General Surgery
Oral and Oropharyngeal Cancer
MBBS surgery notes on oral and oropharyngeal cancer: tobacco and areca nut risk, premalignant lesions and treatment, mapped to NMC codes SU20.1 and SU20.2.
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Oral and Oropharyngeal Cancer
MBBS surgery notes on oral and oropharyngeal cancer: tobacco and areca nut risk, premalignant lesions and treatment, mapped to NMC codes SU20.1 and SU20.2.
This chapter deals with oral and oropharyngeal cancer, a major disease burden in India. It covers the risk factors, premalignant conditions, presentation, staging and the combined surgical, radiotherapy and chemotherapy approach to treatment.
High-yield: Oral and Oropharyngeal Cancer
- Oral cancer is one of the commonest cancers in India, driven by tobacco chewing, smoking, areca nut and alcohol.
- The great majority of oral cavity cancers are squamous cell carcinomas.
- Common premalignant lesions include leukoplakia, erythroplakia and oral submucous fibrosis, the last strongly linked to areca nut.
- Erythroplakia carries a higher risk of malignant change than leukoplakia.
- Oral submucous fibrosis causes progressive trismus and a burning sensation and is common in areca nut users in the Indian subcontinent.
- A persistent oral ulcer that does not heal in three weeks should be biopsied to exclude cancer.
- The tongue and floor of mouth are common sites, and lesions present as ulcers, indurated growths or non-healing patches.
- Cervical lymph node metastasis worsens prognosis and is a key part of staging.
- Diagnosis is confirmed by incisional biopsy, and computed tomography or magnetic resonance imaging assesses local and nodal spread.
- Treatment combines surgery, radiotherapy and chemotherapy depending on the stage and site.
- Early lesions may be treated with surgery or radiotherapy alone, while advanced disease needs combined modality treatment.
- Neck dissection removes cervical lymph nodes when there is nodal involvement or a high risk of it.
- Reconstruction with flaps restores form and function after resection of large tumours.
- Prevention centres on stopping tobacco and areca nut use and on early detection of premalignant lesions.
- Human papillomavirus is an increasingly recognised cause of oropharyngeal cancer and carries a better prognosis than tobacco-related disease.
Premalignant oral lesions
- **Leukoplakia:** White patch that cannot be rubbed off; a proportion undergo malignant change.
- **Erythroplakia:** Red velvety patch with a higher malignant potential than leukoplakia.
- **Oral submucous fibrosis:** Areca nut related; progressive trismus and burning; premalignant.
- **Red flag:** Any oral ulcer not healing in three weeks warrants biopsy to exclude cancer.
NMC competencies in this chapter
- **SU20.1:** Aetiology, premalignant lesions and presentation of oral cancer
- **SU20.2:** Diagnosis, staging and management of oral and oropharyngeal cancer
Frequently Asked Questions
What causes oral cancer in India?
Tobacco chewing and smoking, areca nut and alcohol are the main drivers. Human papillomavirus is an increasingly recognised cause of oropharyngeal cancer with a better prognosis.
What are the important premalignant oral lesions?
Leukoplakia, erythroplakia and oral submucous fibrosis. Erythroplakia has the highest malignant potential, and submucous fibrosis is strongly linked to areca nut use.
When should an oral ulcer be biopsied?
Any oral ulcer that fails to heal within three weeks, or any indurated or non-healing patch, should be biopsied to exclude squamous cell carcinoma.
How is oral cancer treated?
By a combination of surgery, radiotherapy and chemotherapy tailored to stage and site, with neck dissection for nodal disease and flap reconstruction after large resections.
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