Introduction. Oral cancer may present with a variety of signsand symptoms including pain, dysphagia, non-healing ulcers, redand white lesions, and indurated masses. Historically, oral cancerhas been associated with the male population, particularly thosewho use tobacco and alcohol. Recently, there has been a dramaticincrease in oral cancer rates seen in the population aged 40 yearsand younger. This increase has not been associated with thetraditional risk factors for oral cancer and is likely linked to etiologicfactors that remain still undefined. The proliferation of oral canceris also mirrored by an increase in oropharyngeal malignancies suchas base of tongue and tonsil cancer, although the increase in thissubset of patients appears to be clearly associated with HumanPapillomavirus (HPV).1
Methods. We present a summary of all oral malignanciestreated at the University of Minnesota Oral and MaxillofacialSurgery Division from 2008 through early 2011.
Results. Since July of 2008, the Oral and MaxillofacialSurgery Department at the University of Minnesota has beenreferred a total of 69 cases of head and neck malignant tumors, ofwhich 58 were primarily managed with surgery. A broad rangeof head and neck cancers were seen, with the most common beingoral squamous cell carcinoma (OSCC), which accounted for 81% of patients treated by oncologic tumor resection. The tongue was the most common site of occurrence of OSCC with 33% of cases. There was an even distribution between genders. Traditional treatment modalities included surgical resection of primary tumors including neck dissection, when indicated, with postoperative adjuvant therapies being reserved for advanced stage tumors or high-risk pathologic features for recurrence. At the conclusion of the study period in January, 2011, 83% of patients treated surgicallyfor OSCC were living disease free, 4% had recurrent tumors not amenable to resection, 6% of patients had died from other causes, and 6% had succumbed to OSCC, resulting in a disease-specific survival rate of 93% with an overall survival rate of 87%.
Conclusions. Oral cancer continues to be diagnosed with advanced stage disease in 50% of patients. Dental practitioners play a significant role in the early detection and diagnosis of oral cavity cancer. It is incumbent upon dental practitioners to be aware of the early signs and symptoms of oral cancer and to make prompt referral to head and neck cancer specialists when indicated. Diligent and frequent examination, particularly in patients with risk factors, will greatly improve survival rates and minimize the complexity and morbidity of oncologic treatment when patients are diagnosedwith earlier stage disease.
In 2010 it was estimated that 36,540 people would be diagnosed with oral and pharyngeal cancer and that 7,880 would die from the disease.2 The mean age at diagnosis of oral cancer is 62 years, and the current five-year survival rates are 83% when the disease is localized, 55% when metastasis to regional lymph nodes has occurred, and 32% with distant spread of disease.2 Unfortunately, the majority of patients present with advanced stage disease. At present, there are limited methods for early detection, which occurs in only approximately one third of cases.3 Most often, the signs and symptoms of early oral cancer are non-specific and often present as pain,bleeding, loosening of teeth, difficult in articulation of speech, dysphagia, odynophagia, otalgia, motor and sensory nerve disturbances, masses, and cervical lymphadenopathy3 (Table I). Commonly, early stage tumors have few or limited symptoms that develop with advancing disease and have a wide range of clinical presentation. Most often, asymptomatic patients are detected during a routine dentalexamination.4