Oral cancer natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2]; Grammar Reviewer: Natalie Harpenau, B.S.[3]

If left untreated, patients with oral cancer may progress to develop a non-healing ulcer, which demonstrates growth over time. A neck mass may develop, which may cause a mass defect. Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. The 5-year survival rate for oral cancer that is diagnosed early is 75%, compared to 20% for late diagnosis. Complications of oral cancer include difficulty speaking, dysphagia, weight loss, bleeding and even death.

• Oral cancers usually present late, as they are usually painless and often ignored by the patient.
• Eventually they present as a non-healing ulcer, which demonstrates growth over time.
• Due to the extensive lymphatic drainage of the oral cavity, nodal metastases are common at the time of diagnosis.
• A neck mass may be the presenting complaint.
• Because of the difficulties with direct visualization, they may extend into the tongue or have clinical lymph node metastases before the diagnosis is established.
• As the tumors enlarge, they may cause a mass effect, which can lead to respiratory compromise when the patient presents late in their illness.[1]

• The prognosis depends on the following:
  • Stage of the cancer
  • Number and size of lymph nodes with cancer
  • HPV infection of the oropharynx
  • Smoking history more than a ten pack-year

• 5-year survival rate for oral cancer:
  • Diagnosed early – 75%
  • Diagnosed late – 20%
  • Localized disease at diagnosis – 83%
  • Cancer spread to other parts of the body – 32%
• Cure rate:
  • 90% – If cancer is found early and before it has spread to other tissues
• More than 50% oral cancers are diagnosed when they have spread to throat and neck.

• Direct surgical complications include infection, bleeding, aspiration, wound breakdown, flap loss, and fistula.

• Complications of chemotherapy includes the following:^[1]
  • Neurotoxicity– This complication is a side-effect of certain classes of drugs, such as the vinca alkaloids.
  • Bleeding
• Complications of radiation therapy includes the following:^[2]
  • Radiation caries
  • Trismus
  • Osteonecrosis
• Complications common to both chemotherapy and radiation include the following:^[3]
  • Oral mucositis
  • Chronic dysphagia
  • Anemia
  • Pharyngocutaneous fistula
  • Aspiration
  • Infections such as viral, bacterial, and fungal that results from myelosuppression, xerostomia, and damage to the mucosa from radiotherapy or chemotherapy
  • Xerostomia
  • Functional disabilities such as impaired ability to swallow, eat, taste and speak because of trismus, dry mouth, mucositis, and infection
  • Nutritional compromise, such as poor nutrition from eating difficulties caused by dry mouth, mucositis, dysphagia, and loss of taste.
  • Abnormal dental development
    • Altered tooth development, craniofacial growth, or skeletal development in children- secondary to high doses of chemotherapy and radiotherapy before age 9

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