In the United States, cancers of the oral cavity and oropharynx represent approximately three percent of all malignancies in men and two percent of all malignancies in women. The American Cancer Society estimates that 28,900 new cases of oral cancer will be diagnosed in 2002, and nearly 7,400 people will die from this disease. Over 90 percent of these tumors are squamous cell carcinomas, which arise from the oral mucosal lining. In spite of the ready accessibility of the oral cavity to direct examination, these malignancies still are often not detected until a late stage, and the survival rate for oral cancer has remained essentially unchanged over the past three decades. The purpose of this article is to review the clinical features of oral cancer and premalignant oral lesions, with an emphasis on early detection. (CA Cancer J Clin 2002;52:195-215.)
INTRODUCTIONCancers of the oral cavity and oropharynx represent approximately three percent of all malignancies in men and two percent of all malignancies in women in the United States. It is estimated that these tumors will account for 28,900 new cases and 7,400 deaths in 2002 in the United States.1 Squamous cell carcinoma, which arises from the oral mucosal lining, accounts for over 90 percent of these tumors.2-4 This article will review the epidemiology and clinical features of oral and oropharyngeal squamous cell carcinoma, with a special emphasis on the recognition of early cancer and premalignant oral lesions.
EPIDEMIOLOGYOral cancer most commonly occurs in middle-aged and older individuals, although a disturbing number of these malignancies is also being documented in younger adults in recent years. [5][6][7] From an epidemiological and clinicopathological perspective, "oral cancer" can be divided into three categories: carcinomas of the oral cavity proper, carcinomas of the lip vermilion, and carcinomas arising in the oropharynx. Intraoral and oropharyngeal tumors are more common among men than women, with a male:female ratio of over 2:1.2,8-9 However, the disparity in the male:female ratio has become less pronounced over the past half century, probably because women have been more equally exposing themselves to known oral carcinogens such as tobacco and alcohol. pharyngeal cancer in African Americans (12.4 cases per 100,000 population) is higher than among whites (9.7 cases per 100,000); the highest incidence rate is among African-American males (20.5 cases per 100,000 population).
3,9In contrast to intraoral and oropharyngeal carcinomas, cancers of the lip vermilion are more akin epidemiologically to squamous cell carcinoma of the skin and occur primarily in white men.2 These lip tumors are most strongly associated with chronic sun exposure, although sometimes they have been related to the site where cigarettes or pipestems have habitually been held. 10 These malignancies are much more common in men, probably because men are more likely to have vocations and/or avocations that result in greater cumulative sun exposure. At one time, the lip wa...
