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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65821_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65821_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65821_"><span class="title" itemprop="name">Lip and Oral Cavity Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: June 7, 2024.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062930__384">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.</p><p id="CDR0000062930__385">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).</p></div><div id="CDR0000062930__1"><h2 id="_CDR0000062930__1_">General Information About Lip and Oral Cavity Cancer</h2><div id="CDR0000062930__364"><h3>Anatomy</h3><p id="CDR0000062930__3">The oral cavity extends from the skin-vermilion junctions of the anterior lips
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to the junction of the hard and soft palates above and to the line of
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circumvallate papillae below and is divided into the following specific areas:
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</p><ul id="CDR0000062930__4"><li class="half_rhythm"><div>Lip.
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</div></li><li class="half_rhythm"><div>Anterior two thirds of tongue.
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</div></li><li class="half_rhythm"><div>Buccal mucosa.
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</div></li><li class="half_rhythm"><div>Floor of mouth.
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</div></li><li class="half_rhythm"><div>Lower gingiva.
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</div></li><li class="half_rhythm"><div>Retromolar trigone.
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</div></li><li class="half_rhythm"><div>Upper gingiva.
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</div></li><li class="half_rhythm"><div>Hard palate.
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</div></li></ul></div><div id="CDR0000062930__365"><h3>Histopathology</h3><p id="CDR0000062930__5">The main routes of lymph node drainage are into the first station nodes
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(i.e., buccinator, jugulodigastric, submandibular, and submental). Sites close to
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the midline often drain bilaterally. Second station nodes include the parotid,
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jugular, and the upper and lower posterior cervical nodes.
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</p><p id="CDR0000062930__375">Precancerous lesions of the oropharynx include leukoplakia, erythroplakia, and mixed erythroleukoplakia.[<a class="bk_pop" href="#CDR0000062930_rl_1_1">1</a>] 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.”[<a class="bk_pop" href="#CDR0000062930_rl_1_2">2</a>] 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.[<a class="bk_pop" href="#CDR0000062930_rl_1_1">1</a>]</p><p id="CDR0000062930__376">The prevalence of leukoplakia in the United States is decreasing as a result of reduced tobacco consumption.[<a class="bk_pop" href="#CDR0000062930_rl_1_3">3</a>] Although erythroplakia is not as common as leukoplakia, it is much more likely to be associated with dysplasia or carcinoma.[<a class="bk_pop" href="#CDR0000062930_rl_1_1">1</a>,<a class="bk_pop" href="#CDR0000062930_rl_1_4">4</a>]</p></div><div id="CDR0000062930__366"><h3>Prognostic Factors</h3><p id="CDR0000062930__6">Early cancers (stage I and stage II) of the lip and oral cavity are highly curable
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by surgery or radiation therapy. The choice of treatment is dictated by
|
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the anticipated functional and cosmetic results of treatment and by the
|
|
availability of a surgeon or radiation
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|
oncologist with the required expertise.[<a class="bk_pop" href="#CDR0000062930_rl_1_5">5</a>-<a class="bk_pop" href="#CDR0000062930_rl_1_7">7</a>] A positive surgical margin
|
|
or a tumor depth of more than 5 mm significantly increases the risk of
|
|
local recurrence.[<a class="bk_pop" href="#CDR0000062930_rl_1_8">8</a>,<a class="bk_pop" href="#CDR0000062930_rl_1_9">9</a>] 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.[<a class="bk_pop" href="#CDR0000062930_rl_1_10">10</a>,<a class="bk_pop" href="#CDR0000062930_rl_1_11">11</a>] Extranodal extension in a lymph node is a significant adverse prognostic factor and was incorporated into the 8th edition AJCC staging system.[<a class="bk_pop" href="#CDR0000062930_rl_1_12">12</a>,<a class="bk_pop" href="#CDR0000062930_rl_1_13">13</a>] </p><p id="CDR0000062930__7">Advanced cancers (stage III and stage IV) of the lip and oral cavity represent a
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|
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
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|
metastases or who have no lymph nodes larger than 2 cm in diameter, for whom
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treatment by radiation therapy alone or surgery alone might be appropriate.[<a class="bk_pop" href="#CDR0000062930_rl_1_6">6</a>] Furthermore, because local
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|
recurrence and/or distant metastases are common in this group of patients, clinical trials can be considered. Such trials evaluate the potential
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role of radiation modifiers or combination chemotherapy combined with surgery
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|
and/or radiation therapy.
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</p></div><div id="CDR0000062930__367"><h3>Survival</h3><p id="CDR0000062930__8">Patients with head and neck cancers have an increased chance of developing a
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|
second primary tumor of the upper aerodigestive tract.[<a class="bk_pop" href="#CDR0000062930_rl_1_14">14</a>,<a class="bk_pop" href="#CDR0000062930_rl_1_15">15</a>] 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.
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|
An additional trial showed no benefit of retinyl palmitate or retinyl palmitate plus beta-carotene when compared with isotretinoin alone.[<a class="bk_pop" href="#CDR0000062930_rl_1_16">16</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000810025/" class="def">Level of evidence B1</a>]</p><p id="CDR0000062930__9">The rate of curability of cancers of the lip and oral cavity varies depending
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|
on the stage and specific site. Most patients present with early cancers of
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|
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
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|
anterior tongue, the floor of the mouth, and buccal mucosa.[<a class="bk_pop" href="#CDR0000062930_rl_1_17">17</a>]
|
|
</p><p id="CDR0000062930__10">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.[<a class="bk_pop" href="#CDR0000062930_rl_1_17">17</a>,<a class="bk_pop" href="#CDR0000062930_rl_1_18">18</a>]
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|
</p></div><div id="CDR0000062930_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_1_1">Neville BW, Day TA: Oral cancer and precancerous lesions. CA Cancer J Clin 52 (4): 195-215, 2002 Jul-Aug. [<a href="https://pubmed.ncbi.nlm.nih.gov/12139232" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12139232</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_2">Kramer IR, Lucas RB, Pindborg JJ, et al.: Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol 46 (4): 518-39, 1978. [<a href="https://pubmed.ncbi.nlm.nih.gov/280847" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 280847</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_3">Scheifele C, Reichart PA, Dietrich T: Low prevalence of oral leukoplakia in a representative sample of the US population. Oral Oncol 39 (6): 619-25, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/12798406" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12798406</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_4">Shafer WG, Waldron CA: Erythroplakia of the oral cavity. Cancer 36 (3): 1021-8, 1975. [<a href="https://pubmed.ncbi.nlm.nih.gov/1182656" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1182656</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_5">Cummings CW, Fredrickson JM, Harker LA, et al.: Otolaryngology - Head and Neck Surgery. Mosby-Year Book, Inc., 1998.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_6">Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Lippincott, William & Wilkins, 2009.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_7">Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. Wiley-Liss, 1997.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_8">Jones KR, Lodge-Rigal RD, Reddick RL, et al.: Prognostic factors in the recurrence of stage I and II squamous cell cancer of the oral cavity. Arch Otolaryngol Head Neck Surg 118 (5): 483-5, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1571116" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1571116</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_9">Po Wing Yuen A, Lam KY, Lam LK, et al.: Prognostic factors of clinically stage I and II oral tongue carcinoma-A comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic features. Head Neck 24 (6): 513-20, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12112547" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12112547</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_10">Sparano A, Weinstein G, Chalian A, et al.: Multivariate predictors of occult neck metastasis in early oral tongue cancer. Otolaryngol Head Neck Surg 131 (4): 472-6, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15467620" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15467620</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_11">D'Cruz AK, Vaish R, Kapre N, et al.: Elective versus Therapeutic Neck Dissection in Node-Negative Oral Cancer. N Engl J Med 373 (6): 521-9, 2015. [<a href="https://pubmed.ncbi.nlm.nih.gov/26027881" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26027881</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_12">Cooper JS, Pajak TF, Forastiere AA, et al.: Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350 (19): 1937-44, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15128893" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15128893</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_13">Bernier J, Cooper JS, Pajak TF, et al.: Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 27 (10): 843-50, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/16161069" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16161069</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_14">Day GL, Blot WJ: Second primary tumors in patients with oral cancer. Cancer 70 (1): 14-9, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1606536" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1606536</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_15">van der Tol IG, de Visscher JG, Jovanovic A, et al.: Risk of second primary cancer following treatment of squamous cell carcinoma of the lower lip. Oral Oncol 35 (6): 571-4, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10705092" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10705092</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_16">Papadimitrakopoulou VA, Lee JJ, William WN, et al.: Randomized trial of 13-cis retinoic acid compared with retinyl palmitate with or without beta-carotene in oral premalignancy. J Clin Oncol 27 (4): 599-604, 2009. [<a href="/pmc/articles/PMC2645856/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2645856</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19075276" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19075276</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_17">Wallner PE, Hanks GE, Kramer S, et al.: Patterns of Care Study. Analysis of outcome survey data-anterior two-thirds of tongue and floor of mouth. Am J Clin Oncol 9 (1): 50-7, 1986. [<a href="https://pubmed.ncbi.nlm.nih.gov/3953491" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3953491</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_1_18">Takagi M, Kayano T, Yamamoto H, et al.: Causes of oral tongue cancer treatment failures. Analysis of autopsy cases. Cancer 69 (5): 1081-7, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1739904" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1739904</span></a>]</div></li></ol></div></div><div id="CDR0000062930__11"><h2 id="_CDR0000062930__11_">Cellular Classification of Lip and Oral Cavity Cancer</h2><p id="CDR0000062930__12">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 <i>in situ</i> is applied. An
|
|
invasive carcinoma will be well differentiated, moderately
|
|
well differentiated, poorly differentiated, or undifferentiated.
|
|
</p><p id="CDR0000062930__13">Tumor grading is recommended using Broder classification (Tumor Grade [G]):
|
|
</p><ul id="CDR0000062930__14"><li class="half_rhythm"><div>G1: well differentiated.
|
|
</div></li><li class="half_rhythm"><div>G2: moderately well differentiated.
|
|
</div></li><li class="half_rhythm"><div>G3: poorly differentiated.
|
|
</div></li><li class="half_rhythm"><div>G4: undifferentiated.[<a class="bk_pop" href="#CDR0000062930_rl_11_1">1</a>]
|
|
</div></li></ul><p id="CDR0000062930__15">No statistically significant correlation between degree of differentiation and
|
|
the biological behavior of the cancer exists; however, vascular invasion is a
|
|
negative prognostic factor.[<a class="bk_pop" href="#CDR0000062930_rl_11_2">2</a>]
|
|
</p><p id="CDR0000062930__17">Because leukoplakia, erythroplakia, and mixed erythroleukoplakia are exclusively clinical terms that have no specific histopathologic connotations,[<a class="bk_pop" href="#CDR0000062930_rl_11_3">3</a>] 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.
|
|
</p><div id="CDR0000062930_rl_11"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_11_1">Bansberg SF, Olsen KD, Gaffey TA: High-grade carcinoma of the oral cavity. Otolaryngol Head Neck Surg 100 (1): 41-8, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2466229" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2466229</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_11_2">Close LG, Brown PM, Vuitch MF, et al.: Microvascular invasion and survival in cancer of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Surg 115 (11): 1304-9, 1989. [<a href="https://pubmed.ncbi.nlm.nih.gov/2803710" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2803710</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_11_3">Oral cavity and oropharynx. In: Rosai J, ed.: Rosai and Ackerman's Surgical Pathology. Vol. 1. 10th ed. Mosby Elsevier, 2011, pp. 237-264.</div></li></ol></div></div><div id="CDR0000062930__18"><h2 id="_CDR0000062930__18_">Stage Information for Lip and Oral Cavity Cancer</h2><p id="CDR0000062930__19">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.[<a class="bk_pop" href="#CDR0000062930_rl_18_1">1</a>] If a patient's disease
|
|
relapses, complete restaging must be done to select the appropriate additional
|
|
therapy.[<a class="bk_pop" href="#CDR0000062930_rl_18_2">2</a>,<a class="bk_pop" href="#CDR0000062930_rl_18_3">3</a>]
|
|
</p><div id="CDR0000062930__326"><h3>American Joint Committee on Cancer (AJCC) Stage Groupings and TNM Definitions</h3><p id="CDR0000062930__325">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.[<a class="bk_pop" href="#CDR0000062930_rl_18_4">4</a>] The staging described below is used for patients who have not had a lymph node dissection of the neck.</p><div id="CDR0000062930__395" class="table"><h3><span class="title">Table 1. Definition of Primary Tumor (T)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.13/table/CDR0000062930__395/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__395_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">T Category<sup>b</sup></th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">T Criteria</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">TX</td><td colspan="1" rowspan="1" style="vertical-align:top;">Primary tumor cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Tis</td><td colspan="1" rowspan="1" style="vertical-align:top;">Carcinoma <i>in situ</i>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor ≤2 cm with DOI<sup>c</sup> ≤5 mm. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor ≤2 cm with DOI<sup>c</sup> >5 mm <i>or</i> tumor >2 cm and ≤4 cm with DOI<sup>c</sup> ≤10 mm.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor >2 cm and ≤4 cm with DOI<sup>c</sup> >10 mm <i>or</i> tumor >4 cm with DOI<sup>c</sup> ≤10 mm.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4</td><td colspan="1" rowspan="1" style="vertical-align:top;">Moderately advanced or very advanced local disease. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T4a<sup>d</sup></td><td colspan="1" rowspan="1" style="vertical-align:top;">Moderately advanced local disease. Tumor >4 cm with DOI<sup>c</sup> >10 mm <i>or</i> 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).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T4b</td><td colspan="1" rowspan="1" style="vertical-align:top;">Very advanced local disease. Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">DOI = depth of invasion.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 79–94.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Clinical and pathological DOI are now used in conjunction with size to determine the T category.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>c</sup>DOI is depth of invasion and not tumor thickness.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>d</sup>Superficial erosion of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as T4.</p></div></dd></dl></div></div></div><div id="CDR0000062930__396" class="table"><h3><span class="title">Table 2. Definition of Regional Lymph Nodes – Pathological (pN)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.13/table/CDR0000062930__396/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__396_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">N Category</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">N Criteria</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">NX</td><td colspan="1" rowspan="1" style="vertical-align:top;">Regional lymph nodes cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 </td><td colspan="1" rowspan="1" style="vertical-align:top;">No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension and ENE(–).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a single ipsilateral lymph node ≤3 cm in greatest dimension and ENE(+) ; <i>or</i> >3 cm but ≤6 cm in greatest dimension and ENE(–); <i>or</i> metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension and ENE(–); <i>or</i> in bilateral or contralateral lymph node(s), none >6 cm in greatest dimension, and ENE(–).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–N2a</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a single ipsilateral node ≤3 cm in greatest dimension and ENE(+); <i>or</i> a single ipsilateral node >3 cm but ≤6 cm in greatest dimension and ENE(–).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–N2b</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in multiple ipsilateral nodes, none >6 cm in greatest dimension, and ENE(–).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–N2c</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension, and ENE(–).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a lymph node >6 cm in greatest dimension and ENE(–); <i>or</i> metastasis in a single ipsilateral node >3 cm in greatest dimension and ENE(+); <i>or</i> multiple ipsilateral, contralateral, or bilateral nodes, any with ENE(+); <i>or</i> a single contralateral node of any size and ENE(+).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–N3a</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a lymph node >6 cm in greatest dimension and ENE(–).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–N3b</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a single ipsilateral node >3 cm in greatest dimension and ENE(+); <i>or</i> multiple ipsilateral, contralateral, or bilateral nodes, any with ENE(+); <i>or</i> a single contralateral node of any size and ENE(+).</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">ENE = extranodal extension.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 79–94.</p></div></dd><dt></dt><dd><div><p class="no_margin"><i>Note:</i> A designation of <i>U</i> or <i>L</i> 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(+).</p></div></dd></dl></div></div></div><div id="CDR0000062930__398" class="table"><h3><span class="title">Table 3. Definition of Distant Metastasis (M)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.13/table/CDR0000062930__398/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__398_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">M Category</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">M Criteria</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No distant metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Oral cavity. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp. 79–94.</p></div></dd></dl></div></div></div><div id="CDR0000062930__410" class="table"><h3><span class="title">Table 4. Definition of TNM Stage 0<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.13/table/CDR0000062930__410/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__410_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">0</td><td colspan="1" rowspan="3" style="vertical-align:top;">Tis, N0, M0 </td><td colspan="1" rowspan="1" style="vertical-align:top;">Tis = Carcinoma <i>in situ</i>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis. </td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = metastasis.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted 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.</p></div></dd></dl></div></div></div><div id="CDR0000062930__404" class="table"><h3><span class="title">Table 5. Definition of TNM Stage I<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.13/table/CDR0000062930__404/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__404_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">I</td><td colspan="1" rowspan="3" style="vertical-align:top;">T1, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor ≤2 cm with DOI<sup>b</sup> ≤5 mm.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis. </td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = metastasis; DOI = depth of invasion.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted 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.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>DOI is depth of invasion and not tumor thickness.</p></div></dd></dl></div></div></div><div id="CDR0000062930__405" class="table"><h3><span class="title">Table 6. Definition of TNM Stage II<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.13/table/CDR0000062930__405/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__405_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">II</td><td colspan="1" rowspan="3" style="vertical-align:top;">T2, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor ≤2 cm with DOI<sup>b</sup> >5 mm <i>or</i> tumor >2 cm and ≤4 cm with DOI<sup>b</sup> ≤10 mm.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis. </td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = metastasis; DOI = depth of invasion.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted 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.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>DOI is depth of invasion and not tumor thickness.</p></div></dd></dl></div></div></div><div id="CDR0000062930__406" class="table"><h3><span class="title">Table 7. Definitions of TNM Stage III<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.13/table/CDR0000062930__406/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__406_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="6" style="vertical-align:top;">III</td><td colspan="1" rowspan="3" style="vertical-align:top;">T3, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor >2 cm and ≤4 cm with DOI<sup>b</sup> >10 mm <i>or</i> tumor >4 cm with DOI<sup>b</sup> ≤10 mm.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">T1, T2, T3, N1, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1, T2, T3 = see Table <a href="/books/NBK65821.13/table/CDR0000062930__395/?report=objectonly" target="object" rid-ob="figobCDR0000062930395">1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension and ENE(–). </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis. </td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = metastasis; DOI = depth of invasion; ENE = extranodal extension.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted 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.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>DOI is depth of invasion and not tumor thickness.</p></div></dd></dl></div></div></div><div id="CDR0000062930__407" class="table"><h3><span class="title">Table 8. Definitions of TNM Stage IVA, IVB, and IVC<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.13/table/CDR0000062930__407/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__407_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="7" style="vertical-align:top;">IVA</td><td colspan="1" rowspan="4" style="vertical-align:top;">T4a, N0, N1, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T4a<sup>b</sup> = Moderately advanced local disease. Tumor >4 cm with DOI<sup>c</sup> >10 mm <i>or</i> 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).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.
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</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension and ENE(–).
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</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis. </td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">T1, T2, T3, T4a, N2, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1, T2, T3, T4a = see Table <a href="/books/NBK65821.13/table/CDR0000062930__395/?report=objectonly" target="object" rid-ob="figobCDR0000062930395">1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastasis in a single ipsilateral lymph node ≤3 cm in greatest dimension and ENE(+); <i>or</i> >3 cm but ≤6 cm in greatest dimension and ENE(–); <i>or</i> metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension and ENE(–); <i>or</i> in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension, and ENE(–). </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis. </td></tr><tr><td colspan="1" rowspan="6" style="vertical-align:top;">IVB</td><td colspan="1" rowspan="3" style="vertical-align:top;">Any T, N3, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T = See Table <a href="/books/NBK65821.13/table/CDR0000062930__395/?report=objectonly" target="object" rid-ob="figobCDR0000062930395">1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N3 = Metastasis in a lymph node >6 cm in greatest dimension and ENE(–); <i>or</i> metastasis in a single ipsilateral node >3 cm in greatest dimension and ENE(+); <i>or</i> multiple ipsilateral, contralateral, or bilateral nodes, any with ENE(+); <i>or</i> in a single contralateral node of any size and ENE(+).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">T4b, Any N, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T4b = Very advanced local disease. Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any N = See Table <a href="/books/NBK65821.13/table/CDR0000062930__396/?report=objectonly" target="object" rid-ob="figobCDR0000062930396">2</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">IVC</td><td colspan="1" rowspan="3" style="vertical-align:top;">Any T, Any N, M1</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T = See Table <a href="/books/NBK65821.13/table/CDR0000062930__395/?report=objectonly" target="object" rid-ob="figobCDR0000062930395">1</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Any N = See Table <a href="/books/NBK65821.13/table/CDR0000062930__396/?report=objectonly" target="object" rid-ob="figobCDR0000062930396">2</a>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M1 = Distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = metastasis; DOI = depth of invasion; ENE = extranodal extension.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted 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.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Superficial erosion of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as T4. </p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>c</sup>DOI is depth of invasion and not tumor thickness.</p></div></dd></dl></div></div></div></div><div id="CDR0000062930_rl_18"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_18_1">Consensus conference. Magnetic resonance imaging. JAMA 259 (14): 2132-8, 1988. [<a href="https://pubmed.ncbi.nlm.nih.gov/3279242" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3279242</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_18_2">Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Lippincott, William & Wilkins, 2009.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_18_3">Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. Wiley-Liss, 1997.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_18_4">Oral cavity cancer. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp. 79–94.</div></li></ol></div></div><div id="CDR0000062930__53"><h2 id="_CDR0000062930__53_">Treatment Option Overview for Lip and Oral Cavity Cancer</h2><p id="CDR0000062930__54">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
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lymph nodes. Some options for treatment of this cancer include the following:[<a class="bk_pop" href="#CDR0000062930_rl_53_1">1</a>-<a class="bk_pop" href="#CDR0000062930_rl_53_5">5</a>]
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</p><ul id="CDR0000062930__330"><li class="half_rhythm"><div>Surgery
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alone.</div></li><li class="half_rhythm"><div>Radiation therapy alone.</div></li><li class="half_rhythm"><div>A combination of the surgery and radiation therapy.</div></li></ul><p id="CDR0000062930__55">For lesions of the oral cavity, surgery must adequately encompass all of the
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gross as well as the presumed microscopic extent of the disease. If regional
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nodes are positive, cervical node dissection is usually done in continuity.
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With modern approaches, the surgeon can successfully ablate large posterior
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oral cavity tumors and with reconstructive methods can achieve satisfactory
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functional results. Prosthodontic rehabilitation is important, particularly in
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early-stage cancers, to assure the best quality of life.
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</p><p id="CDR0000062930__56">Radiation therapy for lip and oral cavity cancers can be given by external-beam
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radiation therapy (EBRT) or interstitial implantation alone, but for many sites the use of both
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modalities produces better control and functional results. Small superficial
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cancers can be very successfully treated by local implantation using any one of
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several radioactive sources, by intraoral cone radiation therapy, or by
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electrons. Larger lesions are frequently managed using EBRT to include the primary site and regional lymph nodes, even if they are
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not clinically involved. Supplementation with interstitial radiation sources
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may be necessary to achieve adequate doses to large primary tumors and/or bulky
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nodal metastases. A review of published clinical results of radical radiation
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therapy for head and neck cancer suggests a significant loss of local control
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with prolonged radiation therapy; therefore,
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lengthened standard treatment schedules should be avoided whenever
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possible.[<a class="bk_pop" href="#CDR0000062930_rl_53_6">6</a>,<a class="bk_pop" href="#CDR0000062930_rl_53_7">7</a>]
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</p><p id="CDR0000062930__57">Early cancers (stage I and stage II) of the lip, floor of the mouth, and retromolar
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trigone are highly curable by surgery or radiation therapy. The choice of
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treatment is dictated by the anticipated functional and cosmetic results. Availability of a surgeon or
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radiation oncologist with the required expertise for the individual patient is also a factor in treatment choice. </p><p id="CDR0000062930__333">Advanced cancers (stage III
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and stage IV) of the lip, floor of the mouth, and retromolar trigone represent a wide
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spectrum of challenges for the surgeon and radiation oncologists. Most patients with stage III or stage IV tumors are candidates for treatment with a
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combination of surgery and radiation therapy. The exceptions are patients with small T3 lesions and no regional lymph nodes, and no distant
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metastases or patients who have no lymph nodes larger than 2 cm in diameter, for whom
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treatment by radiation therapy alone or surgery alone might be appropriate. Because local
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recurrence and/or distant metastases are common in this group of patients, clinical trials that are evaluating the following should be considered: </p><ul id="CDR0000062930__334"><li class="half_rhythm"><div>The
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potential role of radiation modifiers to improve local control or decrease
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morbidity.</div></li><li class="half_rhythm"><div>The role of combinations of chemotherapy with surgery and/or radiation
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therapy to improve local control and to decrease the frequency of distant
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metastases.</div></li></ul><p id="CDR0000062930__58">Early cancers of the buccal mucosa are equally curable by radiation therapy or
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adequate excision. Patient factors and local expertise influence the choice
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of treatment. Larger cancers require composite resection with reconstruction
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of the defect by pedicle flaps.
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|
</p><p id="CDR0000062930__59">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.
|
|
</p><p id="CDR0000062930__60">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.
|
|
</p><p id="CDR0000062930__61">Patients who smoke while receiving radiation therapy appear to have lower response
|
|
rates and shorter survival durations than those who do not;[<a class="bk_pop" href="#CDR0000062930_rl_53_8">8</a>] 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.
|
|
</p><div id="CDR0000062930__433"><h3>Fluorouracil Dosing</h3><p id="CDR0000062930__sm_CDR0000813769_4"><div class="milestone-start" id="CDR0000062930__sm_CDR0000813769_3"></div>The <i>DPYD</i> 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 <i>DPYD</i>, which lead to reduced DPD protein function and an accumulation of pyrimidines and fluoropyrimidines in the body.[<a class="bk_pop" href="#CDR0000062930_rl_53_9">9</a>,<a class="bk_pop" href="#CDR0000062930_rl_53_10">10</a>] Patients with the <i>DPYD*2A</i> variant who receive fluoropyrimidines may experience severe, life-threatening toxicities that are sometimes fatal. Many other <i>DPYD</i> variants have been identified, with a range of clinical effects.[<a class="bk_pop" href="#CDR0000062930_rl_53_9">9</a>-<a class="bk_pop" href="#CDR0000062930_rl_53_11">11</a>] Fluoropyrimidine avoidance or a dose reduction of 50% may be recommended based on the patient's <i>DPYD</i> genotype and number of functioning <i>DPYD</i> alleles.[<a class="bk_pop" href="#CDR0000062930_rl_53_12">12</a>-<a class="bk_pop" href="#CDR0000062930_rl_53_14">14</a>] <i>DPYD</i> genetic testing costs less than $200, but insurance coverage varies due to a lack of national guidelines.[<a class="bk_pop" href="#CDR0000062930_rl_53_15">15</a>] In addition, testing may delay therapy by 2 weeks, which would not be advisable in urgent situations. This controversial issue requires further evaluation.<div class="milestone-end"></div>[<a class="bk_pop" href="#CDR0000062930_rl_53_16">16</a>]</p></div><div id="CDR0000062930_rl_53"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_53_1">Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Lippincott, William & Wilkins, 2009.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_2">Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. Wiley-Liss, 1997.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_3">Myers EN, Suen MD, Myers J, eds.: Cancer of the Head and Neck. 4th ed. Saunders, 2003.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_4">Freund HR: Principles of Head and Neck Surgery. 2nd ed. Appleton-Century-Crofts, 1979.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_5">Lore JM: An Atlas of Head and Neck Surgery. 3rd ed. Saunders, 1988.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_6">Fowler JF, Lindstrom MJ: Loss of local control with prolongation in radiotherapy. Int J Radiat Oncol Biol Phys 23 (2): 457-67, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1534082" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1534082</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_7">Langendijk JA, de Jong MA, Leemans ChR, et al.: Postoperative radiotherapy in squamous cell carcinoma of the oral cavity: the importance of the overall treatment time. Int J Radiat Oncol Biol Phys 57 (3): 693-700, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/14529773" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14529773</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_8">Browman GP, Wong G, Hodson I, et al.: Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med 328 (3): 159-63, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8417381" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8417381</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_9">Sharma BB, Rai K, Blunt H, et al.: Pathogenic DPYD Variants and Treatment-Related Mortality in Patients Receiving Fluoropyrimidine Chemotherapy: A Systematic Review and Meta-Analysis. Oncologist 26 (12): 1008-1016, 2021. [<a href="/pmc/articles/PMC8649021/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8649021</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34506675" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34506675</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_10">Lam SW, Guchelaar HJ, Boven E: The role of pharmacogenetics in capecitabine efficacy and toxicity. Cancer Treat Rev 50: 9-22, 2016. [<a href="https://pubmed.ncbi.nlm.nih.gov/27569869" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27569869</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_11">Shakeel F, Fang F, Kwon JW, et al.: Patients carrying DPYD variant alleles have increased risk of severe toxicity and related treatment modifications during fluoropyrimidine chemotherapy. Pharmacogenomics 22 (3): 145-155, 2021. [<a href="https://pubmed.ncbi.nlm.nih.gov/33410339" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33410339</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_12">Amstutz U, Henricks LM, Offer SM, et al.: Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update. Clin Pharmacol Ther 103 (2): 210-216, 2018. [<a href="/pmc/articles/PMC5760397/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5760397</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29152729" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29152729</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_13">Henricks LM, Lunenburg CATC, de Man FM, et al.: DPYD genotype-guided dose individualisation of fluoropyrimidine therapy in patients with cancer: a prospective safety analysis. Lancet Oncol 19 (11): 1459-1467, 2018. [<a href="https://pubmed.ncbi.nlm.nih.gov/30348537" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30348537</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_14">Lau-Min KS, Varughese LA, Nelson MN, et al.: Preemptive pharmacogenetic testing to guide chemotherapy dosing in patients with gastrointestinal malignancies: a qualitative study of barriers to implementation. BMC Cancer 22 (1): 47, 2022. [<a href="/pmc/articles/PMC8742388/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8742388</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34996412" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34996412</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_15">Brooks GA, Tapp S, Daly AT, et al.: Cost-effectiveness of DPYD Genotyping Prior to Fluoropyrimidine-based Adjuvant Chemotherapy for Colon Cancer. Clin Colorectal Cancer 21 (3): e189-e195, 2022. [<a href="/pmc/articles/PMC10496767/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10496767</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35668003" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35668003</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_16">Baker SD, Bates SE, Brooks GA, et al.: DPYD Testing: Time to Put Patient Safety First. J Clin Oncol 41 (15): 2701-2705, 2023. [<a href="/pmc/articles/PMC10414691/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10414691</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36821823" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36821823</span></a>]</div></li></ol></div></div><div id="CDR0000062930__63"><h2 id="_CDR0000062930__63_">Treatment of Stage I Lip and Oral Cavity Cancer</h2><p id="CDR0000062930__64">Surgery and/or radiation therapy may be used, depending on the exact site.[<a class="bk_pop" href="#CDR0000062930_rl_63_1">1</a>,<a class="bk_pop" href="#CDR0000062930_rl_63_2">2</a>]
|
|
</p><div id="CDR0000062930__65"><h3>Treatment Options for Small Lesions of the Lip</h3><p id="CDR0000062930__66">Treatment options for stage I small lesions of the lip include the following:</p><ol id="CDR0000062930__363"><li class="half_rhythm"><div>Surgery.</div></li><li class="half_rhythm"><div>Radiation therapy.</div></li></ol><p id="CDR0000062930__338">Surgery and radiation therapy produce similar cure rates, and the method of
|
|
treatment is dictated by the anticipated cosmetic and functional results.</p></div><div id="CDR0000062930__68"><h3>Treatment Options for Small Anterior Tongue Lesions</h3><p id="CDR0000062930__69">Treatment options for stage I small anterior tongue lesions include the following:
|
|
</p><ol id="CDR0000062930__247"><li class="half_rhythm"><div>Wide local excision is often used for small lesions that can be resected
|
|
transorally.
|
|
</div></li><li class="half_rhythm"><div>For patients with larger T1 lesions, the following standard treatments are used:<ol id="CDR0000062930__339" class="lower-alpha"><li class="half_rhythm"><div>Surgery.</div></li><li class="half_rhythm"><div>Radiation therapy.</div></li><li class="half_rhythm"><div>Interstitial implantation alone or with external-beam radiation therapy.</div></li><li class="half_rhythm"><div>Irradiation of the neck.</div></li></ol></div></li></ol></div><div id="CDR0000062930__72"><h3>Treatment Options for Small Lesions of the Buccal Mucosa</h3><p id="CDR0000062930__73">Treatment options for stage I small lesions of the buccal mucosa include the following:
|
|
</p><ol id="CDR0000062930__248"><li class="half_rhythm"><div>Surgery alone for patients with lesions smaller than 1 cm in diameter, if the commissure is not involved.</div></li><li class="half_rhythm"><div>Radiation therapy, including brachytherapy, should be considered to treat lesions smaller than 1 cm in diameter, if the commissure is involved.</div></li><li class="half_rhythm"><div>Surgical excision with a split-thickness skin graft or radiation therapy is used to treat larger T1 lesions.</div></li></ol></div><div id="CDR0000062930__76"><h3>Treatment Options for Small Lesions of the Floor of the Mouth</h3><p id="CDR0000062930__77">Treatment options for stage I small lesions of the floor of the mouth include the following:
|
|
</p><ol id="CDR0000062930__249"><li class="half_rhythm"><div>Surgery for patients with T1 lesions.</div></li><li class="half_rhythm"><div>Radiation therapy is used to treat T1 lesions.</div></li><li class="half_rhythm"><div>Excision alone is generally adequate to treat lesions smaller than 0.5 cm if there is a margin of normal mucosa between the lesion and the gingiva.</div></li><li class="half_rhythm"><div>Surgery is often used if the lesion is attached to the periosteum.</div></li><li class="half_rhythm"><div>Radiation therapy is often used if the lesion encroaches on the tongue.</div></li></ol></div><div id="CDR0000062930__81"><h3>Treatment Options for Small Lesions of the Lower Gingiva</h3><p id="CDR0000062930__82">Treatment options for stage I small lesions of the lower gingiva include the following:
|
|
</p><ol id="CDR0000062930__250"><li class="half_rhythm"><div>Intraoral resection with or without a rim resection of bone and repair with a split-thickness skin graft are used to treat small lesions.</div></li><li class="half_rhythm"><div>Radiation therapy may be used for small lesions, but results are generally
|
|
better after surgery alone.</div></li></ol></div><div id="CDR0000062930__85"><h3>Treatment Options for Small Tumors of the Retromolar Trigone</h3><p id="CDR0000062930__86">Treatment options for stage I small tumors of the retromolar trigone include the following:
|
|
</p><ol id="CDR0000062930__251"><li class="half_rhythm"><div>Limited resection of the mandible is performed for early lesions without detectable bone invasion.</div></li><li class="half_rhythm"><div>Radiation therapy may be used initially if limited resection is not feasible, with surgery reserved for radiation failure.</div></li></ol></div><div id="CDR0000062930__89"><h3>Treatment Options for Small Lesions of the Upper Gingiva and Hard Palate</h3><p id="CDR0000062930__90">Treatment options for stage I small lesions of the upper gingiva and hard palate include the following:
|
|
</p><ol id="CDR0000062930__252"><li class="half_rhythm"><div>Surgical resection is used to treat most small lesions.</div></li><li class="half_rhythm"><div>Postoperative radiation therapy may be used if appropriate.
|
|
</div></li></ol></div><div id="CDR0000062930__TrialSearch_63_sid_5"><h3>Current Clinical Trials</h3><p id="CDR0000062930__TrialSearch_63_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> 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. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062930_rl_63"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_63_1">Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Lippincott, William & Wilkins, 2009.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_63_2">Guerry TL, Silverman S, Dedo HH: Carbon dioxide laser resection of superficial oral carcinoma: indications, technique, and results. Ann Otol Rhinol Laryngol 95 (6 Pt 1): 547-55, 1986 Nov-Dec. [<a href="https://pubmed.ncbi.nlm.nih.gov/3098155" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3098155</span></a>]</div></li></ol></div></div><div id="CDR0000062930__93"><h2 id="_CDR0000062930__93_">Treatment of Stage II Lip and Oral Cavity Cancer</h2><p id="CDR0000062930__94">Surgery and/or radiation therapy may be used, depending on the exact site.[<a class="bk_pop" href="#CDR0000062930_rl_93_1">1</a>]
|
|
</p><div id="CDR0000062930__95"><h3>Treatment Options for Small Lesions of the Lip</h3><p id="CDR0000062930__96">Treatment options for stage II small lesions of the lip include the following:</p><ol id="CDR0000062930__253"><li class="half_rhythm"><div>Surgery is used for patients with smaller T2 lesions on the lower lip, if simple closure
|
|
produces an acceptable cosmetic result.</div></li><li class="half_rhythm"><div>Radiation therapy, which may include external-beam and/or interstitial techniques, as appropriate, has
|
|
the advantage of producing a relatively better functional and cosmetic result,
|
|
with intact skin and muscle innervation, if a reconstructive surgical procedure is required. </div></li></ol></div><div id="CDR0000062930__100"><h3>Treatment Options for Small Anterior Tongue Lesions</h3><p id="CDR0000062930__101">Treatment options for stage II small anterior tongue lesions include the following:
|
|
</p><ol id="CDR0000062930__254"><li class="half_rhythm"><div>Radiation therapy is usually selected for patients with T2 lesions that have minimal
|
|
infiltration to preserve speech and swallowing.[<a class="bk_pop" href="#CDR0000062930_rl_93_2">2</a>]
|
|
</div></li><li class="half_rhythm"><div>Surgery is reserved for
|
|
patients for whom radiation treatment failed.[<a class="bk_pop" href="#CDR0000062930_rl_93_2">2</a>]</div></li><li class="half_rhythm"><div>Neck dissection may be
|
|
considered when primary brachytherapy is used.[<a class="bk_pop" href="#CDR0000062930_rl_93_2">2</a>]</div></li><li class="half_rhythm"><div>Surgery, radiation therapy,
|
|
or a combination of both are used for deeply infiltrative lesions.</div></li></ol></div><div id="CDR0000062930__104"><h3>Treatment Options for Small Lesions of the Buccal Mucosa</h3><p id="CDR0000062930__105">Treatment options for stage II small lesions of the buccal mucosa include the following:
|
|
</p><ol id="CDR0000062930__255"><li class="half_rhythm"><div>Radiation therapy is the usual treatment for patients with small T2 lesions (≤3 cm).</div></li><li class="half_rhythm"><div>Surgery, radiation
|
|
therapy, or a combination of these are used, if indicated to treat large T2 lesions (>3 cm). Radiation therapy is often used if the lesion involves the commissure. Surgery is often used, if tumor invades the mandible or maxilla. </div></li></ol></div><div id="CDR0000062930__108"><h3>Treatment Options for Small Lesions of the Floor of the Mouth</h3><p id="CDR0000062930__109">Treatment options for stage II small lesions of the floor of the mouth include the following:
|
|
</p><ol id="CDR0000062930__256"><li class="half_rhythm"><div>Surgery is often used for patients with small T2 lesions (≤3 cm) if the lesion is attached to the periosteum.</div></li><li class="half_rhythm"><div>Radiation therapy is often used to treat patients with small T2 lesions (≤3 cm) if the lesion encroaches on the tongue.</div></li><li class="half_rhythm"><div>Surgery and radiation therapy are
|
|
alternative methods of treatment for patients with large T2 lesions (>3 cm), the choice of which depends primarily on the
|
|
expected extent of disability from surgery.</div></li><li class="half_rhythm"><div>External-beam radiation therapy with or without interstitial radiation therapy should be
|
|
considered postoperatively for larger lesions.</div></li></ol></div><div id="CDR0000062930__113"><h3>Treatment Options for Small Lesions of the Lower Gingiva</h3><p id="CDR0000062930__114">Treatment options for stage II small lesions of the lower gingiva include the following:
|
|
</p><ol id="CDR0000062930__257"><li class="half_rhythm"><div>Intraoral resection with or without a rim
|
|
resection of bone and repair with a split-thickness skin graft are used to treat patients with small lesions.</div></li><li class="half_rhythm"><div>Radiation therapy may be used to treat patients with small lesions, but results are generally
|
|
better after surgery alone.</div></li></ol></div><div id="CDR0000062930__117"><h3>Treatment Options for Small Tumors of the Retromolar Trigone</h3><p id="CDR0000062930__118">Treatment options for stage II small tumors of the retromolar trigone include the following:
|
|
</p><ol id="CDR0000062930__258"><li class="half_rhythm"><div>Limited resection of the
|
|
mandible is performed to treat patients with early lesions that are without detectable bone invasion.</div></li><li class="half_rhythm"><div>Radiation therapy may be used
|
|
initially if limited resection is not feasible. </div></li><li class="half_rhythm"><div>Surgery is reserved for radiation failure.</div></li></ol></div><div id="CDR0000062930__121"><h3>Treatment Options for Small Lesions of the Upper Gingiva and Hard Palate</h3><p id="CDR0000062930__122">Treatment options for stage II small lesions of the upper gingiva and hard palate include the following:
|
|
</p><ol id="CDR0000062930__452"><li class="half_rhythm"><div>Surgical resection with postoperative radiation therapy, as appropriate, is used to treat most lesions. A small study showed that radiation therapy may be used effectively as the sole treatment modality.[<a class="bk_pop" href="#CDR0000062930_rl_93_3">3</a>]</div></li></ol></div><div id="CDR0000062930__TrialSearch_93_sid_6"><h3>Current Clinical Trials</h3><p id="CDR0000062930__TrialSearch_93_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> 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. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062930_rl_93"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_93_1">Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Lippincott, William & Wilkins, 2009.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_93_2">Pernot M, Malissard L, Aletti P, et al.: Iridium-192 brachytherapy in the management of 147 T2N0 oral tongue carcinomas treated with irradiation alone: comparison of two treatment techniques. Radiother Oncol 23 (4): 223-8, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1609126" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1609126</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_93_3">Yorozu A, Sykes AJ, Slevin NJ: Carcinoma of the hard palate treated with radiotherapy: a retrospective review of 31 cases. Oral Oncol 37 (6): 493-7, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11435175" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11435175</span></a>]</div></li></ol></div></div><div id="CDR0000062930__124"><h2 id="_CDR0000062930__124_">Treatment of Stage III Lip and Oral Cavity Cancer</h2><p id="CDR0000062930__125">Surgery and/or radiation therapy are used, depending on the exact tumor
|
|
site.[<a class="bk_pop" href="#CDR0000062930_rl_124_1">1</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_2">2</a>] 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.[<a class="bk_pop" href="#CDR0000062930_rl_124_3">3</a>-<a class="bk_pop" href="#CDR0000062930_rl_124_6">6</a>] Randomized, prospective trials, however, have yet to demonstrate a benefit in either
|
|
disease-free survival or overall survival for patients receiving neoadjuvant
|
|
chemotherapy.[<a class="bk_pop" href="#CDR0000062930_rl_124_7">7</a>]
|
|
</p><div id="CDR0000062930__126"><h3>Treatment Options for Moderately Advanced Lesions of the Lip</h3><p id="CDR0000062930__127">These lesions, including those involving bone, nerves, and lymph nodes,
|
|
generally require a combination of surgery and radiation therapy. </p><p id="CDR0000062930__128">Treatment options for stage III advanced lesions of the lip include the following:</p><ol id="CDR0000062930__260"><li class="half_rhythm"><div>Surgery using a variety of approaches, the choice of which is dependent on the size and location of the lesion and the need for reconstruction.</div></li><li class="half_rhythm"><div>Radiation therapy using a variety of techniques, including external-beam radiation therapy (EBRT) with or without brachytherapy, the choice of which is dictated by the size and location of the lesion. </div></li><li class="half_rhythm"><div>Clinical trials for advanced tumors evaluating the use of chemotherapy
|
|
preoperatively, before radiation therapy, as adjuvant therapy after surgery, or
|
|
as part of combined modality therapy are appropriate.[<a class="bk_pop" href="#CDR0000062930_rl_124_3">3</a>-<a class="bk_pop" href="#CDR0000062930_rl_124_6">6</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_8">8</a>-<a class="bk_pop" href="#CDR0000062930_rl_124_10">10</a>]</div></li><li class="half_rhythm"><div>Superfractionated radiation therapy (under clinical evaluation).[<a class="bk_pop" href="#CDR0000062930_rl_124_11">11</a>]</div></li></ol></div><div id="CDR0000062930__134"><h3>Treatment Options for Moderately Advanced (Late T2, Small T3) Lesions of the Anterior Tongue</h3><p id="CDR0000062930__135">Treatment options for stage III moderately advanced (late T2, small T3) lesions of the anterior tongue include the following:
|
|
</p><ol id="CDR0000062930__262"><li class="half_rhythm"><div>EBRT with or
|
|
without interstitial implant is used to treat minimally infiltrative lesions.</div></li><li class="half_rhythm"><div>Surgery with postoperative radiation
|
|
therapy is used to treat deeply infiltrative lesions.[<a class="bk_pop" href="#CDR0000062930_rl_124_2">2</a>]</div></li></ol></div><div id="CDR0000062930__138"><h3>Treatment Options for Moderately Advanced Lesions of the Buccal Mucosa</h3><p id="CDR0000062930__139">Treatment options for stage III advanced lesions of the buccal mucosa include the following:</p><ol id="CDR0000062930__263"><li class="half_rhythm"><div>Radical surgical resection alone.
|
|
</div></li><li class="half_rhythm"><div>Radiation therapy alone.
|
|
</div></li><li class="half_rhythm"><div>Surgical resection plus radiation therapy, generally postoperative.</div></li><li class="half_rhythm"><div>Clinical trials for advanced tumors evaluating the use of chemotherapy
|
|
preoperatively, before radiation therapy, as adjuvant therapy after surgery, or
|
|
as part of combined modality therapy are appropriate.[<a class="bk_pop" href="#CDR0000062930_rl_124_3">3</a>-<a class="bk_pop" href="#CDR0000062930_rl_124_6">6</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_8">8</a>-<a class="bk_pop" href="#CDR0000062930_rl_124_10">10</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_12">12</a>] </div></li></ol></div><div id="CDR0000062930__145"><h3>Treatment Options for Moderately Advanced Lesions of the Floor of the Mouth</h3><p id="CDR0000062930__146">Treatment options for stage III moderately advanced lesions of the floor of the mouth include the following:</p><ol id="CDR0000062930__265"><li class="half_rhythm"><div>Surgery using rim resection plus neck dissection or partial mandibulectomy with
|
|
neck dissection, as appropriate.
|
|
</div></li><li class="half_rhythm"><div>Radiation therapy using EBRT alone or EBRT plus an interstitial implant.</div></li><li class="half_rhythm"><div>Clinical trials for advanced tumors evaluating the use of chemotherapy
|
|
preoperatively, before radiation therapy, as adjuvant therapy after surgery, or
|
|
as part of combined modality therapy are appropriate.[<a class="bk_pop" href="#CDR0000062930_rl_124_3">3</a>-<a class="bk_pop" href="#CDR0000062930_rl_124_6">6</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_8">8</a>-<a class="bk_pop" href="#CDR0000062930_rl_124_10">10</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_12">12</a>] </div></li><li class="half_rhythm"><div>Clinical trials using novel radiation therapy fractionation schemas.[<a class="bk_pop" href="#CDR0000062930_rl_124_13">13</a>]</div></li></ol></div><div id="CDR0000062930__152"><h3>Treatment Options for Moderately Advanced Lesions of the Lower Gingiva</h3><p id="CDR0000062930__153">Treatment options for stage III moderately advanced lesions of the lower gingiva include the following:</p><ol id="CDR0000062930__453"><li class="half_rhythm"><div>Combined radiation therapy and radical resection or radical
|
|
resection alone are used to treat extensive lesions with moderate bone destruction and/or nodal metastases. Radiation therapy may be administered either preoperatively or
|
|
postoperatively.</div></li></ol></div><div id="CDR0000062930__155"><h3>Treatment Options for Moderately Advanced Lesions of the Retromolar Trigone</h3><p id="CDR0000062930__156">Treatment options for stage III advanced lesions of the retromolar trigone include the following:</p><ol id="CDR0000062930__454"><li class="half_rhythm"><div>Surgical composite resection, which may be followed by postoperative radiation
|
|
therapy.
|
|
</div></li><li class="half_rhythm"><div>Clinical trials for advanced tumors evaluating the use of chemotherapy
|
|
preoperatively, before radiation therapy, as adjuvant therapy after surgery, or
|
|
as part of combined modality therapy are appropriate.[<a class="bk_pop" href="#CDR0000062930_rl_124_3">3</a>-<a class="bk_pop" href="#CDR0000062930_rl_124_6">6</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_8">8</a>-<a class="bk_pop" href="#CDR0000062930_rl_124_10">10</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_12">12</a>]</div></li><li class="half_rhythm"><div> Clinical trials using novel radiation therapy fractionation schemas.[<a class="bk_pop" href="#CDR0000062930_rl_124_13">13</a>]</div></li></ol></div><div id="CDR0000062930__161"><h3>Treatment Options for Moderately Advanced Lesions of the Upper Gingiva</h3><p id="CDR0000062930__162">Treatment options for stage III moderately advanced lesions of the upper gingiva include the following:</p><ol id="CDR0000062930__270"><li class="half_rhythm"><div>Radiation therapy alone is used to treat superficial lesions with extensive involvement of the gingiva, hard palate, or soft palate.</div></li><li class="half_rhythm"><div>A combination of surgery and radiation therapy is used to treat deeply invasive lesions involving bone.</div></li></ol></div><div id="CDR0000062930__165"><h3>Treatment Options for Moderately Advanced Lesions of the Hard Palate</h3><p id="CDR0000062930__166">Treatment options for stage III moderately advanced lesions of the hard palate include the following:</p><ol id="CDR0000062930__271"><li class="half_rhythm"><div>Radiation therapy alone is used to treat superficial lesions with extensive involvement of the gingiva, hard palate, or soft palate.</div></li><li class="half_rhythm"><div>A combination of
|
|
surgery and radiation therapy or surgery alone is used to treat deeply invasive lesions involving bone.</div></li></ol></div><div id="CDR0000062930__459"><h3>Treatment Options Under Clinical Evaluation for All Stage III Lip and Oral Cavity Cancers</h3><ol id="CDR0000062930__460"><li class="half_rhythm"><div class="half_rhythm">Chemotherapy has been combined with radiation therapy in patients who have
|
|
locally advanced disease that is surgically unresectable.[<a class="bk_pop" href="#CDR0000062930_rl_124_8">8</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_10">10</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_14">14</a>,<a class="bk_pop" href="#CDR0000062930_rl_124_15">15</a>]</div><div class="half_rhythm">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.[<a class="bk_pop" href="#CDR0000062930_rl_124_16">16</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000810033/" class="def">Level of evidence B4</a>] 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.</div><div class="half_rhythm">The best chemotherapy to use and the appropriate way to integrate the two
|
|
modalities is still unresolved.[<a class="bk_pop" href="#CDR0000062930_rl_124_17">17</a>]</div><div class="half_rhythm">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.
|
|
</div></li><li class="half_rhythm"><div class="half_rhythm">Clinical trials of novel fractionation radiation therapy are under evaluation.[<a class="bk_pop" href="#CDR0000062930_rl_124_13">13</a>]</div></li></ol></div><div id="CDR0000062930__TrialSearch_124_sid_7"><h3>Current Clinical Trials</h3><p id="CDR0000062930__TrialSearch_124_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> 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. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062930_rl_124"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_124_1">Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Lippincott, William & Wilkins, 2009.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_2">Franceschi D, Gupta R, Spiro RH, et al.: Improved survival in the treatment of squamous carcinoma of the oral tongue. Am J Surg 166 (4): 360-5, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8214293" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8214293</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_3">Ervin TJ, Clark JR, Weichselbaum RR, et al.: An analysis of induction and adjuvant chemotherapy in the multidisciplinary treatment of squamous-cell carcinoma of the head and neck. J Clin Oncol 5 (1): 10-20, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2433406" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2433406</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_4">Al-Kourainy K, Kish J, Ensley J, et al.: Achievement of superior survival for histologically negative versus histologically positive clinically complete responders to cisplatin combination in patients with locally advanced head and neck cancer. Cancer 59 (2): 233-8, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2433016" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2433016</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_5">Adjuvant chemotherapy for advanced head and neck squamous carcinoma. Final report of the Head and Neck Contracts Program. Cancer 60 (3): 301-11, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2885080" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2885080</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_6">Ensley J, Crissman J, Kish J, et al.: The impact of conventional morphologic analysis on response rates and survival in patients with advanced head and neck cancers treated initially with cisplatin-containing combination chemotherapy. Cancer 57 (4): 711-7, 1986. [<a href="https://pubmed.ncbi.nlm.nih.gov/3943009" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3943009</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_7">Mazeron JJ, Martin M, Brun B, et al.: Induction chemotherapy in head and neck cancer: results of a phase III trial. Head Neck 14 (2): 85-91, 1992 Mar-Apr. [<a href="https://pubmed.ncbi.nlm.nih.gov/1376306" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1376306</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_8">Al-Sarraf M, Pajak TF, Marcial VA, et al.: Concurrent radiotherapy and chemotherapy with cisplatin in inoperable squamous cell carcinoma of the head and neck. An RTOG Study. Cancer 59 (2): 259-65, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/3802013" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3802013</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_9">Browman GP, Cripps C, Hodson DI, et al.: Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer. J Clin Oncol 12 (12): 2648-53, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7989940" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7989940</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_10">Merlano M, Benasso M, Corvò R, et al.: Five-year update of a randomized trial of alternating radiotherapy and chemotherapy compared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck. J Natl Cancer Inst 88 (9): 583-9, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8609658" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8609658</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_11">Johnson CR, Khandelwal SR, Schmidt-Ullrich RK, et al.: The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation. Int J Radiat Oncol Biol Phys 32 (3): 635-41, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7790249" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7790249</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_12">Licitra L, Grandi C, Guzzo M, et al.: Primary chemotherapy in resectable oral cavity squamous cell cancer: a randomized controlled trial. J Clin Oncol 21 (2): 327-33, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/12525526" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12525526</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_13">Stuschke M, Thames HD: Hyperfractionated radiotherapy of human tumors: overview of the randomized clinical trials. Int J Radiat Oncol Biol Phys 37 (2): 259-67, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9069295" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9069295</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_14">Bachaud JM, David JM, Boussin G, et al.: Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial. Int J Radiat Oncol Biol Phys 20 (2): 243-6, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1991685" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1991685</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_15">Merlano M, Corvo R, Margarino G, et al.: Combined chemotherapy and radiation therapy in advanced inoperable squamous cell carcinoma of the head and neck. The final report of a randomized trial. Cancer 67 (4): 915-21, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1703916" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1703916</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_16">Pignon JP, Bourhis J, Domenge C, et al.: Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355 (9208): 949-55, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10768432" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10768432</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_124_17">Taylor SG, Murthy AK, Vannetzel JM, et al.: Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol 12 (2): 385-95, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8113846" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8113846</span></a>]</div></li></ol></div></div><div id="CDR0000062930__186"><h2 id="_CDR0000062930__186_">Treatment of Stage IV Lip and Oral Cavity Cancer</h2><p id="CDR0000062930__187">Randomized prospective trials have yet to demonstrate a benefit in either
|
|
disease-free survival or overall survival for patients receiving neoadjuvant
|
|
chemotherapy.[<a class="bk_pop" href="#CDR0000062930_rl_186_1">1</a>] The use of isotretinoin daily for 1
|
|
year to prevent development of second upper aerodigestive tract primaries is
|
|
under clinical evaluation.[<a class="bk_pop" href="#CDR0000062930_rl_186_2">2</a>]
|
|
</p><div id="CDR0000062930__188"><h3>Treatment Options for Advanced Lesions of the Lip</h3><p id="CDR0000062930__189">These lesions, including those involving bone, nerves, and lymph nodes,
|
|
generally require a combination of surgery and radiation therapy. </p><p id="CDR0000062930__190">Treatment options for stage IV advanced lesions of the lip include the following:</p><ol id="CDR0000062930__274"><li class="half_rhythm"><div>Surgery using a variety of approaches, the choice of which is dependent on the size and location of the lesion and the need for reconstruction. Treatment of both
|
|
sides of the neck is indicated for selected patients.
|
|
</div></li><li class="half_rhythm"><div>Radiation therapy using a variety of techniques, including external-beam radiation therapy (EBRT) with or without brachytherapy, the choice of which is dictated by the size and location of the lesion.</div></li><li class="half_rhythm"><div>Superfractionated radiation therapy (under clinical evaluation).[<a class="bk_pop" href="#CDR0000062930_rl_186_3">3</a>]
|
|
</div></li></ol></div><div id="CDR0000062930__195"><h3>Treatment Options for Advanced Lesions of the Anterior Tongue</h3><p id="CDR0000062930__196">Treatment options for stage IV advanced lesions of the anterior tongue include the following:
|
|
</p><ol id="CDR0000062930__276"><li class="half_rhythm"><div>Combined surgery (i.e., total glossectomy, sometimes requiring
|
|
laryngectomy), possibly followed by postoperative radiation therapy, may be used to treat selected patients.[<a class="bk_pop" href="#CDR0000062930_rl_186_4">4</a>]</div></li><li class="half_rhythm"><div>Palliative radiation therapy may be used to treat patients with very advanced lesions.</div></li></ol></div><div id="CDR0000062930__199"><h3>Treatment Options for Advanced Lesions of the Buccal Mucosa</h3><p id="CDR0000062930__200">Treatment options for stage IV advanced lesions of the buccal mucosa include the following:
|
|
</p><ol id="CDR0000062930__277"><li class="half_rhythm"><div>Radical surgical resection alone.</div></li><li class="half_rhythm"><div>Radiation therapy alone.</div></li><li class="half_rhythm"><div>Surgical resection plus radiation therapy, which is generally administered postoperatively.
|
|
</div></li></ol></div><div id="CDR0000062930__204"><h3>Treatment Options for Advanced Lesions of the Floor of the Mouth</h3><p id="CDR0000062930__205">Treatment options for stage IV advanced lesions of the floor of the mouth include the following:
|
|
</p><ol id="CDR0000062930__278"><li class="half_rhythm"><div>A combination of surgery and radiation therapy, which is generally administered postoperatively, is often used.
|
|
</div></li><li class="half_rhythm"><div>Preoperative radiation therapy is often used for fixed nodes (≥5 cm).</div></li></ol></div><div id="CDR0000062930__208"><h3>Treatment Options for Advanced Lesions of the Lower Gingiva</h3><p id="CDR0000062930__209">Treatment options for stage IV advanced lesions of the lower gingiva include the following:
|
|
</p><ol id="CDR0000062930__455"><li class="half_rhythm"><div>Surgery, radiation therapy, or a
|
|
combination of both are poor controls for advanced tumors with extensive destruction of the mandible and with nodal metastases.</div></li></ol></div><div id="CDR0000062930__211"><h3>Treatment Options for Advanced Lesions of the Retromolar Trigone</h3><p id="CDR0000062930__212">Treatment options for stage IV advanced lesions of the retromolar trigone include the following:
|
|
</p><ol id="CDR0000062930__456"><li class="half_rhythm"><div>Surgical composite resection followed by postoperative radiation therapy.
|
|
</div></li></ol></div><div id="CDR0000062930__214"><h3>Treatment Options for Advanced Lesions of the Upper Gingiva</h3><p id="CDR0000062930__215">Treatment options for stage IV advanced lesions of the upper gingiva include the following:</p><ol id="CDR0000062930__457"><li class="half_rhythm"><div>Surgery in combination with radiation therapy is generally used to treat lesions that are extensive and infiltrating.</div></li></ol></div><div id="CDR0000062930__217"><h3>Treatment Options for Advanced Lesions of the Hard Palate</h3><p id="CDR0000062930__218">Treatment options for stage IV advanced lesions of the hard palate include the following:</p><ol id="CDR0000062930__458"><li class="half_rhythm"><div>Surgery in combination with radiation therapy is generally used to treat lesions that are extensive and infiltrating.</div></li></ol></div><div id="CDR0000062930__464"><h3>Treatment Options Under Clinical Evaluation for All Stage IV Lip and Oral Cavity Cancers</h3><ol id="CDR0000062930__465"><li class="half_rhythm"><div class="half_rhythm">Chemotherapy has been combined with radiation therapy in patients who
|
|
have locally advanced disease that is surgically unresectable.[<a class="bk_pop" href="#CDR0000062930_rl_186_5">5</a>-<a class="bk_pop" href="#CDR0000062930_rl_186_8">8</a>]</div><div class="half_rhythm">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.[<a class="bk_pop" href="#CDR0000062930_rl_186_9">9</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000810033/" class="def">Level of evidence B4</a>] 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.
|
|
</div><div class="half_rhythm">The best chemotherapy to use and the appropriate way to integrate the two
|
|
modalities is still unresolved.[<a class="bk_pop" href="#CDR0000062930_rl_186_10">10</a>]</div><div class="half_rhythm">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.</div></li><li class="half_rhythm"><div class="half_rhythm">Clinical trials for advanced tumors evaluating the use of chemotherapy
|
|
preoperatively, before radiation therapy, or as adjuvant therapy after surgery
|
|
are appropriate.[<a class="bk_pop" href="#CDR0000062930_rl_186_5">5</a>,<a class="bk_pop" href="#CDR0000062930_rl_186_11">11</a>-<a class="bk_pop" href="#CDR0000062930_rl_186_18">18</a>]</div></li><li class="half_rhythm"><div class="half_rhythm">Clinical trials of novel fractionation radiation therapy are under evaluation.[<a class="bk_pop" href="#CDR0000062930_rl_186_19">19</a>]</div></li></ol></div><div id="CDR0000062930__TrialSearch_186_sid_8"><h3>Current Clinical Trials</h3><p id="CDR0000062930__TrialSearch_186_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> 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. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062930_rl_186"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_186_1">Mazeron JJ, Martin M, Brun B, et al.: Induction chemotherapy in head and neck cancer: results of a phase III trial. Head Neck 14 (2): 85-91, 1992 Mar-Apr. [<a href="https://pubmed.ncbi.nlm.nih.gov/1376306" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1376306</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_2">Hong WK, Lippman SM, Itri LM, et al.: Prevention of second primary tumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med 323 (12): 795-801, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2202902" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2202902</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_3">Johnson CR, Khandelwal SR, Schmidt-Ullrich RK, et al.: The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation. Int J Radiat Oncol Biol Phys 32 (3): 635-41, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7790249" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7790249</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_4">Franceschi D, Gupta R, Spiro RH, et al.: Improved survival in the treatment of squamous carcinoma of the oral tongue. Am J Surg 166 (4): 360-5, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8214293" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8214293</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_5">Al-Sarraf M, Pajak TF, Marcial VA, et al.: Concurrent radiotherapy and chemotherapy with cisplatin in inoperable squamous cell carcinoma of the head and neck. An RTOG Study. Cancer 59 (2): 259-65, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/3802013" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3802013</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_6">Bachaud JM, David JM, Boussin G, et al.: Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced squamous cell carcinoma of the head and neck: preliminary report of a randomized trial. Int J Radiat Oncol Biol Phys 20 (2): 243-6, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1991685" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1991685</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_7">Merlano M, Corvo R, Margarino G, et al.: Combined chemotherapy and radiation therapy in advanced inoperable squamous cell carcinoma of the head and neck. The final report of a randomized trial. Cancer 67 (4): 915-21, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1703916" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1703916</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_8">Merlano M, Benasso M, Corvò R, et al.: Five-year update of a randomized trial of alternating radiotherapy and chemotherapy compared with radiotherapy alone in treatment of unresectable squamous cell carcinoma of the head and neck. J Natl Cancer Inst 88 (9): 583-9, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8609658" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8609658</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_9">Pignon JP, Bourhis J, Domenge C, et al.: Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355 (9208): 949-55, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/10768432" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10768432</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_10">Taylor SG, Murthy AK, Vannetzel JM, et al.: Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol 12 (2): 385-95, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8113846" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8113846</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_11">Al-Kourainy K, Kish J, Ensley J, et al.: Achievement of superior survival for histologically negative versus histologically positive clinically complete responders to cisplatin combination in patients with locally advanced head and neck cancer. Cancer 59 (2): 233-8, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2433016" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2433016</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_12">Adjuvant chemotherapy for advanced head and neck squamous carcinoma. Final report of the Head and Neck Contracts Program. Cancer 60 (3): 301-11, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2885080" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2885080</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_13">Toohill RJ, Duncavage JA, Grossmam TW, et al.: The effects of delay in standard treatment due to induction chemotherapy in two randomized prospective studies. Laryngoscope 97 (4): 407-12, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/3550340" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3550340</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_14">Ensley J, Crissman J, Kish J, et al.: The impact of conventional morphologic analysis on response rates and survival in patients with advanced head and neck cancers treated initially with cisplatin-containing combination chemotherapy. Cancer 57 (4): 711-7, 1986. [<a href="https://pubmed.ncbi.nlm.nih.gov/3943009" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3943009</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_15">Fu KK, Phillips TL, Silverberg IJ, et al.: Combined radiotherapy and chemotherapy with bleomycin and methotrexate for advanced inoperable head and neck cancer: update of a Northern California Oncology Group randomized trial. J Clin Oncol 5 (9): 1410-8, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2442323" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2442323</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_16">Ryan RF, Krementz ET, Truesdale GL: Salvage of stage IV intraoral squamous cell carcinomas with preoperative 5-fluorouracil. Cancer 57 (4): 699-705, 1986. [<a href="https://pubmed.ncbi.nlm.nih.gov/3943008" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3943008</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_17">Ervin TJ, Clark JR, Weichselbaum RR, et al.: An analysis of induction and adjuvant chemotherapy in the multidisciplinary treatment of squamous-cell carcinoma of the head and neck. J Clin Oncol 5 (1): 10-20, 1987. [<a href="https://pubmed.ncbi.nlm.nih.gov/2433406" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2433406</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_18">Browman GP, Cripps C, Hodson DI, et al.: Placebo-controlled randomized trial of infusional fluorouracil during standard radiotherapy in locally advanced head and neck cancer. J Clin Oncol 12 (12): 2648-53, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7989940" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7989940</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_19">Stuschke M, Thames HD: Hyperfractionated radiotherapy of human tumors: overview of the randomized clinical trials. Int J Radiat Oncol Biol Phys 37 (2): 259-67, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9069295" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9069295</span></a>]</div></li></ol></div></div><div id="CDR0000062930__450"><h2 id="_CDR0000062930__450_">Treatment Options for Management of Lymph Node Metastases</h2><p id="CDR0000062930__438">Patients with advanced lesions should have elective lymph node radiation
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therapy or node dissection. The risk of metastases to lymph nodes is increased
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by high-grade histology, large lesions, spread to involve the wet mucosa of the
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lip or the buccal mucosa in patients with recurrent disease, and invasion of
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muscle (i.e., orbicularis oris).[<a class="bk_pop" href="#CDR0000062930_rl_450_1">1</a>]</p><p id="CDR0000062930__439">Treatment options for management of lymph node metastases include the following:</p><ol id="CDR0000062930__440"><li class="half_rhythm"><div>Radiation therapy alone or neck dissection:<ul id="CDR0000062930__441"><li class="half_rhythm"><div>N1 (0–2 cm).
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</div></li><li class="half_rhythm"><div>N2b or N3; all nodes smaller than 2 cm. (A combined surgical and
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radiation therapy approach should also be considered.)</div></li></ul></div></li><li class="half_rhythm"><div>Radiation therapy and neck dissection:<ul id="CDR0000062930__442"><li class="half_rhythm"><div>N1 (2–3 cm), N2a, N3.
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</div></li></ul></div></li><li class="half_rhythm"><div>Surgery followed by radiation therapy, indications for which are as follows:<ul id="CDR0000062930__443"><li class="half_rhythm"><div>Multiple positive nodes.
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</div></li><li class="half_rhythm"><div>Contralateral subclinical metastases.
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</div></li><li class="half_rhythm"><div>Invasion of tumor through the capsule of the lymph node.
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</div></li><li class="half_rhythm"><div>N2b or N3 (one or more nodes in each side of the neck, as appropriate, >2 cm).</div></li></ul></div></li><li class="half_rhythm"><div>Radiation therapy prior to surgery:<ul id="CDR0000062930__444"><li class="half_rhythm"><div>Large fixed nodes.</div></li></ul></div></li></ol><div id="CDR0000062930_rl_450"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_450_1">Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Lippincott, William & Wilkins, 2009.</div></li></ol></div></div><div id="CDR0000062930__238"><h2 id="_CDR0000062930__238_">Treatment of Metastatic and Recurrent Lip and Oral Cavity Cancer</h2><p id="CDR0000062930__239">For lesions of the lip, anterior tongue, buccal mucosa, floor of the mouth,
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retromolar trigone, upper gingiva, and hard palate, treatment is dictated
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by the location and size of the recurrent lesion as well as prior
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treatment.[<a class="bk_pop" href="#CDR0000062930_rl_238_1">1</a>,<a class="bk_pop" href="#CDR0000062930_rl_238_2">2</a>]
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</p><p id="CDR0000062930__240">Treatment options for recurrent lip and oral cavity cancer include the following:
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</p><ol id="CDR0000062930__285"><li class="half_rhythm"><div>Surgery is the preferred treatment, if radiation therapy was used initially.[<a class="bk_pop" href="#CDR0000062930_rl_238_3">3</a>]</div></li><li class="half_rhythm"><div>Surgery,[<a class="bk_pop" href="#CDR0000062930_rl_238_3">3</a>] radiation
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therapy, or a combination of these may be considered for treatment, if surgery was used to treat the lesion initially.</div></li><li class="half_rhythm"><div>Although chemotherapy has been shown to induce responses, no increase in
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survival has been demonstrated.[<a class="bk_pop" href="#CDR0000062930_rl_238_4">4</a>]</div></li><li class="half_rhythm"><div>Clinical trials
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evaluating new chemotherapy drugs, chemotherapy and re-irradiation, or
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hyperthermia should be considered because both surgical salvage after primary radiation therapy and
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radiation therapy after primary surgery give poor results.[<a class="bk_pop" href="#CDR0000062930_rl_238_5">5</a>,<a class="bk_pop" href="#CDR0000062930_rl_238_6">6</a>]</div></li></ol><div id="CDR0000062930__TrialSearch_238_sid_10"><h3>Current Clinical Trials</h3><p id="CDR0000062930__TrialSearch_238_22">Use our <a href="https://www.cancer.gov/research/participate/clinical-trials-search/advanced" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> 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. <a href="https://www.cancer.gov/research/participate/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062930_rl_238"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062930_rl_238_1">Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Lippincott, William & Wilkins, 2009.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_238_2">Vikram B, Strong EW, Shah JP, et al.: Intraoperative radiotherapy in patients with recurrent head and neck cancer. Am J Surg 150 (4): 485-7, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/4051112" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4051112</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_238_3">Wong LY, Wei WI, Lam LK, et al.: Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery. Head Neck 25 (11): 953-9, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/14603456" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14603456</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_238_4">Jacobs C, Lyman G, Velez-García E, et al.: A phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 10 (2): 257-63, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1732427" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1732427</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_238_5">Hong WK, Bromer R: Chemotherapy in head and neck cancer. N Engl J Med 308 (2): 75-9, 1983. [<a href="https://pubmed.ncbi.nlm.nih.gov/6183588" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 6183588</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062930_rl_238_6">Vokes EE, Athanasiadis I: Chemotherapy of squamous cell carcinoma of head and neck: the future is now. Ann Oncol 7 (1): 15-29, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/9081382" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9081382</span></a>]</div></li></ol></div></div><div id="CDR0000062930__293"><h2 id="_CDR0000062930__293_">Latest Updates to This Summary (06/07/2024)</h2><p id="CDR0000062930__294">The PDQ cancer information summaries are reviewed regularly and updated as
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new information becomes available. This section describes the latest
|
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changes made to this summary as of the date above.
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</p><p id="CDR0000062930__434">
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<b>
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<a href="#CDR0000062930__53">Treatment Option Overview for Lip and Oral Cavity Cancer</a>
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</b>
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</p><p id="CDR0000062930__435">Added <a href="#CDR0000062930__433">Fluorouracil Dosing</a> as a new subsection.</p><p id="CDR0000062930__disclaimerHP_3">This summary is written and maintained by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is
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editorially independent of NCI. The summary reflects an independent review of
|
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the literature and does not represent a policy statement of NCI or NIH. More
|
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information about summary policies and the role of the PDQ Editorial Boards in
|
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maintaining the PDQ summaries can be found on the <a href="#CDR0000062930__AboutThis_1">About This PDQ Summary</a> and <a href="https://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® Cancer Information for Health Professionals</a> pages.
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</p></div><div id="CDR0000062930__AboutThis_1"><h2 id="_CDR0000062930__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062930__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062930__AboutThis_3">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.</p></div><div id="CDR0000062930__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062930__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, 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).</p><p id="CDR0000062930__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062930__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062930__AboutThis_7">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.</p><p>The lead reviewers for Lip and Oral Cavity Cancer Treatment are:</p><ul><li class="half_rhythm"><div>Andrea Bonetti, MD (Azienda ULSS 9 of the Veneto Region)</div></li><li class="half_rhythm"><div>Monaliben Patel, MD (University of Rochester Medical Center)</div></li><li class="half_rhythm"><div>Minh Tam Truong, MD (Boston University Medical Center)</div></li></ul><p id="CDR0000062930__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062930__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062930__AboutThis_11">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 <a href="/books/n/pdqcis/CDR0000062796/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062930__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062930__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062930__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062930__AboutThis_15">PDQ® Adult Treatment Editorial Board. PDQ Lip and Oral Cavity Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/head-and-neck/hp/adult/lip-mouth-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/head-and-neck/hp/adult/lip-mouth-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389262]</p><p id="CDR0000062930__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000062930__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062930__AboutThis_18">Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062930__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062930__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div><div class="small"><span class="label">Bookshelf ID: NBK65821</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/26389262" title="PubMed record of this page" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">26389262</a></span></div></div></div>
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September 25, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65821.1/">NBK65821.1</a></span> July 22, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062930__1" ref="log$=inpage&link_id=inpage">General Information About Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__11" ref="log$=inpage&link_id=inpage">Cellular Classification of Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__18" ref="log$=inpage&link_id=inpage">Stage Information for Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__53" ref="log$=inpage&link_id=inpage">Treatment Option Overview for Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__63" ref="log$=inpage&link_id=inpage">Treatment of Stage I Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__93" ref="log$=inpage&link_id=inpage">Treatment of Stage II Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__124" ref="log$=inpage&link_id=inpage">Treatment of Stage III Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__186" ref="log$=inpage&link_id=inpage">Treatment of Stage IV Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__450" ref="log$=inpage&link_id=inpage">Treatment Options for Management of Lymph Node Metastases</a></li><li><a href="#CDR0000062930__238" ref="log$=inpage&link_id=inpage">Treatment of Metastatic and Recurrent Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__293" ref="log$=inpage&link_id=inpage">Latest Updates to This Summary (06/07/2024)</a></li><li><a href="#CDR0000062930__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65887/">Patient Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="discovery_db_links" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper"><a 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xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hypopharyngeal Cancer Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Hypopharyngeal Cancer Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/39591488" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> PALB2: Cancer Risks and Management (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> PALB2: Cancer Risks and Management (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Cancer Genetics Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper 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class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/38113349" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> RUNX1-Familial Platelet Disorder (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> RUNX1-Familial Platelet Disorder (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Cancer Genetics Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" 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