell carcinoma of the buccal mucosa. Otolaryngol Head Neck Surg 1999; 120:375.
- Bessell A, Glenny AM, Furness S, et al. Interventions for the treatment of oral and oropharyngeal cancers: surgical treatment. Cochrane Database Syst Rev 2011; :CD006205.
- D'Cruz AK, Vaish R, Kapre N, et al. Elective versus Therapeutic Neck Dissection in Node-Negative Oral Cancer. N Engl J Med 2015; 373:521.
- 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; 27:1080.
- Huang SH, Hwang D, Lockwood G, et al. Predictive value of tumor thickness for cervical lymph-node involvement in squamous cell carcinoma of the oral cavity: a meta-analysis of reported studies. Cancer 2009; 115:1489.
- Dias FL, Lima RA, Kligerman J, et al. Relevance of skip metastases for squamous cell carcinoma of the oral tongue and the floor of the mouth. Otolaryngol Head Neck Surg 2006; 134:460.
- Ferlito A, Silver CE, Rinaldo A. Elective management of the neck in oral cavity squamous carcinoma: current concepts supported by prospective studies. Br J Oral Maxillofac Surg 2009; 47:5.
- De Cicco C, Trifirò G, Calabrese L, et al. Lymphatic mapping to tailor selective lymphadenectomy in cN0 tongue carcinoma: beyond the sentinel node concept. Eur J Nucl Med Mol Imaging 2006; 33:900.
- Civantos FJ, Zitsch RP, Schuller DE, et al. 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; 28:1395.
- Thompson CF, St John MA, Lawson G, et al. Diagnostic value of sentinel lymph node biopsy in head and neck cancer: a meta-analysis. Eur Arch Otorhinolaryngol 2013; 270:2115.
- Schantz SP, Harrison LB, Forasteriere AA. Tumors of the nasal cavity and paranasal sinuses, nasopharynx, oral cavity, and oropharynx. In: Cancer: Principles and Practice of Oncology, 5th, Devita VT Jr, Hellman S, Rosenberg, SA (Eds), Lippincott-Raven, Philadelphia 1997. p.753.
- Greenberg JS, El Naggar AK, Mo V, et al. Disparity in pathologic and clinical lymph node staging in oral tongue carcinoma. Implication for therapeutic decision making. Cancer 2003; 98:508.
- Haddadin KJ, Soutar DS, Oliver RJ, et al. Improved survival for patients with clinically T1/T2, N0 tongue tumors undergoing a prophylactic neck dissection. Head Neck 1999; 21:517.
- Byers RM, El-Naggar AK, Lee YY, et al. Can we detect or predict the presence of occult nodal metastases in patients with squamous carcinoma of the oral tongue? Head Neck 1998; 20:138.
- Kurokawa H, Yamashita Y, Takeda S, et al. Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue. Head Neck 2002; 24:731.
- Ganly I, Goldstein D, Carlson DL, et al. Long-term regional control and survival in patients with "low-risk," early stage oral tongue cancer managed by partial glossectomy and neck dissection without postoperative radiation: the importance of tumor thickness. Cancer 2013; 119:1168.
- Hinerman RW, Mendenhall WM, Morris CG, et al. Postoperative irradiation for squamous cell carcinoma of the oral cavity: 35-year experience. Head Neck 2004; 26:984.
- Gomez DR, Zhung JE, Gomez J, et al. Intensity-modulated radiotherapy in postoperative treatment of oral cavity cancers. Int J Radiat Oncol Biol Phys 2009; 73:1096.
- Luryi AL, Chen MM, Mehra S, et al. Treatment Factors Associated With Survival in Early-Stage Oral Cavity Cancer: Analysis of 6830 Cases From the National Cancer Data Base. JAMA Otolaryngol Head Neck Surg 2015; 141:593.
- EPIDEMIOLOGY AND RISK FACTORS
- OVERVIEW OF APPROACH TO ORAL CAVITY CANCERS
- Pretreatment evaluation
- MANAGEMENT OF PRIMARY TUMOR
- Radiation therapy
- SPECIFIC TUMOR SITES
- - Squamous cell carcinoma
- - Basal cell carcinoma
- Floor of mouth
- Oral tongue
- Retromolar trigone and lower alveolar ridge
- Upper alveolar ridge and hard palate
- Buccal mucosa
- MANAGEMENT OF THE NECK
- ADJUVANT THERAPY
- POSTTREATMENT SURVEILLANCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS