837 lines
No EOL
149 KiB
HTML
837 lines
No EOL
149 KiB
HTML
<?xml version="1.0" encoding="utf-8"?>
|
|
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en">
|
|
|
|
<head><meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
|
|
<!-- AppResources meta begin -->
|
|
<meta name="paf-app-resources" content="" />
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- AppResources meta end -->
|
|
|
|
<!-- TemplateResources meta begin -->
|
|
<meta name="paf_template" content="" />
|
|
|
|
<!-- TemplateResources meta end -->
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books" /><meta name="ncbi_pdid" content="book-part" /><meta name="ncbi_acc" content="NBK65821" /><meta name="ncbi_domain" content="pdqcis" /><meta name="ncbi_report" content="record" /><meta name="ncbi_type" content="fulltext" /><meta name="ncbi_objectid" content="" /><meta name="ncbi_pcid" content="/NBK65821.4/" /><meta name="ncbi_pagename" content="Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf" /><meta name="ncbi_bookparttype" content="chapter" /><meta name="ncbi_app" content="bookshelf" />
|
|
<!-- Logger end -->
|
|
|
|
<title>Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf</title>
|
|
|
|
<!-- AppResources external_resources begin -->
|
|
<link rel="stylesheet" href="/core/jig/1.15.2/css/jig.min.css" /><script type="text/javascript" src="/core/jig/1.15.2/js/jig.min.js"></script>
|
|
|
|
<!-- AppResources external_resources end -->
|
|
|
|
<!-- Page meta begin -->
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="PDQ Cancer Information Summaries [Internet]" /><meta name="citation_title" content="Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®)" /><meta name="citation_publisher" content="National Cancer Institute (US)" /><meta name="citation_date" content="2018/01/19" /><meta name="citation_author" content="PDQ Adult Treatment Editorial Board" /><meta name="citation_pmid" content="26389262" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK65821/" /><meta name="citation_keywords" content="lip and oral cavity cancer" /><meta name="citation_keywords" content="adult lip and oral cavity cancer" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®)" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Cancer Institute (US)" /><meta name="DC.Contributor" content="PDQ Adult Treatment Editorial Board" /><meta name="DC.Date" content="2018/01/19" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK65821/" /><meta name="description" content="Expert-reviewed information summary about the treatment of adult lip and oral cavity cancer." /><meta name="og:title" content="Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®)" /><meta name="og:type" content="book" /><meta name="og:description" content="Expert-reviewed information summary about the treatment of adult lip and oral cavity cancer." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK65821/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/pdqcis/CDR0000062930/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK65821/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
|
|
|
|
<!-- Page meta end -->
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico" /><meta name="ncbi_phid" content="CE8D36AF7C9765210000000000F500C0.m_13" />
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3985586/3808861/4121862/3974050/3917732/251717/4216701/14534/45193/4113719/3849091/3984811/3751656/4033350/3840896/3577051/3852958/4008682/4207974/4206132/4062871/12930/3964959/3854974/36029/4128070/9685/3549676/3609192/3609193/3609213/3395586.css" /><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3411343/3882866.css" media="print" /></head>
|
|
<body class="book-part">
|
|
<div class="grid">
|
|
<div class="col twelve_col nomargin shadow">
|
|
<!-- System messages like service outage or JS required; this is handled by the TemplateResources portlet -->
|
|
<div class="sysmessages">
|
|
<noscript>
|
|
<p class="nojs">
|
|
<strong>Warning:</strong>
|
|
The NCBI web site requires JavaScript to function.
|
|
<a href="/guide/browsers/#enablejs" title="Learn how to enable JavaScript" target="_blank">more...</a>
|
|
</p>
|
|
</noscript>
|
|
</div>
|
|
<!--/.sysmessage-->
|
|
<div class="wrap">
|
|
<div class="page">
|
|
<div class="top">
|
|
<div id="universal_header">
|
|
<section class="usa-banner">
|
|
<div class="usa-accordion">
|
|
<header class="usa-banner-header">
|
|
<div class="usa-grid usa-banner-inner">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png" alt="U.S. flag" />
|
|
<p>An official website of the United States government</p>
|
|
<button class="non-usa-accordion-button usa-banner-button" aria-expanded="false" aria-controls="gov-banner-top" type="button">
|
|
<span class="usa-banner-button-text">Here's how you know</span>
|
|
</button>
|
|
</div>
|
|
</header>
|
|
<div class="usa-banner-content usa-grid usa-accordion-content" id="gov-banner-top" aria-hidden="true">
|
|
<div class="usa-banner-guidance-gov usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg" alt="Dot gov" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The .gov means it's official.</strong>
|
|
<br />
|
|
Federal government websites often end in .gov or .mil. Before
|
|
sharing sensitive information, make sure you're on a federal
|
|
government site.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
<div class="usa-banner-guidance-ssl usa-width-one-half">
|
|
<img class="usa-banner-icon usa-media_block-img" src="https://www.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg" alt="Https" />
|
|
<div class="usa-media_block-body">
|
|
<p>
|
|
<strong>The site is secure.</strong>
|
|
<br />
|
|
The <strong>https://</strong> ensures that you are connecting to the
|
|
official website and that any information you provide is encrypted
|
|
and transmitted securely.
|
|
</p>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<div class="usa-overlay"></div>
|
|
<header class="ncbi-header" role="banner" data-section="Header">
|
|
|
|
<div class="usa-grid">
|
|
<div class="usa-width-one-whole">
|
|
|
|
<div class="ncbi-header__logo">
|
|
<a href="/" class="logo" aria-label="NCBI Logo" data-ga-action="click_image" data-ga-label="NIH NLM Logo">
|
|
<img src="https://www.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg" alt="NIH NLM Logo" />
|
|
</a>
|
|
</div>
|
|
|
|
<div class="ncbi-header__account">
|
|
<a id="account_login" href="https://account.ncbi.nlm.nih.gov" class="usa-button header-button" style="display:none" data-ga-action="open_menu" data-ga-label="account_menu">Log in</a>
|
|
<button id="account_info" class="header-button" style="display:none" aria-controls="account_popup" type="button">
|
|
<span class="fa fa-user" aria-hidden="true">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" width="20px" height="20px">
|
|
<g style="fill: #fff">
|
|
<ellipse cx="12" cy="8" rx="5" ry="6"></ellipse>
|
|
<path d="M21.8,19.1c-0.9-1.8-2.6-3.3-4.8-4.2c-0.6-0.2-1.3-0.2-1.8,0.1c-1,0.6-2,0.9-3.2,0.9s-2.2-0.3-3.2-0.9 C8.3,14.8,7.6,14.7,7,15c-2.2,0.9-3.9,2.4-4.8,4.2C1.5,20.5,2.6,22,4.1,22h15.8C21.4,22,22.5,20.5,21.8,19.1z"></path>
|
|
</g>
|
|
</svg>
|
|
</span>
|
|
<span class="username desktop-only" aria-hidden="true" id="uname_short"></span>
|
|
<span class="sr-only">Show account info</span>
|
|
</button>
|
|
</div>
|
|
|
|
<div class="ncbi-popup-anchor">
|
|
<div class="ncbi-popup account-popup" id="account_popup" aria-hidden="true">
|
|
<div class="ncbi-popup-head">
|
|
<button class="ncbi-close-button" data-ga-action="close_menu" data-ga-label="account_menu" type="button">
|
|
<span class="fa fa-times">
|
|
<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 48 48" width="24px" height="24px">
|
|
<path d="M38 12.83l-2.83-2.83-11.17 11.17-11.17-11.17-2.83 2.83 11.17 11.17-11.17 11.17 2.83 2.83 11.17-11.17 11.17 11.17 2.83-2.83-11.17-11.17z"></path>
|
|
</svg>
|
|
</span>
|
|
<span class="usa-sr-only">Close</span></button>
|
|
<h4>Account</h4>
|
|
</div>
|
|
<div class="account-user-info">
|
|
Logged in as:<br />
|
|
<b><span class="username" id="uname_long">username</span></b>
|
|
</div>
|
|
<div class="account-links">
|
|
<ul class="usa-unstyled-list">
|
|
<li><a id="account_myncbi" href="/myncbi/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_myncbi">Dashboard</a></li>
|
|
<li><a id="account_pubs" href="/myncbi/collections/bibliography/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_pubs">Publications</a></li>
|
|
<li><a id="account_settings" href="/account/settings/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_settings">Account settings</a></li>
|
|
<li><a id="account_logout" href="/account/signout/" class="set-base-url" data-ga-action="click_menu_item" data-ga-label="account_logout">Log out</a></li>
|
|
</ul>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
</div>
|
|
</div>
|
|
</header>
|
|
<div role="navigation" aria-label="access keys">
|
|
<a id="nws_header_accesskey_0" href="https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys" class="usa-sr-only" accesskey="0" tabindex="-1">Access keys</a>
|
|
<a id="nws_header_accesskey_1" href="https://www.ncbi.nlm.nih.gov" class="usa-sr-only" accesskey="1" tabindex="-1">NCBI Homepage</a>
|
|
<a id="nws_header_accesskey_2" href="/myncbi/" class="set-base-url usa-sr-only" accesskey="2" tabindex="-1">MyNCBI Homepage</a>
|
|
<a id="nws_header_accesskey_3" href="#maincontent" class="usa-sr-only" accesskey="3" tabindex="-1">Main Content</a>
|
|
<a id="nws_header_accesskey_4" href="#" class="usa-sr-only" accesskey="4" tabindex="-1">Main Navigation</a>
|
|
</div>
|
|
<section data-section="Alerts">
|
|
<div class="ncbi-alerts-placeholder"></div>
|
|
</section>
|
|
</div>
|
|
<div class="header">
|
|
<div class="res_logo"><h1 class="res_name"><a href="/books/" title="Bookshelf home">Bookshelf</a></h1><h2 class="res_tagline"></h2></div>
|
|
<div class="search"><form method="get" action="/books/"><div class="search_form"><label for="database" class="offscreen_noflow">Search database</label><select id="database"><optgroup label="Recent"><option value="books" selected="selected" data-ac_dict="bookshelf-search">Books</option><option value="nlmcatalog">NLM Catalog</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed" class="last">PubMed</option></optgroup><optgroup label="All"><option value="gquery">All Databases</option><option value="assembly">Assembly</option><option value="biocollections">Biocollections</option><option value="bioproject">BioProject</option><option value="biosample">BioSample</option><option value="books" data-ac_dict="bookshelf-search">Books</option><option value="clinvar">ClinVar</option><option value="cdd">Conserved Domains</option><option value="gap">dbGaP</option><option value="dbvar">dbVar</option><option value="gene">Gene</option><option value="genome">Genome</option><option value="gds">GEO DataSets</option><option value="geoprofiles">GEO Profiles</option><option value="gtr">GTR</option><option value="ipg">Identical Protein Groups</option><option value="medgen">MedGen</option><option value="mesh">MeSH</option><option value="nlmcatalog">NLM Catalog</option><option value="nuccore">Nucleotide</option><option value="omim">OMIM</option><option value="pmc">PMC</option><option value="protein">Protein</option><option value="proteinclusters">Protein Clusters</option><option value="protfam">Protein Family Models</option><option value="pcassay">PubChem BioAssay</option><option value="pccompound">PubChem Compound</option><option value="pcsubstance">PubChem Substance</option><option value="pubmed">PubMed</option><option value="snp">SNP</option><option value="sra">SRA</option><option value="structure">Structure</option><option value="taxonomy">Taxonomy</option><option value="toolkit">ToolKit</option><option value="toolkitall">ToolKitAll</option><option value="toolkitbookgh">ToolKitBookgh</option></optgroup></select><div class="nowrap"><label for="term" class="offscreen_noflow" accesskey="/">Search term</label><div class="nowrap"><input type="text" name="term" id="term" title="Search Books. Use up and down arrows to choose an item from the autocomplete." value="" class="jig-ncbiclearbutton jig-ncbiautocomplete" data-jigconfig="dictionary:'bookshelf-search',disableUrl:'NcbiSearchBarAutoComplCtrl'" autocomplete="off" data-sbconfig="ds:'no',pjs:'no',afs:'no'" /></div><button id="search" type="submit" class="button_search nowrap" cmd="go">Search</button></div></div></form><ul class="searchlinks inline_list"><li>
|
|
<a href="/books/browse/">Browse Titles</a>
|
|
</li><li>
|
|
<a href="/books/advanced/">Advanced</a>
|
|
</li><li class="help">
|
|
<a href="/books/NBK3833/">Help</a>
|
|
</li><li class="disclaimer">
|
|
<a target="_blank" data-ga-category="literature_resources" data-ga-action="link_click" data-ga-label="disclaimer_link" href="https://www.ncbi.nlm.nih.gov/books/about/disclaimer/">Disclaimer</a>
|
|
</li></ul></div>
|
|
</div>
|
|
|
|
|
|
|
|
<!--<component id="Page" label="headcontent"/>-->
|
|
|
|
</div>
|
|
<div class="content">
|
|
<!-- site messages -->
|
|
<!-- Custom content 1 -->
|
|
<div class="col1">
|
|
|
|
</div>
|
|
|
|
<div class="container">
|
|
<div id="maincontent" class="content eight_col col">
|
|
<!-- Custom content in the left column above book nav -->
|
|
<div class="col2">
|
|
|
|
</div>
|
|
|
|
<!-- Book content -->
|
|
|
|
|
|
<!-- Custom content between navigation and content -->
|
|
<div class="col3">
|
|
|
|
</div>
|
|
|
|
<div class="document">
|
|
<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>
|
|
<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 (Adult) (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: January 19, 2018.</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 who care for cancer 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
|
|
to the junction of the hard and soft palates above and to the line of
|
|
circumvallate papillae below and is divided into the following specific areas:
|
|
</p><ul id="CDR0000062930__4"><li class="half_rhythm"><div>Lip.
|
|
</div></li><li class="half_rhythm"><div>Anterior two thirds of tongue.
|
|
</div></li><li class="half_rhythm"><div>Buccal mucosa.
|
|
</div></li><li class="half_rhythm"><div>Floor of mouth.
|
|
</div></li><li class="half_rhythm"><div>Lower gingiva.
|
|
</div></li><li class="half_rhythm"><div>Retromolar trigone.
|
|
</div></li><li class="half_rhythm"><div>Upper gingiva.
|
|
</div></li><li class="half_rhythm"><div>Hard palate.
|
|
</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
|
|
(i.e., buccinator, jugulodigastric, submandibular, and submental). Sites close to
|
|
the midline often drain bilaterally. Second station nodes include the parotid,
|
|
jugular, and the upper and lower posterior cervical nodes.
|
|
</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; this decline has been related to 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
|
|
by surgery or by radiation therapy, and the choice of treatment is dictated by
|
|
the anticipated functional and cosmetic results of treatment and by the
|
|
availability of the particular expertise required of the surgeon or radiation
|
|
oncologist for the individual patient.[<a class="bk_pop" href="#CDR0000062930_rl_1_5">5</a>-<a class="bk_pop" href="#CDR0000062930_rl_1_7">7</a>] The presence of a positive margin
|
|
or a tumor depth of more than 5 mm significantly increases the risk of
|
|
local recurrence and suggests that combined modality treatment may be
|
|
beneficial.[<a class="bk_pop" href="#CDR0000062930_rl_1_8">8</a>,<a class="bk_pop" href="#CDR0000062930_rl_1_9">9</a>]</p><p id="CDR0000062930__7">Advanced cancers (stage III and stage IV) of the lip and oral cavity represent a
|
|
wide spectrum of challenges for the surgeon and radiation oncologist. Except
|
|
for patients with small T3 lesions and no regional lymph node and no distant
|
|
metastases or who have no lymph nodes larger than 2 cm in diameter, for whom
|
|
treatment by radiation therapy alone or surgery alone might be appropriate,
|
|
most patients with stage III or stage IV tumors are candidates for treatment by a
|
|
combination of surgery and radiation therapy.[<a class="bk_pop" href="#CDR0000062930_rl_1_6">6</a>] Furthermore, because local
|
|
recurrence and/or distant metastases are common in this group of patients, they
|
|
should be considered for clinical trials. Such trials evaluate the potential
|
|
role of radiation modifiers or combination chemotherapy combined with surgery
|
|
and/or radiation therapy.
|
|
</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
|
|
second primary tumor of the upper aerodigestive tract.[<a class="bk_pop" href="#CDR0000062930_rl_1_10">10</a>,<a class="bk_pop" href="#CDR0000062930_rl_1_11">11</a>] A study has shown
|
|
that daily treatment of these patients with moderate doses of isotretinoin
|
|
(13-cis-retinoic acid) for 1 year can significantly reduce the incidence of
|
|
second tumors. No survival advantage has yet been demonstrated, however, in
|
|
part due to recurrence and death from the primary malignancy.
|
|
An additional trial has shown no benefit of retinyl palmitate or retinyl palmitate plus beta-carotene when compared to retinoic acid alone.[<a class="bk_pop" href="#CDR0000062930_rl_1_12">12</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335129/" class="def">Level of evidence: 1iiDii</a>]</p><p id="CDR0000062930__9">The rate of curability of cancers of the lip and oral cavity varies depending
|
|
on the stage and specific site. Most patients present with early cancers of
|
|
the lip, which are highly curable by surgery or by radiation therapy with cure
|
|
rates of 90% to 100%. Small cancers of the retromolar trigone, hard palate,
|
|
and upper gingiva are highly curable by either radiation therapy or surgery
|
|
with survival rates of as much as 100%. Local control rates of as much as 90% can be
|
|
achieved with either radiation therapy or surgery in small cancers of the
|
|
anterior tongue, the floor of the mouth, and buccal mucosa.[<a class="bk_pop" href="#CDR0000062930_rl_1_13">13</a>]
|
|
</p><p id="CDR0000062930__10">Moderately advanced and advanced cancers of the lip also can be controlled
|
|
effectively by surgery or radiation therapy or a combination of these. 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 of as much as 90%; such lesions of the
|
|
hard palate, upper gingiva, and buccal mucosa have a local control rate of as much as 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 much as 70% and 65%, respectively.[<a class="bk_pop" href="#CDR0000062930_rl_1_13">13</a>,<a class="bk_pop" href="#CDR0000062930_rl_1_14">14</a>]
|
|
</p></div><div id="CDR0000062930__371"><h3>Related Summaries</h3><p id="CDR0000062930__369">Other PDQ summaries containing information related to lip and oral cavity cancer include the following: </p><ul id="CDR0000062930__370"><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062837/">Oral Cavity and Oropharyngeal Cancer Prevention</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062752/">Head and Neck Squamous Cell Cancer Screening</a></div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/CDR0000062870/">Oral Complications of Chemotherapy and Head/Neck Radiation</a></div></li></ul></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. Saint Louis, Mo: 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. Philadelphia, PA: 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. New York: 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">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_11">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_12">Papadimitrakopoulou VA, Lee JJ, William WN Jr, 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_13">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_14">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 biologic 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__16">Other tumors of glandular epithelium, odontogenic apparatus, lymphoid tissue,
|
|
soft tissue, and bone and cartilage origin require special consideration and
|
|
are not included in this section of PDQ. Reference to the World Health
|
|
Organization nomenclature is recommended.
|
|
</p><p id="CDR0000062930__17">Because leukoplakia, erythroplakia, and mixed erythroleukoplaia 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 the histologic findings. Leukoplakia can
|
|
range from hyperkeratosis to an actual 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. New York, NY: 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 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 pathologic 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
|
|
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>Definitions of TNM</h3><p id="CDR0000062930__325">The American Joint Committee on Cancer has designated staging by TNM
|
|
classification to define lip and oral cavity cancer.[<a class="bk_pop" href="#CDR0000062930_rl_18_4">4</a>]</p><div id="CDR0000062930__322" class="table"><h3><span class="title">Table 1. Primary Tumor (T)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.4/table/CDR0000062930__322/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__322_lrgtbl__"><table class="no_margin"><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;">T0</td><td colspan="1" rowspan="1" style="vertical-align:top;">No evidence of primary tumor.</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 in greatest dimension.</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 but ≤4 cm in greatest dimension.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor >4 cm in greatest dimension.</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">T4a</td><td colspan="1" rowspan="1" style="vertical-align:top;">Moderately advanced local disease.<sup>b</sup></td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">(Lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face, that is, chin or nose.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">(Oral cavity) Tumor invades adjacent structures only (e.g., through cortical bone [mandible or maxilla] into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus, palatoglossus, and styloglossus], maxillary sinus, or skin of face).</td></tr><tr><td colspan="1" rowspan="2" style="vertical-align:top;">T4b</td><td colspan="1" rowspan="1" style="vertical-align:top;">Very advanced local disease.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery.</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: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>b</sup>Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumor as T4.</p></div></dd></dl></div></div></div><div id="CDR0000062930__316" class="table"><h3><span class="title">Table 2. Regional Lymph Nodes (N)<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.4/table/CDR0000062930__316/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__316_lrgtbl__"><table class="no_margin"><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.</td></tr><tr><td colspan="1" rowspan="3" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension. </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension.</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 single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension. </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 lymph nodes, none >6 cm in greatest dimension.</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.</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.</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: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40.</p></div></dd></dl></div></div></div><div id="CDR0000062930__317" class="table"><h3><span class="title">Table 3. Distant Metastasis<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.4/table/CDR0000062930__317/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__317_lrgtbl__"><table class="no_margin"><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: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40.</p></div></dd></dl></div></div></div><div id="CDR0000062930__318" class="table"><h3><span class="title">Table 4. Anatomic Stage/Prognostic Groups<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65821.4/table/CDR0000062930__318/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062930__318_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;">T</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">N</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">M</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;"> 0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tis</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"> I</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"> II</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="4" style="vertical-align:top;"> III</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="6" style="vertical-align:top;"> IVA</td><td colspan="1" rowspan="1" style="vertical-align:top;">T4a</td><td colspan="1" rowspan="1" style="vertical-align:top;">N0</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4a</td><td colspan="1" rowspan="1" style="vertical-align:top;">N1</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1</td><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2</td><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3</td><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4a</td><td colspan="1" rowspan="1" style="vertical-align:top;">N2</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="2" style="vertical-align:top;"> IVB</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T</td><td colspan="1" rowspan="1" style="vertical-align:top;">N3</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4b</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any N</td><td colspan="1" rowspan="1" style="vertical-align:top;">M0</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"> IVC</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any T</td><td colspan="1" rowspan="1" style="vertical-align:top;">Any N</td><td colspan="1" rowspan="1" style="vertical-align:top;">M1</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: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40.</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. Philadelphia, PA: 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. New York: Wiley-Liss, 1997.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_18_4">Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-35.</div></li></ol></div></div><div id="CDR0000062930__53"><h2 id="_CDR0000062930__53_">Treatment Option Overview</h2><p id="CDR0000062930__54">Depending on the site and extent of the primary tumor and the status of the
|
|
lymph nodes, some general considerations for the treatment of lip and oral cavity 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>]
|
|
</p><ul id="CDR0000062930__330"><li class="half_rhythm"><div>Surgery
|
|
alone.</div></li><li class="half_rhythm"><div>Radiation therapy alone.</div></li><li class="half_rhythm"><div>A combination of the above.</div></li></ul><p id="CDR0000062930__55">For lesions of the oral cavity, surgery must adequately encompass all of the
|
|
gross as well as the presumed microscopic extent of the disease. If regional
|
|
nodes are positive, cervical node dissection is usually done in continuity.
|
|
With modern approaches, the surgeon can successfully ablate large posterior
|
|
oral cavity tumors and with reconstructive methods can achieve satisfactory
|
|
functional results. Prosthodontic rehabilitation is important, particularly in
|
|
early-stage cancers, to assure the best quality of life.
|
|
</p><p id="CDR0000062930__56">Radiation therapy for lip and oral cavity cancers can be administered by external-beam
|
|
radiation therapy (EBRT) or interstitial implantation alone, but for many sites the use of both
|
|
modalities produces better control and functional results. Small superficial
|
|
cancers can be very successfully treated by local implantation using any one of
|
|
several radioactive sources, by intraoral cone radiation therapy, or by
|
|
electrons. Larger lesions are frequently managed using EBRT to include the primary site and regional lymph nodes, even if they are
|
|
not clinically involved. Supplementation with interstitial radiation sources
|
|
may be necessary to achieve adequate doses to large primary tumors and/or bulky
|
|
nodal metastases. A review of published clinical results of radical radiation
|
|
therapy for head and neck cancer suggests a significant loss of local control
|
|
when the administration of radiation therapy was prolonged; therefore,
|
|
lengthening of standard treatment schedules should be avoided whenever
|
|
possible.[<a class="bk_pop" href="#CDR0000062930_rl_53_6">6</a>,<a class="bk_pop" href="#CDR0000062930_rl_53_7">7</a>]
|
|
</p><p id="CDR0000062930__57">Early cancers (stage I and stage II) of the lip, floor of the mouth, and retromolar
|
|
trigone are highly curable by surgery or radiation therapy. The choice of
|
|
treatment is dictated by the anticipated functional and cosmetic results. Availability of the particular expertise required of the surgeon or
|
|
radiation oncologist for the individual patient is also a factor in treatment choice. </p><p id="CDR0000062930__333">Advanced cancers (stage III
|
|
and stage IV) of the lip, floor of the mouth, and retromolar trigone represent a wide
|
|
spectrum of challenges for the surgeon and radiation oncologists. Most patients with stage III or stage IV tumors are candidates for treatment by a
|
|
combination of surgery and radiation therapy. Patients with small T3 lesions and no regional lymph nodes, and no distant
|
|
metastases or patients who have no lymph nodes larger than 2 cm in diameter, for whom
|
|
treatment by radiation therapy alone or surgery alone might be appropriate,
|
|
are the exceptions. Because local
|
|
recurrence and/or distant metastases are common in this group of patients, they
|
|
should be considered for clinical trials that are evaluating the following: </p><ul id="CDR0000062930__334"><li class="half_rhythm"><div>The
|
|
potential role of radiation modifiers to improve local control or decrease
|
|
morbidity.</div></li><li class="half_rhythm"><div>The role of combinations of chemotherapy with surgery and/or radiation
|
|
therapy both to improve local control and to decrease the frequency of distant
|
|
metastases.</div></li></ul><p id="CDR0000062930__58">Early cancers of the buccal mucosa are equally curable by radiation therapy or
|
|
by adequate excision. Patient factors and local expertise influence the choice
|
|
of treatment. Larger cancers require composite resection with reconstruction
|
|
of the defect by pedicle flaps.
|
|
</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
|
|
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. If, however, the resection is more
|
|
extensive, problems may include aspiration of liquids and solids and difficulty
|
|
in swallowing in addition to 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 by 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 are
|
|
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 on 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_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. Philadelphia, PA: 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. New York: 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. Philadelphia, Pa: Saunders, 2003.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_53_4">Freund HR: Principles of Head and Neck Surgery. 2nd ed. New York, NY: 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. Philadelphia, Pa: 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></ol></div></div><div id="CDR0000062930__63"><h2 id="_CDR0000062930__63_">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>Small Lesions of the Lip</h3><p id="CDR0000062930__66"><b>Standard treatment options:</b>
|
|
</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>Small Anterior Tongue Lesions</h3><p id="CDR0000062930__69"><b>Standard treatment options:</b>
|
|
</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>Small Lesions of the Buccal Mucosa</h3><p id="CDR0000062930__73"><b>Standard treatment options:</b>
|
|
</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>Small Lesions of the Floor of the Mouth</h3><p id="CDR0000062930__77"><b>Standard treatment options:</b>
|
|
</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>Small Lesions of the Lower Gingiva</h3><p id="CDR0000062930__82"><b>Standard treatment options:</b>
|
|
</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>Small Tumors of the Retromolar Trigone</h3><p id="CDR0000062930__86"><b>Standard treatment options:</b>
|
|
</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>Small Lesions of the Upper Gingiva and Hard Palate</h3><p id="CDR0000062930__90"><b>Standard treatment options:</b>
|
|
</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/about-cancer/treatment/clinical-trials/advanced-search" 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/about-cancer/treatment/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. Philadelphia, PA: Lippincott, William & Wilkins, 2009.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_63_2">Guerry TL, Silverman S Jr, 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_">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>Small Lesions of the Lip</h3><p id="CDR0000062930__96"><b>Standard treatment options:</b>
|
|
</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>Small Anterior Tongue Lesions</h3><p id="CDR0000062930__101"><b>Standard treatment options:</b>
|
|
</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>Small Lesions of the Buccal Mucosa</h3><p id="CDR0000062930__105"><b>Standard treatment options:</b>
|
|
</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>Small Lesions of the Floor of the Mouth</h3><p id="CDR0000062930__109"><b>Standard treatment options:</b>
|
|
</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>Small Lesions of the Lower Gingiva</h3><p id="CDR0000062930__114"><b>Standard treatment options:</b>
|
|
</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>Small Tumors of the Retromolar Trigone</h3><p id="CDR0000062930__118"><b>Standard treatment options:</b>
|
|
</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>Small Lesions of the Upper Gingiva and Hard Palate</h3><p id="CDR0000062930__122"><b>Standard treatment options:</b>
|
|
</p><ul id="CDR0000062930__259"><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></ul></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/about-cancer/treatment/clinical-trials/advanced-search" 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/about-cancer/treatment/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. Philadelphia, PA: 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_">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>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"><b>Standard treatment options:</b>
|
|
</p><ol id="CDR0000062930__260"><li class="half_rhythm"><div>Surgery using a variety of surgical approaches, the choice of which is dependent on the size and location of the lesion and the needs for reconstruction.</div></li><li class="half_rhythm"><div>Radiation therapy using a variety of therapy 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></ol><p id="CDR0000062930__131"><b>Treatment options under clinical evaluation:</b>
|
|
</p><ol id="CDR0000062930__261"><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.[<a class="bk_pop" href="#CDR0000062930_rl_124_11">11</a>]</div></li></ol></div><div id="CDR0000062930__134"><h3>Moderately Advanced (Late T2, Small T3) Lesions of the Anterior Tongue</h3><p id="CDR0000062930__135"><b>Standard treatment options:</b>
|
|
</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>Advanced Lesions of the Buccal Mucosa</h3><p id="CDR0000062930__139"><b>Standard treatment options:</b>
|
|
</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></ol><p id="CDR0000062930__143"><b>Treatment options under clinical evaluation:</b>
|
|
</p><ul id="CDR0000062930__264"><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></ul></div><div id="CDR0000062930__145"><h3>Moderately Advanced Lesions of the Floor of the Mouth</h3><p id="CDR0000062930__146"><b>Standard treatment options:</b>
|
|
</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></ol><p id="CDR0000062930__149"><b>Treatment options under clinical evaluation:</b>
|
|
</p><ol id="CDR0000062930__266"><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>Moderately Advanced Lesions of the Lower Gingiva</h3><p id="CDR0000062930__153"><b>Standard treatment options:</b>
|
|
</p><ul id="CDR0000062930__267"><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></ul></div><div id="CDR0000062930__155"><h3>Advanced Lesions of the Retromolar Trigone</h3><p id="CDR0000062930__156"><b>Standard treatment options:</b>
|
|
</p><ul id="CDR0000062930__268"><li class="half_rhythm"><div>Surgical composite resection that may be followed by postoperative radiation
|
|
therapy.
|
|
</div></li></ul><p id="CDR0000062930__158"><b>Treatment options under clinical evaluation:</b>
|
|
</p><ol id="CDR0000062930__269"><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>Moderately Advanced Lesions of the Upper Gingiva</h3><p id="CDR0000062930__162"><b>Standard treatment options:</b>
|
|
</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>Moderately Advanced Lesions of the Hard Palate</h3><p id="CDR0000062930__166"><b>Standard treatment options:</b>
|
|
</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><p id="CDR0000062930__169"><b>Treatment options for management of lymph nodes:</b>[<a class="bk_pop" href="#CDR0000062930_rl_124_1">1</a>]
|
|
</p><ul id="CDR0000062930__298"><li class="half_rhythm"><div>Patients with advanced lesions should have elective lymph node radiation
|
|
therapy or node dissection. The risk of metastases to lymph nodes is increased
|
|
by high-grade histology, large lesions, spread to involve the wet mucosa of the
|
|
lip or the buccal mucosa in patients with recurrent disease, and invasion of
|
|
muscle (i.e., orbicularis oris).</div></li></ul><p id="CDR0000062930__171"><b>Standard treatment options:</b>
|
|
</p><ol id="CDR0000062930__272"><li class="half_rhythm"><div> Radiation therapy alone or neck dissection:
|
|
<ul id="CDR0000062930__273"><li class="half_rhythm"><div>N1 (0–2 cm).
|
|
</div></li><li class="half_rhythm"><div>N2b or N3; all nodes smaller than 2 cm. (A combined surgical and
|
|
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__176"><li class="half_rhythm"><div>N1 (2–3 cm), N2a, N3.
|
|
</div></li></ul></div></li><li class="half_rhythm"><div>Surgery followed by radiation therapy, indications for which are as follows:
|
|
<ul id="CDR0000062930__178"><li class="half_rhythm"><div>Multiple positive nodes.
|
|
</div></li><li class="half_rhythm"><div>Contralateral subclinical metastases.
|
|
</div></li><li class="half_rhythm"><div>Invasion of tumor through the capsule of the lymph node.
|
|
</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__180"><li class="half_rhythm"><div>Large fixed nodes.
|
|
</div></li></ul></div></li></ol><p id="CDR0000062930__181"><b>Treatment options under clinical evaluation (all stage III lesions):</b></p><ul id="CDR0000062930__287"><li class="half_rhythm"><div>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></li></ul><p id="CDR0000062930__182">A meta-analysis of 63 randomized, prospective trials published between 1965 and
|
|
1993 showed an 8% absolute survival advantage in the subset of patients
|
|
receiving concomitant 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_CDR0000335132/" class="def">Level of
|
|
evidence: 2A</a>] Patients receiving 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 concomitant chemotherapy and
|
|
radiation therapy in the management of oral cavity cancer.
|
|
</p><p id="CDR0000062930__183">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>]
|
|
</p><p id="CDR0000062930__184">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.
|
|
</p><p id="CDR0000062930__185">Novel fractionation radiation therapy clinical trials are under clinical
|
|
evaluation.[<a class="bk_pop" href="#CDR0000062930_rl_124_13">13</a>] </p></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/about-cancer/treatment/clinical-trials/advanced-search" 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/about-cancer/treatment/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. Philadelphia, PA: 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 4th, 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_">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 (13-cis-retinoic acid) 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>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"><b>Standard treatment options:</b>
|
|
</p><ol id="CDR0000062930__274"><li class="half_rhythm"><div>Surgery using a variety of surgical approaches, the choice of which is dependent on the size and location of the lesion and the needs 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 therapy 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></ol><p id="CDR0000062930__193"><b>Treatment option under clinical evaluation:</b>
|
|
</p><ul id="CDR0000062930__275"><li class="half_rhythm"><div>Superfractionated radiation therapy.[<a class="bk_pop" href="#CDR0000062930_rl_186_3">3</a>]
|
|
</div></li></ul></div><div id="CDR0000062930__195"><h3>Advanced Lesions of the Anterior Tongue</h3><p id="CDR0000062930__196"><b>Standard treatment options:</b>
|
|
</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>Advanced Lesions of the Buccal Mucosa</h3><p id="CDR0000062930__200"><b>Standard treatment options:</b>
|
|
</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>Advanced Lesions of the Floor of the Mouth</h3><p id="CDR0000062930__205"><b>Standard treatment options:</b>
|
|
</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>Advanced Lesions of the Lower Gingiva</h3><p id="CDR0000062930__209"><b>Standard treatment options:</b>
|
|
</p><ul id="CDR0000062930__279"><li class="half_rhythm"><div>Surgery, radiation therapy, or a
|
|
combination of both are poor controls for far advanced tumors with extensive destruction of the mandible and with nodal metastases.</div></li></ul></div><div id="CDR0000062930__211"><h3>Advanced Lesions of the Retromolar Trigone</h3><p id="CDR0000062930__212"><b>Standard treatment options:</b>
|
|
</p><ul id="CDR0000062930__280"><li class="half_rhythm"><div>Surgical composite resection followed by postoperative radiation therapy.
|
|
</div></li></ul></div><div id="CDR0000062930__214"><h3>Advanced Lesions of the Upper Gingiva</h3><p id="CDR0000062930__215"><b>Standard treatment options:</b>
|
|
</p><ul id="CDR0000062930__281"><li class="half_rhythm"><div>Surgery in combination with radiation therapy is generally used to treat lesions that are extensive and infiltrating.</div></li></ul></div><div id="CDR0000062930__217"><h3>Advanced Lesions of the Hard Palate</h3><p id="CDR0000062930__218"><b>Standard treatment options:</b>
|
|
</p><ul id="CDR0000062930__282"><li class="half_rhythm"><div>Surgery in combination with radiation therapy is generally used to treat lesions that are extensive and infiltrating.</div></li></ul><p id="CDR0000062930__220"><b>Treatment options for management of lymph nodes:</b>[<a class="bk_pop" href="#CDR0000062930_rl_186_5">5</a>]
|
|
</p><p id="CDR0000062930__221">Patients with advanced lesions should have elective lymph node radiation
|
|
therapy or node dissection. The risk of metastases to lymph nodes is increased
|
|
by high-grade histology, large lesions, spread involving the wet mucosa of the
|
|
lip or the buccal mucosa in patients with recurrent disease, and invasion of
|
|
muscle (orbicularis oris).
|
|
</p><p id="CDR0000062930__222"><b>Standard treatment options:</b>
|
|
</p><ol id="CDR0000062930__283"><li class="half_rhythm"><div> Radiation therapy alone or neck dissection:
|
|
<ul id="CDR0000062930__224"><li class="half_rhythm"><div>N1 (0–2 cm).
|
|
</div></li><li class="half_rhythm"><div>N2b or N3; all nodes smaller than 2 cm. (A combined surgical and
|
|
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__226"><li class="half_rhythm"><div>N1 (2–3 cm), N2a, N3.
|
|
</div></li></ul></div></li><li class="half_rhythm"><div> Surgery followed by radiation therapy is indicated for the following:<ul id="CDR0000062930__228"><li class="half_rhythm"><div>Multiple positive nodes.
|
|
</div></li><li class="half_rhythm"><div>Contralateral subclinical metastases.
|
|
</div></li><li class="half_rhythm"><div>Invasion of tumor through the capsule of the lymph node.
|
|
</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__231"><li class="half_rhythm"><div>Large fixed nodes.
|
|
</div></li></ul></div></li></ol><p id="CDR0000062930__232"><b>Treatment options under clinical evaluation (all stage IV lesions):</b></p><ol id="CDR0000062930__284"><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_6">6</a>-<a class="bk_pop" href="#CDR0000062930_rl_186_9">9</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
|
|
receiving concomitant chemotherapy and radiation therapy.[<a class="bk_pop" href="#CDR0000062930_rl_186_10">10</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335132/" class="def">Level of
|
|
evidence: 2A</a>] Patients receiving 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 concomitant 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_11">11</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_6">6</a>,<a class="bk_pop" href="#CDR0000062930_rl_186_12">12</a>-<a class="bk_pop" href="#CDR0000062930_rl_186_19">19</a>]</div></li><li class="half_rhythm"><div class="half_rhythm"> Novel fractionation radiation therapy clinical trials are under clinical
|
|
evaluation.[<a class="bk_pop" href="#CDR0000062930_rl_186_20">20</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/about-cancer/treatment/clinical-trials/advanced-search" 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/about-cancer/treatment/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">Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Philadelphia, PA: Lippincott, William & Wilkins, 2009.</div></li><li><div class="bk_ref" id="CDR0000062930_rl_186_6">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_7">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_8">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_9">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_10">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_11">Taylor SG 4th, 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_12">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_13">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_14">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_15">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_16">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_17">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_18">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_19">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_20">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__238"><h2 id="_CDR0000062930__238_">Recurrent Lip and Oral Cavity Cancer</h2><p id="CDR0000062930__239">For lesions of the lip, anterior tongue, buccal mucosa, floor of the mouth,
|
|
retromolar trigone, upper gingiva, and hard palate, treatment will be dictated
|
|
by the location and size of the recurrent lesion as well as prior
|
|
treatment.[<a class="bk_pop" href="#CDR0000062930_rl_238_1">1</a>,<a class="bk_pop" href="#CDR0000062930_rl_238_2">2</a>]
|
|
</p><p id="CDR0000062930__240"><b>Standard treatment options:</b>
|
|
</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
|
|
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
|
|
survival has been demonstrated.[<a class="bk_pop" href="#CDR0000062930_rl_238_4">4</a>]</div></li></ol><p id="CDR0000062930__244"><b>Treatment options under clinical evaluation:</b>
|
|
</p><ul id="CDR0000062930__286"><li class="half_rhythm"><div>Clinical trials
|
|
evaluating new chemotherapy drugs, chemotherapy and re-irradiation, or
|
|
hyperthermia should be considered because surgical salvage after primary treatment by radiation therapy and
|
|
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></ul><div id="CDR0000062930__TrialSearch_238_sid_9"><h3>Current Clinical Trials</h3><p id="CDR0000062930__TrialSearch_238_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" 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/about-cancer/treatment/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. Philadelphia, PA: 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_">Changes to This Summary (01/19/2018)
|
|
</h2><p id="CDR0000062930__294">The PDQ cancer information summaries are reviewed regularly and updated as
|
|
new information becomes available. This section describes the latest
|
|
changes made to this summary as of the date above.
|
|
</p><p id="CDR0000062930__389">This summary was renamed from Lip and Oral Cavity Cancer Treatment.</p><p id="CDR0000062930__disclaimerHP_3">This summary is written and maintained by the <a href="http://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 NCI. The summary reflects an independent review of
|
|
the literature and does not represent a policy statement of NCI or NIH. More
|
|
information about summary policies and the role of the PDQ Editorial Boards in
|
|
maintaining the PDQ summaries can be found on the <a href="#CDR0000062930__AboutThis_1">About This PDQ Summary</a> and <a href="http://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
|
|
</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 who care for cancer 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="http://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 (Adult) are:</p><ul><li class="half_rhythm"><div>Ann W. Gramza, MD (Georgetown Lombardi Comprehensive Cancer Center)</div></li><li class="half_rhythm"><div>Scharukh Jalisi, MD, FACS (Boston University 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 (Adult). 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.
|
|
</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>
|
|
<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>
|
|
|
|
</div>
|
|
|
|
<!-- Custom content below content -->
|
|
<div class="col4">
|
|
|
|
</div>
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<!-- Custom contetnt below bottom nav -->
|
|
<div class="col5">
|
|
|
|
</div>
|
|
</div>
|
|
|
|
<div id="rightcolumn" class="four_col col last">
|
|
<!-- Custom content above discovery portlets -->
|
|
<div class="col6">
|
|
<div id="ncbi_share_book"><a href="#" class="ncbi_share" data-ncbi_share_config="popup:false,shorten:true" ref="id=NBK65821&db=books">Share</a></div>
|
|
|
|
</div>
|
|
<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" 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/NBK65821.4/?report=reader">PubReader</a></li><li><a href="/books/NBK65821.4/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65821" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65821" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®): Health Professional Version. 2018 Jan 19. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65821.14/">NBK65821.14</a></span> November 25, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65821.13/">NBK65821.13</a></span> June 7, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65821.12/">NBK65821.12</a></span> October 15, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65821.11/">NBK65821.11</a></span> June 11, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65821.10/">NBK65821.10</a></span> February 5, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65821.9/">NBK65821.9</a></span> January 29, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65821.8/">NBK65821.8</a></span> January 20, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65821.7/">NBK65821.7</a></span> September 5, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65821.6/">NBK65821.6</a></span> March 28, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65821.5/">NBK65821.5</a></span> February 8, 2018</li><li><span class="bk_col_itm">NBK65821.4</span> January 19, 2018 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65821.3/">NBK65821.3</a></span> January 12, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65821.2/">NBK65821.2</a></span> 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</a></li><li><a href="#CDR0000062930__63" ref="log$=inpage&link_id=inpage">Stage I Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__93" ref="log$=inpage&link_id=inpage">Stage II Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__124" ref="log$=inpage&link_id=inpage">Stage III Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__186" ref="log$=inpage&link_id=inpage">Stage IV Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__238" ref="log$=inpage&link_id=inpage">Recurrent Lip and Oral Cavity Cancer</a></li><li><a href="#CDR0000062930__293" ref="log$=inpage&link_id=inpage">Changes to This Summary (01/19/2018)
|
|
</a></li><li><a href="#CDR0000062930__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65887/">Patient Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="discovery_db_links" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pmc&DbFrom=books&Cmd=Link&LinkName=books_pmc_refs&IdsFromResult=2823888" ref="log$=recordlinks">PMC</a><div class="brieflinkpop offscreen_noflow">PubMed Central citations</div></li><li class="brieflinkpopper"><a class="brieflinkpopperctrl" href="/books/?Db=pubmed&DbFrom=books&Cmd=Link&LinkName=books_pubmed_refs&IdsFromResult=2823888" ref="log$=recordlinks">PubMed</a><div class="brieflinkpop offscreen_noflow">Links to PubMed</div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389199" ref="ordinalpos=1&linkpos=1&log$=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> 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$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> PALB2: Cancer Risks and Management (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> PALB2: Cancer Risks and Management (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Cancer Genetics Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/38261695" ref="ordinalpos=1&linkpos=3&log$=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> Hospice (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> Hospice (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 Supportive and Palliative Care 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/26389330" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Craniopharyngioma Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Craniopharyngioma Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/38113349" ref="ordinalpos=1&linkpos=5&log$=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" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li></ul><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed_reviews&uid=26389262" ref="ordinalpos=1&log$=relatedreviews_seeall&logdbfrom=pubmed">See reviews...</a><a class="seemore" href="/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=26389262" ref="ordinalpos=1&log$=relatedarticles_seeall&logdbfrom=pubmed">See all...</a></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Recent Activity</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="recent_activity" id="Shutter"></a></div><div class="portlet_content"><div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" id="HTDisplay" class=""><div class="action"><a href="javascript:historyDisplayState('ClearHT')">Clear</a><a href="javascript:historyDisplayState('HTOff')" class="HTOn">Turn Off</a><a href="javascript:historyDisplayState('HTOn')" class="HTOff">Turn On</a></div><ul id="activity"><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67c984c5b15b832ebc75f382">Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Sum...</a><div class="ralinkpop offscreen_noflow">Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=2" href="/portal/utils/pageresolver.fcgi?recordid=67c984beab82281a80a6c979">Lip and Oral Cavity Cancer Treatment (PDQ®) - PDQ Cancer Information Summaries</a><div class="ralinkpop offscreen_noflow">Lip and Oral Cavity Cancer Treatment (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li><li class="ra_qry two_line"><a class="htb" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67c98495ab82281a80a5f83f">PMC Links for Books (Select 2826568) <span class="number">(121)</span></a><div class="tertiary">PMC</div></li><li class="ra_rcd ralinkpopper two_line"><a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67c98494ab82281a80a5ec8c">Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®) - PDQ Cancer...</a><div class="ralinkpop offscreen_noflow">Plasma Cell Neoplasms (Including Multiple Myeloma) Treatment (PDQ®) - PDQ Cancer Information Summaries<div class="brieflinkpopdesc"></div></div><div class="tertiary"></div></li></ul><p class="HTOn">Your browsing activity is empty.</p><p class="HTOff">Activity recording is turned off.</p><p id="turnOn" class="HTOff"><a href="javascript:historyDisplayState('HTOn')">Turn recording back on</a></p><a class="seemore" href="/sites/myncbi/recentactivity">See more...</a></div></div></div>
|
|
|
|
<!-- Custom content below discovery portlets -->
|
|
<div class="col7">
|
|
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<!-- Custom content after all -->
|
|
<div class="col8">
|
|
|
|
</div>
|
|
<div class="col9">
|
|
|
|
</div>
|
|
|
|
<script type="text/javascript" src="/corehtml/pmc/js/jquery.scrollTo-1.4.2.js"></script>
|
|
<script type="text/javascript">
|
|
(function($){
|
|
$('.skiplink').each(function(i, item){
|
|
var href = $($(item).attr('href'));
|
|
href.attr('tabindex', '-1').addClass('skiptarget'); // ensure the target can receive focus
|
|
$(item).on('click', function(event){
|
|
event.preventDefault();
|
|
$.scrollTo(href, 0, {
|
|
onAfter: function(){
|
|
href.focus();
|
|
}
|
|
});
|
|
});
|
|
});
|
|
})(jQuery);
|
|
</script>
|
|
</div>
|
|
<div class="bottom">
|
|
|
|
<div id="NCBIFooter_dynamic">
|
|
<!--<component id="Breadcrumbs" label="breadcrumbs"/>
|
|
<component id="Breadcrumbs" label="helpdesk"/>-->
|
|
|
|
</div>
|
|
|
|
<div class="footer" id="footer">
|
|
<section class="icon-section">
|
|
<div id="icon-section-header" class="icon-section_header">Follow NCBI</div>
|
|
<div class="grid-container container">
|
|
<div class="icon-section_container">
|
|
<a class="footer-icon" id="footer_twitter" href="https://twitter.com/ncbi" aria-label="Twitter"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11 {
|
|
fill: #737373;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>Twitter</title>
|
|
<path class="cls-11" d="M250.11,105.48c-7,3.14-13,3.25-19.27.14,8.12-4.86,8.49-8.27,11.43-17.46a78.8,78.8,0,0,1-25,9.55,39.35,39.35,0,0,0-67,35.85,111.6,111.6,0,0,1-81-41.08A39.37,39.37,0,0,0,81.47,145a39.08,39.08,0,0,1-17.8-4.92c0,.17,0,.33,0,.5a39.32,39.32,0,0,0,31.53,38.54,39.26,39.26,0,0,1-17.75.68,39.37,39.37,0,0,0,36.72,27.3A79.07,79.07,0,0,1,56,223.34,111.31,111.31,0,0,0,116.22,241c72.3,0,111.83-59.9,111.83-111.84,0-1.71,0-3.4-.1-5.09C235.62,118.54,244.84,113.37,250.11,105.48Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_facebook" href="https://www.facebook.com/ncbi.nlm" aria-label="Facebook"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>Facebook</title>
|
|
<path class="cls-11" d="M210.5,115.12H171.74V97.82c0-8.14,5.39-10,9.19-10h27.14V52l-39.32-.12c-35.66,0-42.42,26.68-42.42,43.77v19.48H99.09v36.32h27.24v109h45.41v-109h35Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_linkedin" href="https://www.linkedin.com/company/ncbinlm" aria-label="LinkedIn"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<title>LinkedIn</title>
|
|
<path class="cls-11" d="M101.64,243.37H57.79v-114h43.85Zm-22-131.54h-.26c-13.25,0-21.82-10.36-21.82-21.76,0-11.65,8.84-21.15,22.33-21.15S101.7,78.72,102,90.38C102,101.77,93.4,111.83,79.63,111.83Zm100.93,52.61A17.54,17.54,0,0,0,163,182v61.39H119.18s.51-105.23,0-114H163v13a54.33,54.33,0,0,1,34.54-12.66c26,0,44.39,18.8,44.39,55.29v58.35H198.1V182A17.54,17.54,0,0,0,180.56,164.44Z">
|
|
</path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_github" href="https://github.com/ncbi" aria-label="GitHub"><svg xmlns="http://www.w3.org/2000/svg" data-name="Layer 1" viewBox="0 0 300 300">
|
|
<defs>
|
|
<style>
|
|
.cls-11,
|
|
.cls-12 {
|
|
fill: #737373;
|
|
}
|
|
|
|
.cls-11 {
|
|
fill-rule: evenodd;
|
|
}
|
|
</style>
|
|
</defs>
|
|
<title>GitHub</title>
|
|
<path class="cls-11" d="M151.36,47.28a105.76,105.76,0,0,0-33.43,206.1c5.28,1,7.22-2.3,7.22-5.09,0-2.52-.09-10.85-.14-19.69-29.42,6.4-35.63-12.48-35.63-12.48-4.81-12.22-11.74-15.47-11.74-15.47-9.59-6.56.73-6.43.73-6.43,10.61.75,16.21,10.9,16.21,10.9,9.43,16.17,24.73,11.49,30.77,8.79,1-6.83,3.69-11.5,6.71-14.14C108.57,197.1,83.88,188,83.88,147.51a40.92,40.92,0,0,1,10.9-28.39c-1.1-2.66-4.72-13.42,1-28,0,0,8.88-2.84,29.09,10.84a100.26,100.26,0,0,1,53,0C198,88.3,206.9,91.14,206.9,91.14c5.76,14.56,2.14,25.32,1,28a40.87,40.87,0,0,1,10.89,28.39c0,40.62-24.74,49.56-48.29,52.18,3.79,3.28,7.17,9.71,7.17,19.58,0,14.15-.12,25.54-.12,29,0,2.82,1.9,6.11,7.26,5.07A105.76,105.76,0,0,0,151.36,47.28Z">
|
|
</path>
|
|
<path class="cls-12" d="M85.66,199.12c-.23.52-1.06.68-1.81.32s-1.2-1.06-.95-1.59,1.06-.69,1.82-.33,1.21,1.07.94,1.6Zm-1.3-1">
|
|
</path>
|
|
<path class="cls-12" d="M90,203.89c-.51.47-1.49.25-2.16-.49a1.61,1.61,0,0,1-.31-2.19c.52-.47,1.47-.25,2.17.49s.82,1.72.3,2.19Zm-1-1.08">
|
|
</path>
|
|
<path class="cls-12" d="M94.12,210c-.65.46-1.71,0-2.37-.91s-.64-2.07,0-2.52,1.7,0,2.36.89.65,2.08,0,2.54Zm0,0"></path>
|
|
<path class="cls-12" d="M99.83,215.87c-.58.64-1.82.47-2.72-.41s-1.18-2.06-.6-2.7,1.83-.46,2.74.41,1.2,2.07.58,2.7Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M107.71,219.29c-.26.82-1.45,1.2-2.64.85s-2-1.34-1.74-2.17,1.44-1.23,2.65-.85,2,1.32,1.73,2.17Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M116.36,219.92c0,.87-1,1.59-2.24,1.61s-2.29-.68-2.3-1.54,1-1.59,2.26-1.61,2.28.67,2.28,1.54Zm0,0">
|
|
</path>
|
|
<path class="cls-12" d="M124.42,218.55c.15.85-.73,1.72-2,1.95s-2.37-.3-2.52-1.14.73-1.75,2-2,2.37.29,2.53,1.16Zm0,0"></path>
|
|
</svg></a>
|
|
<a class="footer-icon" id="footer_blog" href="https://ncbiinsights.ncbi.nlm.nih.gov/" aria-label="Blog">
|
|
<svg xmlns="http://www.w3.org/2000/svg" id="Layer_1" data-name="Layer 1" viewBox="0 0 40 40">
|
|
<defs><style>.cls-1{fill:#737373;}</style></defs>
|
|
<title>NCBI Insights Blog</title>
|
|
<path class="cls-1" d="M14,30a4,4,0,1,1-4-4,4,4,0,0,1,4,4Zm11,3A19,19,0,0,0,7.05,15a1,1,0,0,0-1,1v3a1,1,0,0,0,.93,1A14,14,0,0,1,20,33.07,1,1,0,0,0,21,34h3a1,1,0,0,0,1-1Zm9,0A28,28,0,0,0,7,6,1,1,0,0,0,6,7v3a1,1,0,0,0,1,1A23,23,0,0,1,29,33a1,1,0,0,0,1,1h3A1,1,0,0,0,34,33Z"></path>
|
|
</svg>
|
|
</a>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
|
|
<section class="container-fluid bg-primary">
|
|
<div class="container pt-5">
|
|
<div class="row mt-3">
|
|
<div class="col-lg-3 col-12">
|
|
<p><a class="text-white" href="https://www.nlm.nih.gov/socialmedia/index.html">Connect with NLM</a></p>
|
|
<ul class="list-inline social_media">
|
|
<li class="list-inline-item"><a href="https://twitter.com/NLM_NIH" aria-label="Twitter" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st20 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st30 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Twitter</title>
|
|
<g>
|
|
<g>
|
|
<g>
|
|
<path class="st20" d="M192.9,88.1c-5,2.2-9.2,2.3-13.6,0.1c5.7-3.4,6-5.8,8.1-12.3c-5.4,3.2-11.4,5.5-17.6,6.7 c-10.5-11.2-28.1-11.7-39.2-1.2c-7.2,6.8-10.2,16.9-8,26.5c-22.3-1.1-43.1-11.7-57.2-29C58,91.6,61.8,107.9,74,116 c-4.4-0.1-8.7-1.3-12.6-3.4c0,0.1,0,0.2,0,0.4c0,13.2,9.3,24.6,22.3,27.2c-4.1,1.1-8.4,1.3-12.5,0.5c3.6,11.3,14,19,25.9,19.3 c-11.6,9.1-26.4,13.2-41.1,11.5c12.7,8.1,27.4,12.5,42.5,12.5c51,0,78.9-42.2,78.9-78.9c0-1.2,0-2.4-0.1-3.6 C182.7,97.4,189.2,93.7,192.9,88.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st30" cx="124.4" cy="128.8" r="108.2"></circle>
|
|
</g>
|
|
</svg></a></li>
|
|
<li class="list-inline-item"><a href="https://www.facebook.com/nationallibraryofmedicine" aria-label="Facebook" rel="noopener noreferrer" target="_blank">
|
|
<svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<style type="text/css">
|
|
.st10 {
|
|
fill: #FFFFFF;
|
|
}
|
|
|
|
.st110 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
</style>
|
|
<title>Facebook</title>
|
|
<g>
|
|
<g>
|
|
<path class="st10" d="M159,99.1h-24V88.4c0-5,3.3-6.2,5.7-6.2h16.8V60l-24.4-0.1c-22.1,0-26.2,16.5-26.2,27.1v12.1H90v22.5h16.9 v67.5H135v-67.5h21.7L159,99.1z"></path>
|
|
</g>
|
|
</g>
|
|
<circle class="st110" cx="123.6" cy="123.2" r="108.2"></circle>
|
|
</svg>
|
|
</a></li>
|
|
<li class="list-inline-item"><a href="https://www.youtube.com/user/NLMNIH" aria-label="Youtube" target="_blank" rel="noopener noreferrer"><svg xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" version="1.1" x="0px" y="0px" viewBox="0 0 249 249" style="enable-background:new 0 0 249 249;" xml:space="preserve">
|
|
<title>Youtube</title>
|
|
<style type="text/css">
|
|
.st4 {
|
|
fill: none;
|
|
stroke: #FFFFFF;
|
|
stroke-width: 8;
|
|
stroke-miterlimit: 10;
|
|
}
|
|
|
|
.st5 {
|
|
fill: #FFFFFF;
|
|
}
|
|
</style>
|
|
<circle class="st4" cx="124.2" cy="123.4" r="108.2"></circle>
|
|
<g transform="translate(0,-952.36218)">
|
|
<path class="st5" d="M88.4,1037.4c-10.4,0-18.7,8.3-18.7,18.7v40.1c0,10.4,8.3,18.7,18.7,18.7h72.1c10.4,0,18.7-8.3,18.7-18.7 v-40.1c0-10.4-8.3-18.7-18.7-18.7H88.4z M115.2,1058.8l29.4,17.4l-29.4,17.4V1058.8z"></path>
|
|
</g>
|
|
</svg></a></li>
|
|
</ul>
|
|
</div>
|
|
<div class="col-lg-3 col-12">
|
|
<p class="address_footer text-white">National Library of Medicine<br />
|
|
<a href="https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323" class="text-white" target="_blank" rel="noopener noreferrer">8600 Rockville Pike<br />
|
|
Bethesda, MD 20894</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a href="https://www.nlm.nih.gov/web_policies.html" class="text-white">Web Policies</a><br />
|
|
<a href="https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office" class="text-white">FOIA</a><br />
|
|
<a href="https://www.hhs.gov/vulnerability-disclosure-policy/index.html" class="text-white" id="vdp">HHS Vulnerability Disclosure</a></p>
|
|
</div>
|
|
<div class="col-lg-3 col-12 centered-lg">
|
|
<p><a class="supportLink text-white" href="https://support.nlm.nih.gov/">Help</a><br />
|
|
<a href="https://www.nlm.nih.gov/accessibility.html" class="text-white">Accessibility</a><br />
|
|
<a href="https://www.nlm.nih.gov/careers/careers.html" class="text-white">Careers</a></p>
|
|
</div>
|
|
</div>
|
|
<div class="row">
|
|
<div class="col-lg-12 centered-lg">
|
|
<nav class="bottom-links">
|
|
<ul class="mt-3">
|
|
<li>
|
|
<a class="text-white" href="//www.nlm.nih.gov/">NLM</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.nih.gov/">NIH</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.hhs.gov/">HHS</a>
|
|
</li>
|
|
<li>
|
|
<a class="text-white" href="https://www.usa.gov/">USA.gov</a>
|
|
</li>
|
|
</ul>
|
|
</nav>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</section>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentOmnitureBaseJS/InstrumentNCBIConfigJS/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js?v=1"> </script>
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/static/js/hfjs2.js"> </script>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
<!--/.page-->
|
|
</div>
|
|
<!--/.wrap-->
|
|
</div><!-- /.twelve_col -->
|
|
</div>
|
|
<!-- /.grid -->
|
|
|
|
<span class="PAFAppResources"></span>
|
|
|
|
<!-- BESelector tab -->
|
|
|
|
|
|
|
|
<noscript><img alt="statistics" src="/stat?jsdisabled=true&ncbi_db=books&ncbi_pdid=book-part&ncbi_acc=NBK65821&ncbi_domain=pdqcis&ncbi_report=record&ncbi_type=fulltext&ncbi_objectid=&ncbi_pcid=/NBK65821.4/&ncbi_pagename=Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf&ncbi_bookparttype=chapter&ncbi_app=bookshelf" /></noscript>
|
|
|
|
|
|
<!-- usually for JS scripts at page bottom -->
|
|
<!--<component id="PageFixtures" label="styles"></component>-->
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal106 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3879255/4121861/3501987/4008961/3893018/3821238/4062932/4209313/4212053/4076480/3921943/3400083/3426610.js" snapshot="books"></script></body>
|
|
</html> |