Oral Cancer and Neck Dissection

1. ORAL CANCER
Dr. Hadi Munib
Oral and Maxillofacial
Surgery Resident

2. OUTLINE
Introduction
Risk Factors
Premalignant Lesions
Classification
Treatment
References

3. INTRODUCTION
More than 1.3 million new cancers will be diagnosed in the United States this
year and 27,700 will be located in the mouth and oropharynx.
3% of all cancers
8th most common cancer affecting males in the United States.
Globally, more than 360,000 new cases of oral cancer will be diagnosed this year.
There will be approximately 200,000 deaths worldwide.
African Americans to have more advanced disease compared with white
Americans (68% vs 52%)
Approximately 85 to 95% of all oral cancer is squamous cell carcinoma (SCC).
However, multiple other malignant lesions can be found in the oral cavity such as
sarcoma, minor salivary gland tumors, mucosal melanoma, lymphoma.

4. RISK FACTORS
1. Smoking; *2 – 12 times
2. Alcohol; Promoter
3. Viral Infections; HPV 16 and 18
4. Betel Quid and Areca-Nut chewing
5. Age and Family History
6. Immunosuppression
7. Sun Exposure
8. Plummer Vinson Syndrome – Hysterical Dysphagia

6. CLINICAL EXAMINATION

7. PREMALIGNANT LESIONS
Precancerous lesion is defined as morphologically altered tissue in which the
development of malignancy is more likely than with normal mucosa
Leukoplakia
Erythroplakia
Oral Submucous Fibrosis
Lichen Planus
Actinic Cheilitis

8. LEUKOPLAKIA
White patch or plaque that cannot be characterized clinically or ascribed to any
other pathologic disease.
1.5 – 2.6%
Cannot be scraped or rubbed off.
Generally asymptomatic and clinically appears as a white or off-white lesion that
may be flat, slightly elevated, rugated, or smooth.
> 70% of the time leukoplakia occurs on two or more surfaces and has a strong
male predilection.
Proliferative Verrucous Leukoplakia and Speckled Leukoplakia [23%].
The lower lip vermilion, buccal mucosa, and gingiva account for most oral cavity
leukoplakia.
The tongue and floor of the mouth account for most lesions exhibiting dysplasia

11. ERYTHROPLAKIA
Red patch that cannot be scraped off or characterized clinically or ascribed to any
other pathologic disease.
Almost all true Erythroplakia demonstrates dysplasia, carcinoma in situ, or
invasive carcinoma.
Floor of the mouth and retromolar trigone.
Bright red, “velvety” in appearance, and have a sharply demarcated border.

12. ORAL SUBMUCOUS FIBROSIS
Precancerous condition seen predominantly in India and Southeast Asia.
Chronic, progressive mucosal disorder most frequently associated with
the habit of chewing betel quid.
Multifactorial in nature with genetic, immunologic, nutritional and
autoimmune factors.
Mucosal rigidity that leads to trismus, odynophagia with spicy foods and
difficulty with speech and swallowing.
Does not regress with the cessation of betel quid use.
Malignant transformation rate of 7.6% over a 17-year period.

14. ACTINIC CHEILITIS
Individuals with chronic unprotected exposure to sunlight are at the
highest risk

16. I: Submental [A] and Submandibular [B]
II: Upper Jugular Lymph Node
III: Middle Jugular Lymph Node
IV: Lower Jugular Lymph Node
V: Posterior Triangle
VI: pretracheal, paratracheal and prelaryngeal or so-called Delphian
lymph node
CERVICAL LYMPH
NODE LEVELS

17. AMERICAN JOINT COMMITTEE ON
CANCER
Seven Distinct Anatomical locations where Primary lesions develop
1. Mucosal Lip: 2 – 42% Oral Cancer – Level 1
2. Buccal Mucosa: 2 -10% SCC – Level 1 (10 - 27%)
3. Alveolar Ridge: 2 – 18% Oral Cancer – Level 1 and II (24 – 28%)
4. Retromolar Gingiva: 6% Oral Cancer tumors – Level IB and II
5. Floor of the Mouth: 25% of SCC – Level 1
6. Hard Palate: 3 – 6% SCC – Levels I and II
7. Tongue: 49% Oral Cancer – Level II, III and I

19. STAGING
TNM
P-TNM
A-TNM

23. ORAL CANCER TREATMENT

24. CHOOSING TREATMENT MODALITY
Best chance of cure vs. Quality of life
Cancer treatment still falls into three basic categories:
1. Surgery
2. Radiation
3. Chemotherapy
4. Combination.
Choosing the appropriate treatment relies on many factors, including the
patient’s medical condition as well as the modalities available to the clinician.

25. PRE-OPERATIVE MANAGEMENT
1. Airway
2. Pre-Operative Antibiotics
3. Nutrition
4. Fluid Management

26. Survival Rate for early
stage Lip Cancer = 90%

29. NECK DISSECTION
Radical Neck Dissection: removal of all ipsilateral cervical lymph node groups
extending from the inferior border of the mandible to the clavicle, from the
lateral border of the sternohyoid muscle, hyoid bone, and contralateral anterior
belly of the digastric muscle medially, to the anterior border of the trapezius.
Modified radical neck dissection: removal of the same lymph node levels (I
through V) as the radical neck dissection, but with preservation of the spinal
accessory nerve or the sternocleidomastoid muscle or the internal jugular vein,
Type I, II and III
Selective Neck Dissection: preservation of one or more lymph node groups
normally removed in a radical neck dissection.
Therapeutic Neck Dissection

32. REFERENCES
Chapter 32: Oral Cancer, Classification, Staging and Diagnosis
Chapter 33: Oral Cancer Treatment

33. THANK YOU