Sites of oral cavity cancer con’t:

FLOOR OF MOUTH:

Location: continuous with the lining of the tongue

• Full of salivary glands

 

Epidemiology :Consists of only 10% of all oral cavity cancers / are very rare

 

Natural History: Cancers of this area arise on the anterior surface on either side of midline

 

Nodal Involvement: 30% of these cancers have involvement with the submaxillary and subdiagastric nodes  (opposing lateral ports are used)

Tumors of the floor of the mouth can get quite large before they spread to the nodes

• If they do spread they spread to the bone or the tongue

 

Treatment Options:

• surgery is the most common treatment (resection gives best results)
• radiation therapy can be used (60 - 70 Gy with boosts)
  • brachytherapy is used if the tumor is close to midline (interstitial implants)
  • intraoral cone can be used
• if the tumor is large a multimodal approach is taken
• positive nodes are either reseccted or irradiated

 

Prognosis: is dependent on stage

• Stage 1 – 5 year survival rate of 90%
• Stage 2 – 5 year survival rate of only 32%

As the stage gets worse the survival rates drop significantly

Most people who die from cancer of the floor of the mouth die from starvation or asphyxiation

 

 

 

HARD PALATE : 

Location : is the area of the top of the mouth that is formed by the vomer (semilunar area between the upper alveolar ridge and the mucous membrane covering the palatine process of the maxiallary palatine bones

 

Natural History :

• Most malignant tumors of the hard palate are of the minor salivary gland origin
• Hard palate carcinomas are extremely rare and mostly adenocarcinomas
• Squamous cell carcinomas of the hard palate are rare

 

Nodal Involvement and Metastasis:

• Tend to spread to the bones if they do spread (invade the maxiallary antrum)
• These tumors seldom metastasize (spread to lung if they do)
• Seldom spread to lymph nodes

 

Treatment Options:

• Superficial Irradiation is used only if the cancer is  in situ
• Surgical Resection is the usual treatment
• postoperative radiation is usually added in high risk patients  (opposed lateral fields or wedged pairs to 65 - 70 Gy in  6 1/2 to 7 weeks)

CANCERS OF THE PHARYNX

Pharynx - space behind the mouth that serves as a passage for food from the mouth to the esophagus and for air from the nose and mouth to the larynx.  The pharynx is subdivided into three anatomical divisions:

1. Oropharynx
2. Nasopharynx
3. Hypopharynx

If the patient presents disease in any of these areas of the Pharynx they will present with these symptoms:

• Persistent sore throat
• Painful swallowing
• Pain in the ear (otalgia)

May indicate advanced disease :

• Enlargement of the cervical nodes
• Bad breath (fetor oris)
• Dyspnea – difficulty breathing
• Dysphagia – difficulty swallowing
• Hoarseness
• Hypersalivation

Most tumors of the Pharynx are squamous cell carcinomas (90%)

OROPHARYNX:

Location:

the oropharynx is both digestive and respiratory in function (it is situated between the axis and C3 vertebral bodies

included in the anatomy of the oropharynx are these soft tissue regions:

• the base of the tongue
• soft palate
• oropharyngeal walls
• tonsillar fossa
• tonsillar pillars
• TONSILS – mass of lymphatic tissue (most common site of disease)
• Waldeyers Ring - Ring of lymphoid tissue, formed by the lingual tonsil, palatine tonsils (also called faucial tonsils), and nasopharyngeal tonsils (also called adenoids)

Epidiemiology:

Usually effect 4000 patients a year in the Unites States

Usually occurs in people 50 -70

Etiology:  alcohol and tobacco use are main risk factors

Histology:

Cancer in the Oropharynx usually arise in the BASE OF TONGUE AND TONSILLAR FOSSA

Nodal Involvement:  the upper spinal accessory nodes are involved bilaterally in 50 – 70% of the patients

Treatment Options:

Early T1 – T2 lesions : treatable with external beam or surgery (radiation produces the best results)

T3 – T4 Lesions : require large ports that encompass the cervical and supraclavicular neck nodes

• External Beam dose is 65 -70 Gy over 7 weeks

BASE OF THE TONGUE:

Symptoms:

• Unilateral earache , pain, dsyphagia
• Weight loss due to less eating
• Neck mass is present (bilateral nodes present around 40% of the time)
• Cancer of the base of the tongue usually presents around T3

 

Treatment Options:

• Surgery is not usually an option due to the fact that a complete glosectomy would be devastating to the Patient.  Minor surgical resecction can be used.
• Radiation Therapy is used to irradiate the base of the tongue

  Usually give a dose of 70Gy

  Or 80Gy B.I.D.

• Chemo can also be used in conjunction with radiation

Survival : 5 year survival of 30%

 

 

TONSILLAR FOSSA:

Usually lymphomas

Present with palpable neck nodes in 60 – 70% of the cases

Most often treated with surgical resection