Oral cancer is a heterogenous group of conditions encompassing the main subsites of the external lip, oral cavity and oropharynx. With over 657,000 new cases diagnosed annually, it is the sixth most common cancer.
In Australia, a decline in the incidence of lip and oral cavity cancer and a rise in the incidence of oropharyngeal cancer has been reported. It is typically a disease of the elderly, occurring during the fifth to eighth decades of life. Considered rare in younger age groups, there have been reports of increasing incidence.
Inconsistency exists in the oral cancer literature, with wide variations in definition and description making comparison difficult across studies. A distinction should be made between oral cavity, external lip, nasopharyngeal and oropharyngeal sites, due to different aetiology, prognosis and management.
The vast majority of oral cancers are of epithelial origin. Cancers may also arise from other oral tissues, including the salivary glands. Oral cavity squamous cell carcinoma (OCSCC) is mostly preceded by lesions termed oral potentially malignant disorders (OPMDs). The most common OPMDs are leukoplakia, erythroplakia, oral submucous fibrosis, actinic cheilitis and oral lichen planus.
Despite technological advances, OCSCC survival rates have not improved. Much of the current research aims towards uncovering biomarkers for the disease and therapeutic alternatives. The overall five-year survival rate for oral cancer is approximately 50% for all anatomical sites and stages. Cases which present with regional lymph node infiltration (Stages III and IV) are reported to have a five-year survival rate of 9-41%, compared to the 66-85% survival associated with cases without lymph node involvement (Stages I and II).
Oral cancer aetiology is multifactorial. Human papillomavirus (HPV) infection, most commonly HPV16 and 18, is implicated especially in oropharyngeal SCC. Alcohol and smoking are major risk factors, with a synergistic effect when used together. Other risk factors for OCSCC include areca nut/betel quid chewing, other smokeless tobacco use, marijuana and qat use, use of alcohol containing mouthwash, poor diet and genetic predisposition.
High risk sites for OCSCC include the lateral tongue and floor of mouth. Early presentation of oral cancer is usually asymptomatic. It can appear as an ulcerative, flat, raised or exophytic, red and/or white lesion. The oral cavity can also be the site of cancer metastasis from other parts of the body, most commonly of breast, kidney and lung. Metastasis may present similarly to primary cancers, or mimic inflammatory or reactive lesions.
Key messages
- Five-year survival in oral cancer is approximately 50% for all anatomical sites and stages
- The poor prognosis is largely due to its frequent diagnosis at an advanced stage, making early detection vital
- View an oral mucosal lesion persisting beyond two weeks with a degree of suspicion
References available on request.
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Author competing interests: nil relevant disclosures.
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