Oral cavity comprises the lips, buccal mucosa, teeth, gums, bony roof of the mouth, ﬂoor of the mouth, oral tongue, and retromolar trigone. More than 90% of oral cavity cancers are squamous cell carcinoma.
How is the Staging of Oral (Mouth) Cancer done?
TNM staging is the staging system used for oral cavity cancer. It is described as follows-
Tis – Tumor present only in the superficial layer of the oral cavity.
T1 – Tumor </=2 cm in size and the depth of invasion (DOI) is </=5 mm.
T2 – Tumor </=2 cm in size with DOI between 5 mm and 10 mm, or tumor >2 cm but </=4 cm with the DOI </=10 mm.
T3 – Tumor is >4 cm in size with the DOI between 10 mm and 20 mm.
T4a – Tumor invades adjacent structures and/or DOI > 20 mm.
T4b – Tumor of any size that invades a vital structure, such as masticator space, pterygoid plates, skull base and/or surrounds the carotid artery.
N0 – No involvement of nearby lymph nodes
N1 – Involvement of single ipsilateral lymph node measuring </=3 cm.
N2a – Involvement of single ipsilateral lymph node measuring >3 cm and </= 6 cm
N2b – Involvement of multiple ipsilateral nodes, none >6 cm
N2c – Involvement of bilateral/contralateral lymph nodes, all measuring <6 cm.
N3 – Involvement of lymph nodes measuring >6 cm or extranodal involvement.
M0 – No spread to distant body parts
M1 – Spread of the tumor to distant body parts.
How is the final Stage decided based on TNM classification discussed above?
Once T, N, and M categories are determined through different diagnostic techniques, this information is combined to assign an overall stage (from 0 to IV) to the disease.
|0||Tis N0 M0|
|I||T1 N0 M0|
|II||T2 N0 M0|
|III||T1-2 N1 M0|
|T3 N0-1 M0|
|IVA||T1-3 N2 M0|
|T4a N0-2 M0|
|IVB||Any T N3 M0|
|T4b Any N M0|
|IVC||Any T Any N M1|
What is the Treatment of Oral (Mouth) Cancer?
The treatment of oral cancer depends on stage of disease, site, performance status of the patient, along with other factors.
For Stage 0 cancers, surgical resection of the involved site is considered as the standard treatment. The patient should be followed-up closely after treatment for any sign of recurrence.
Stage I and II
For Stage I and II cancers, surgical resection is considered as the preferred treatment. Then depending on the presence of adverse prognostic factors, radiation therapy with or without chemotherapy may be required.
Stage III, IVA and IVB
If the tumor is surgically resectable, surgical resection is considered as the preferred treatment. Then depending on the presence of adverse prognostic factors, radiation therapy with or without chemotherapy may be required.
If upfront surgery is not possible, then chemotherapy and/or radiation therapy may be employed and further management is decided depending on response to treatment.
Chemotherapy, immunotherapy or targeted therapy are the treatment options. Radiation therapy or surgery may be employed as palliative treatment or for relief of symptoms.
What is the role of Targeted Therapy in Treatment of Oral Cancer?
Targeted therapy is designed to target a specific alteration/mutation and produce anticancer effect by selectively modifying a target key to the growth of cancer cells.
What is the role of Immunotherapy in Treatment of Oral Cancer?
Immunotherapy acts by stimulating the body’s immune system to kill or retard the growth of cancer cells.
Best Oral (Mouth) Cancer Specialist in Delhi
Dr Sunny Garg is a renowned Medical Oncologist in New Delhi with an experience of more than 6 years of treating oral cancer patients. He has practiced in leading cancer hospitals in Delhi, and currently practicing at Manipal Hospital, Dwarka.
He is well versed with Immunotherapy, Targeted therapy, and Chemotherapy for Oral Cancer treatment and also general supportive care for patients. He works in close collaboration with surgical and radiation oncologists, oncopathologists, nuclear medicine, and genetic counselors for comprehensive cancer care for the patients.
Call +91 9686813020 for appointment.