Maxillofacial oncology at the University of Minnesota: treating the epidemic of oral cancer.

INTRODUCTION: Oral cancer may present with a variety of signs and symptoms including pain, dysphagia, non-healing ulcers, red and white lesions, and indurated masses. Historically, oral cancer has been associated with the male population, particularly those who use tobacco and alcohol. Recently, there has been a dramatic increase in oral cancer rates seen in the population aged 40 years and younger. This increase has not been associated with the traditional risk factors for oral cancer and is likely linked to etiologic factors that remain still undefined. The proliferation of oral cancer is also mirrored by an increase in oropharyngeal malignancies such as base of tongue and tonsil cancer, although the increase in this subset of patients appears to be clearly associated with Human Papillomavirus (HPV).

METHODS: We present a summary of all oral malignancies treated at the University of Minnesota Oral and Maxillofacial Surgery Division from 2008 through early 2011.

RESULTS: Since July of 2008, the Oral and Maxillofacial Surgery Department at the University of Minnesota has been referred a total of 69 cases of head and neck malignant tumors, of which 58 were primarily managed with surgery. A broad range of head and neck cancers were seen, with the most common being oral 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 surgically for 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 diagnosed with earlier stage disease.