Management Strategies for Oral Cancer Subsites

Abstract

Oral cancers are the most common cancers in India, especially in males. This can be attributed primarily to consumption of tobacco and areca related products. Surgery is the mainstay of treatment for oral cancers with subtle subsite-specific nuances. The oral cavity starts at the mucocutaneous junction of the lips (the vermilion border) extending posteriorly to the junction of the hard and soft palate superiorly, anterior fauces laterally and the junction of the anterior two-thirds and posterior third of the tongue inferiorly. The oral cavity is lined by stratified squamous epithelium of varying degrees of keratinization. Primary tumors of the oral cavity may be derived from the mucosa, salivary glands, neurovascular tissues, bone or dental tissues. Over 90% of malignant tumors of the oral cavity are squamous cell carcinomas. There are certain basic principles of oncology, those hold true, despite the disease subsite and pathology. Stage I and II disease should be dealt with single modality treatment , whereas Stage III and IV warrant combined modality approach. Choice of modality (surgical versus non-surgical), depends on intent of treatment, chances of cure, accessibility and resectability of disease, impact on quality of life and patient's general health profile.