The oral cavity extends from the skin-vermilion junctions of the anterior lips to the junction of the hard and soft palates above and to the line of circumvallate papillae below and is divided into the following specific areas:
The main routes of lymph node drainage are into the first station nodes (i.e., buccinator, jugulodigastric, submandibular, and submental). Sites close to the midline often drain bilaterally. Second station nodes include the parotid, jugular, and the upper and lower posterior cervical nodes.
Precancerous lesions of the oropharynx include leukoplakia, erythroplakia, and mixed erythroleukoplakia.[1] Leukoplakia, the most common of the three conditions, is defined by the World Health Organization as “a white patch or plaque that cannot be characterized clinically or pathologically as any other disease.”[2] The diagnosis of leukoplakia is one of exclusion; conditions such as candidiasis, lichen planus, leukoedema, and others must be ruled out before a diagnosis of leukoplakia can be made.[1]
The prevalence of leukoplakia in the United States is decreasing as a result of reduced tobacco consumption.[3] Although erythroplakia is not as common as leukoplakia, it is much more likely to be associated with dysplasia or carcinoma.[1,4]
Early cancers (stage I and stage II) of the lip and oral cavity are highly curable by surgery or radiation therapy. The choice of treatment is dictated by the anticipated functional and cosmetic results of treatment and by the availability of a surgeon or radiation oncologist with the required expertise.[5-7] A positive surgical margin or a tumor depth of more than 5 mm significantly increases the risk of local recurrence.[8,9] The risk of occult nodal metastases increases based on depth of invasion of the primary tumor. Depth of invasion holds prognostic significance and was included in tumor staging definitions in the American Joint Committee on Cancer (AJCC) 8th edition staging classification.[10,11] Extranodal extension in a lymph node is a significant adverse prognostic factor and was incorporated into the 8th edition AJCC staging system.[12,13]
Advanced cancers (stage III and stage IV) of the lip and oral cavity represent a wide spectrum of challenges for the surgeon and radiation oncologist. Most patients with stage III or stage IV tumors are candidates for treatment by a combination of surgery and radiation therapy. The exception is patients with small T3 lesions and no regional lymph node and no distant metastases or who have no lymph nodes larger than 2 cm in diameter, for whom treatment by radiation therapy alone or surgery alone might be appropriate.[6] Furthermore, because local recurrence and/or distant metastases are common in this group of patients, clinical trials can be considered. Such trials evaluate the potential role of radiation modifiers or combination chemotherapy combined with surgery and/or radiation therapy.
Patients with head and neck cancers have an increased chance of developing a second primary tumor of the upper aerodigestive tract.[14,15] A study has shown that daily treatment with moderate doses of isotretinoin for 1 year can significantly reduce the incidence of second tumors. However, no survival advantage has been demonstrated, in part due to recurrence and death from the primary malignancy. An additional trial showed no benefit of retinyl palmitate or retinyl palmitate plus beta-carotene when compared with isotretinoin alone.[16][Level of evidence B1]
The rate of curability of cancers of the lip and oral cavity varies depending on the stage and specific site. Most patients present with early cancers of the lip, which are highly curable by surgery or by radiation therapy with cure rates of 90% to 100%. Small cancers of the retromolar trigone, hard palate, and upper gingiva are highly curable by either radiation therapy or surgery with survival rates of as high as 100%. Local control rates as high as 90% can be achieved with either radiation therapy or surgery in small cancers of the anterior tongue, the floor of the mouth, and buccal mucosa.[17]
Moderately advanced and advanced cancers of the lip also can be controlled effectively by surgery, radiation therapy, or both. The choice of treatment is generally dictated by the anticipated functional and cosmetic results of the treatment. Moderately advanced lesions of the retromolar trigone without evidence of spread to cervical lymph nodes are usually curable and have shown local control rates as high as 90%. Such lesions of the hard palate, upper gingiva, and buccal mucosa have a local control rate of up to 80%. In the absence of clinical evidence of spread to cervical lymph nodes, moderately advanced lesions of the floor of the mouth and anterior tongue are generally curable, with survival rates of as high as 70% and 65%, respectively.[17,18]
Most head and neck cancers are of the squamous cell variety and may be preceded by various precancerous lesions. Minor salivary gland tumors are not uncommon in these sites. Specimens removed from the lesions may show the carcinomas to be noninvasive, in which case the term carcinoma in situ is applied. An invasive carcinoma will be well differentiated, moderately well differentiated, poorly differentiated, or undifferentiated.
Tumor grading is recommended using Broder classification (Tumor Grade [G]):
No statistically significant correlation between degree of differentiation and the biological behavior of the cancer exists; however, vascular invasion is a negative prognostic factor.[2]
Because leukoplakia, erythroplakia, and mixed erythroleukoplakia are exclusively clinical terms that have no specific histopathologic connotations,[3] the term leukoplakia should be used solely as a clinically descriptive term to mean that the observer sees a white patch that does not rub off, the significance of which depends on histological findings. Leukoplakia can range from hyperkeratosis to an early invasive carcinoma, or it may represent a fungal infection, lichen planus, or other benign oral disease.
The staging systems for lip and oral cavity cancer are all clinical staging and are based on the best possible estimate of the extent of disease before treatment. The assessment of the primary tumor is based on inspection and palpation when possible and by both indirect mirror examination and direct endoscopy when necessary. The tumor must be confirmed histologically, and any other pathological data obtained on biopsy may be included. The appropriate nodal drainage areas are examined by careful palpation. Information from diagnostic imaging studies may be used in staging. Magnetic resonance imaging offers an advantage over computed tomographic scans in the detection and localization of head and neck tumors and in the distinction of lymph nodes from blood vessels.[1] If a patient's disease relapses, complete restaging must be done to select the appropriate additional therapy.[2,3]
The AJCC has designated staging by TNM (tumor, node, metastasis) classification to define lip and oral cavity cancer. The staging system reflects the whole oral cavity, which includes the mucosa of the lip but not the external (dry) lip.[4] The staging described below is used for patients who have not had a lymph node dissection of the neck.
| T Categoryb | T Criteria |
|---|---|
| DOI = depth of invasion. | |
| aReprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 79–94. | |
| bClinical and pathological DOI are now used in conjunction with size to determine the T category. | |
| cDOI is depth of invasion and not tumor thickness. | |
| dSuperficial erosion of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as T4. | |
| TX | Primary tumor cannot be assessed. |
| Tis | Carcinoma in situ. |
| T1 | Tumor ≤2 cm with DOIc ≤5 mm. |
| T2 | Tumor ≤2 cm with DOIc >5 mm or tumor >2 cm and ≤4 cm with DOIc ≤10 mm. |
| T3 | Tumor >2 cm and ≤4 cm with DOIc >10 mm or tumor >4 cm with DOIc ≤10 mm. |
| T4 | Moderately advanced or very advanced local disease. |
| –T4ad | Moderately advanced local disease. Tumor >4 cm with DOIc >10 mm or tumor invades adjacent structures only (e.g., through cortical bone of the mandible or maxilla or involves the maxillary sinus or skin of the face). |
| –T4b | Very advanced local disease. Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery. |
| N Category | N Criteria |
|---|---|
| ENE = extranodal extension. | |
| aReprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 79–94. | |
| Note: A designation of U or L may be used for any N category to indicate metastasis above the lower border of the cricoid (U) or below the lower border of the cricoid (L). Similarly, clinical and pathological ENE should be recorded as ENE(–) or ENE(+). | |
| NX | Regional lymph nodes cannot be assessed. |
| N0 | No regional lymph node metastasis. |
| N1 | Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension and ENE(–). |
| N2 | Metastasis in a single ipsilateral lymph node ≤3 cm in greatest dimension and ENE(+) ; or >3 cm but ≤6 cm in greatest dimension and ENE(–); or metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension and ENE(–); or in bilateral or contralateral lymph node(s), none >6 cm in greatest dimension, and ENE(–). |
| –N2a | Metastasis in a single ipsilateral node ≤3 cm in greatest dimension and ENE(+); or a single ipsilateral node >3 cm but ≤6 cm in greatest dimension and ENE(–). |
| –N2b | Metastases in multiple ipsilateral nodes, none >6 cm in greatest dimension, and ENE(–). |
| –N2c | Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension, and ENE(–). |
| N3 | Metastasis in a lymph node >6 cm in greatest dimension and ENE(–); or metastasis in a single ipsilateral node >3 cm in greatest dimension and ENE(+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE(+); or a single contralateral node of any size and ENE(+). |
| –N3a | Metastasis in a lymph node >6 cm in greatest dimension and ENE(–). |
| –N3b | Metastasis in a single ipsilateral node >3 cm in greatest dimension and ENE(+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE(+); or a single contralateral node of any size and ENE(+). |
| M Category | M Criteria |
|---|---|
| aReprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 79–94. | |
| M0 | No distant metastasis. |
| M1 | Distant metastasis. |
| Stage | TNM | Description |
|---|---|---|
| T = primary tumor; N = regional lymph node; M = metastasis. | ||
| aReprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 79–94. | ||
| 0 | Tis, N0, M0 | Tis = Carcinoma in situ. |
| N0 = No regional lymph node metastasis. | ||
| M0 = No distant metastasis. | ||
| Stage | TNM | Description |
|---|---|---|
| T = primary tumor; N = regional lymph node; M = metastasis; DOI = depth of invasion. | ||
| aReprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 79–94. | ||
| bDOI is depth of invasion and not tumor thickness. | ||
| I | T1, N0, M0 | T1 = Tumor ≤2 cm with DOIb ≤5 mm. |
| N0 = No regional lymph node metastasis. | ||
| M0 = No distant metastasis. | ||
| Stage | TNM | Description |
|---|---|---|
| T = primary tumor; N = regional lymph node; M = metastasis; DOI = depth of invasion. | ||
| aReprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 79–94. | ||
| bDOI is depth of invasion and not tumor thickness. | ||
| II | T2, N0, M0 | T2 = Tumor ≤2 cm with DOIb >5 mm or tumor >2 cm and ≤4 cm with DOIb ≤10 mm. |
| N0 = No regional lymph node metastasis. | ||
| M0 = No distant metastasis. | ||
| Stage | TNM | Description |
|---|---|---|
| T = primary tumor; N = regional lymph node; M = metastasis; DOI = depth of invasion; ENE = extranodal extension. | ||
| aReprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 79–94. | ||
| bDOI is depth of invasion and not tumor thickness. | ||
| III | T3, N0, M0 | T3 = Tumor >2 cm and ≤4 cm with DOIb >10 mm or tumor >4 cm with DOIb ≤10 mm. |
| N0 = No regional lymph node metastasis. | ||
| M0 = No distant metastasis. | ||
| T1, T2, T3, N1, M0 | T1, T2, T3 = see Table 1. | |
| N1 = Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension and ENE(–). | ||
| M0 = No distant metastasis. | ||
| Stage | TNM | Description |
|---|---|---|
| T = primary tumor; N = regional lymph node; M = metastasis; DOI = depth of invasion; ENE = extranodal extension. | ||
| aReprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 79–94. | ||
| bSuperficial erosion of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as T4. | ||
| cDOI is depth of invasion and not tumor thickness. | ||
| IVA | T4a, N0, N1, M0 | T4ab = Moderately advanced local disease. Tumor >4 cm with DOIc >10 mm or tumor invades adjacent structures only (e.g., through cortical bone of the mandible or maxilla or involves the maxillary sinus or skin of the face). |
| N0 = No regional lymph node metastasis. | ||
| N1 = Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension and ENE(–). | ||
| M0 = No distant metastasis. | ||
| T1, T2, T3, T4a, N2, M0 | T1, T2, T3, T4a = see Table 1. | |
| N2 = Metastasis in a single ipsilateral lymph node ≤3 cm in greatest dimension and ENE(+); or >3 cm but ≤6 cm in greatest dimension and ENE(–); or metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension and ENE(–); or in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension, and ENE(–). | ||
| M0 = No distant metastasis. | ||
| IVB | Any T, N3, M0 | Any T = See Table 1. |
| N3 = Metastasis in a lymph node >6 cm in greatest dimension and ENE(–); or metastasis in a single ipsilateral node >3 cm in greatest dimension and ENE(+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE(+); or in a single contralateral node of any size and ENE(+). | ||
| M0 = No distant metastasis. | ||
| T4b, Any N, M0 | T4b = Very advanced local disease. Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery. | |
| Any N = See Table 2. | ||
| M0 = No distant metastasis. | ||
| IVC | Any T, Any N, M1 | Any T = See Table 1. |
| Any N = See Table 2. | ||
| M1 = Distant metastasis. | ||
The selection of treatment for lip and oral cavity cancer depends on the site and extent of the primary tumor and the status of the lymph nodes. Some options for treatment of this cancer include the following:[1-5]
For lesions of the oral cavity, surgery must adequately encompass all of the gross as well as the presumed microscopic extent of the disease. If regional nodes are positive, cervical node dissection is usually done in continuity. With modern approaches, the surgeon can successfully ablate large posterior oral cavity tumors and with reconstructive methods can achieve satisfactory functional results. Prosthodontic rehabilitation is important, particularly in early-stage cancers, to assure the best quality of life.
Radiation therapy for lip and oral cavity cancers can be given by external-beam radiation therapy (EBRT) or interstitial implantation alone, but for many sites the use of both modalities produces better control and functional results. Small superficial cancers can be very successfully treated by local implantation using any one of several radioactive sources, by intraoral cone radiation therapy, or by electrons. Larger lesions are frequently managed using EBRT to include the primary site and regional lymph nodes, even if they are not clinically involved. Supplementation with interstitial radiation sources may be necessary to achieve adequate doses to large primary tumors and/or bulky nodal metastases. A review of published clinical results of radical radiation therapy for head and neck cancer suggests a significant loss of local control with prolonged radiation therapy; therefore, lengthened standard treatment schedules should be avoided whenever possible.[6,7]
Early cancers (stage I and stage II) of the lip, floor of the mouth, and retromolar trigone are highly curable by surgery or radiation therapy. The choice of treatment is dictated by the anticipated functional and cosmetic results. Availability of a surgeon or radiation oncologist with the required expertise for the individual patient is also a factor in treatment choice.
Advanced cancers (stage III and stage IV) of the lip, floor of the mouth, and retromolar trigone represent a wide spectrum of challenges for the surgeon and radiation oncologists. Most patients with stage III or stage IV tumors are candidates for treatment with a combination of surgery and radiation therapy. The exceptions are patients with small T3 lesions and no regional lymph nodes, and no distant metastases or patients who have no lymph nodes larger than 2 cm in diameter, for whom treatment by radiation therapy alone or surgery alone might be appropriate. Because local recurrence and/or distant metastases are common in this group of patients, clinical trials that are evaluating the following should be considered:
Early cancers of the buccal mucosa are equally curable by radiation therapy or adequate excision. Patient factors and local expertise influence the choice of treatment. Larger cancers require composite resection with reconstruction of the defect by pedicle flaps.
Early lesions (T1 and T2) of the anterior tongue may be managed by surgery or by radiation therapy alone. Both modalities produce 70% to 85% cure rates in patients with early lesions. Moderate excisions of tongue, even hemiglossectomy, can often result in little speech disability provided the wound closure is such that the tongue is not bound down. However, if the resection is more extensive, problems may include aspiration of liquids and solids, difficulty swallowing, and speech difficulties. Occasionally, patients with tumor of the tongue require almost total glossectomy. Large lesions generally require combined surgical and radiation treatment. The control rates for larger lesions are about 30% to 40%. According to clinical and radiological evidence of involvement, cancers of the lower gingiva that are exophytic and amenable to adequate local excision may be excised to include portions of bone. More advanced lesions require segmental bone resection, hemimandibulectomy, or maxillectomy, depending on the extent of the lesion and its location.
Early lesions of the upper gingiva or hard palate without bone involvement can be treated with equal effectiveness by surgery or radiation therapy alone. Advanced infiltrative and ulcerating lesions should be treated by a combination of radiation therapy and surgery. Most primary cancers of the hard palate are of minor salivary gland origin. Primary squamous cell carcinoma of the hard palate is uncommon, and these tumors generally represent invasion of squamous cell carcinoma arising on the upper gingiva, which is much more common. Management of squamous cell carcinoma of the upper gingiva and hard palate is usually considered together. Surgical treatment of cancer of the hard palate usually requires excision of underlying bone producing an opening into the antrum. This defect can be filled and covered with a dental prosthesis, which is a maneuver that restores satisfactory swallowing and speech.
Patients who smoke while receiving radiation therapy appear to have lower response rates and shorter survival durations than those who do not;[8] therefore, patients should be counseled to stop smoking before beginning radiation therapy. Dental status evaluation should be performed prior to therapy to prevent late sequelae.
The DPYD gene encodes an enzyme that catabolizes pyrimidines and fluoropyrimidines, like capecitabine and fluorouracil. An estimated 1% to 2% of the population has germline pathogenic variants in DPYD, which lead to reduced DPD protein function and an accumulation of pyrimidines and fluoropyrimidines in the body.[9,10] Patients with the DPYD*2A variant who receive fluoropyrimidines may experience severe, life-threatening toxicities that are sometimes fatal. Many other DPYD variants have been identified, with a range of clinical effects.[9-11] Fluoropyrimidine avoidance or a dose reduction of 50% may be recommended based on the patient's DPYD genotype and number of functioning DPYD alleles.[12-14] DPYD genetic testing costs less than $200, but insurance coverage varies due to a lack of national guidelines.[15] In addition, testing may delay therapy by 2 weeks, which would not be advisable in urgent situations. This controversial issue requires further evaluation.[16]
Surgery and/or radiation therapy may be used, depending on the exact site.[1,2]
Treatment options for stage I small lesions of the lip include the following:
Surgery and radiation therapy produce similar cure rates, and the method of treatment is dictated by the anticipated cosmetic and functional results.
Treatment options for stage I small anterior tongue lesions include the following:
Treatment options for stage I small lesions of the buccal mucosa include the following:
Treatment options for stage I small lesions of the floor of the mouth include the following:
Treatment options for stage I small lesions of the lower gingiva include the following:
Treatment options for stage I small tumors of the retromolar trigone include the following:
Treatment options for stage I small lesions of the upper gingiva and hard palate include the following:
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
Surgery and/or radiation therapy may be used, depending on the exact site.[1]
Treatment options for stage II small lesions of the lip include the following:
Treatment options for stage II small anterior tongue lesions include the following:
Treatment options for stage II small lesions of the buccal mucosa include the following:
Treatment options for stage II small lesions of the floor of the mouth include the following:
Treatment options for stage II small lesions of the lower gingiva include the following:
Treatment options for stage II small tumors of the retromolar trigone include the following:
Treatment options for stage II small lesions of the upper gingiva and hard palate include the following:
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
Surgery and/or radiation therapy are used, depending on the exact tumor site.[1,2] Neoadjuvant chemotherapy, as given in clinical trials, has been used to shrink tumors and render them more definitively treatable with either surgery or radiation. Neoadjuvant chemotherapy is given prior to the other modalities, as opposed to standard adjuvant chemotherapy, which is given after or during definitive therapy with radiation or after surgery. Many drug combinations have been used as neoadjuvant chemotherapy.[3-6] Randomized, prospective trials, however, have yet to demonstrate a benefit in either disease-free survival or overall survival for patients receiving neoadjuvant chemotherapy.[7]
These lesions, including those involving bone, nerves, and lymph nodes, generally require a combination of surgery and radiation therapy.
Treatment options for stage III advanced lesions of the lip include the following:
Treatment options for stage III moderately advanced (late T2, small T3) lesions of the anterior tongue include the following:
Treatment options for stage III advanced lesions of the buccal mucosa include the following:
Treatment options for stage III moderately advanced lesions of the floor of the mouth include the following:
Treatment options for stage III moderately advanced lesions of the lower gingiva include the following:
Treatment options for stage III advanced lesions of the retromolar trigone include the following:
Treatment options for stage III moderately advanced lesions of the upper gingiva include the following:
Treatment options for stage III moderately advanced lesions of the hard palate include the following:
A meta-analysis of 63 randomized prospective trials published between 1965 and 1993 showed an 8% absolute survival advantage in the subset of patients who received concurrent chemotherapy and radiation therapy.[16][Level of evidence B4] Patients who received adjuvant or neoadjuvant chemotherapy had no survival advantage. Cost, quality of life, and morbidity data were not available. No standard regimen existed, and the trials were felt to be too heterogenous to provide definitive recommendations. The results of 18 ongoing trials may further clarify the role of concurrent chemotherapy and radiation therapy in the management of oral cavity cancer.
The best chemotherapy to use and the appropriate way to integrate the two modalities is still unresolved.[17]
Similar approaches in the patient with resectable disease, in whom resection would lead to a major functional deficit, are also being explored in randomized trials but cannot be recommended at this time as standard.
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
Randomized prospective trials have yet to demonstrate a benefit in either disease-free survival or overall survival for patients receiving neoadjuvant chemotherapy.[1] The use of isotretinoin daily for 1 year to prevent development of second upper aerodigestive tract primaries is under clinical evaluation.[2]
These lesions, including those involving bone, nerves, and lymph nodes, generally require a combination of surgery and radiation therapy.
Treatment options for stage IV advanced lesions of the lip include the following:
Treatment options for stage IV advanced lesions of the anterior tongue include the following:
Treatment options for stage IV advanced lesions of the buccal mucosa include the following:
Treatment options for stage IV advanced lesions of the floor of the mouth include the following:
Treatment options for stage IV advanced lesions of the lower gingiva include the following:
Treatment options for stage IV advanced lesions of the retromolar trigone include the following:
Treatment options for stage IV advanced lesions of the upper gingiva include the following:
Treatment options for stage IV advanced lesions of the hard palate include the following:
A meta-analysis of 63 randomized prospective trials published between 1965 and 1993 showed an 8% absolute survival advantage in the subset of patients who received concurrent chemotherapy and radiation therapy.[9][Level of evidence B4] Patients who received adjuvant or neoadjuvant chemotherapy had no survival advantage. Cost, quality of life, and morbidity data were not available. No standard regimen existed, and the trials were felt to be too heterogenous to provide definitive recommendations. The results of 18 ongoing trials may further clarify the role of concurrent chemotherapy and radiation therapy in the management of oral cavity cancer.
The best chemotherapy to use and the appropriate way to integrate the two modalities is still unresolved.[10]
Similar approaches in the patient with resectable disease, in whom resection would lead to a major functional deficit, are also being explored in randomized trials but cannot be recommended at this time as standard.
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
Patients with advanced lesions should have elective lymph node radiation therapy or node dissection. The risk of metastases to lymph nodes is increased by high-grade histology, large lesions, spread to involve the wet mucosa of the lip or the buccal mucosa in patients with recurrent disease, and invasion of muscle (i.e., orbicularis oris).[1]
Treatment options for management of lymph node metastases include the following:
For lesions of the lip, anterior tongue, buccal mucosa, floor of the mouth, retromolar trigone, upper gingiva, and hard palate, treatment is dictated by the location and size of the recurrent lesion as well as prior treatment.[1,2]
Treatment options for recurrent lip and oral cavity cancer include the following:
Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Treatment Option Overview for Lip and Oral Cavity Cancer
Added Fluorouracil Dosing as a new subsection.
This summary is written and maintained by the PDQ Adult Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® Cancer Information for Health Professionals pages.
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of adult lip and oral cavity cancer. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.
This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).
Board members review recently published articles each month to determine whether an article should:
Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.
The lead reviewers for Lip and Oral Cavity Cancer Treatment are:
Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's Email Us. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.
Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.
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The preferred citation for this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Lip and Oral Cavity Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/head-and-neck/hp/adult/lip-mouth-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389262]
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