Management of Gingivobuccal Complex Cancer

Abstract

INTRODUCTION Squamous cell carcinoma of the oral cavity ranks as the 12th most common cancer in the world and the 8th most frequent in males. It accounts for up to one-third of all tobacco-related cancers in India. Cancer of the gingivobuccal complex is especially common in Indians due to their tobacco habits. This review focuses on the management of lower gingivobuccal complex cancers. PATIENTS AND METHODS References for this review were identified by search of Medline and other bibliographic information available in the PubMed database. The search terms carcinoma oral cavity, and cancer oral cavity, buccal mucosa, gingiva, gingivobuccal complex, and alveolus cancer/carcinoma were used. References from relevant articles and abstracts from international conferences were also included. Only articles published in the English language were used. RESULTS Treatment of gingivobuccal complex cancer is primarily surgical. Radical neck dissection, or its modification, is the standard treatment for the node-positive neck. Supraomohyoid neck dissection is the accepted treatment for the node-negative neck. Radiotherapy is usually not the preferred modality of treatment for early gingivobuccal complex cancer. It is used either as postoperative adjuvant treatment or as definitive treatment for advanced cancer with or witihout chemotherapy. Chemotherapy has been used as neo-adjuvant, adjuvant or palliative treatment. Advanced cancers are common and continue to pose a challenge to the multidisciplinary team. CONCLUSIONS Gingivobuccal complex cancer remains a major public health problem despite being highly preventable and easily detectable. Advanced cancers constitute a major proportion of patients presenting for treatment. These patients are difficult to treat and have a poor outcome.

Induction chemotherapy in technically unresectable locally advanced oral cavity cancers: Does it make a difference?

“…[16] Induction followed by surgery, if effective, can be an important strategy as oral cavity cancers have poor response radiation alone. [12,[20][21][22] There is some evidence that patients who undergo surgery have a better outcome than patients who did not undergo resection in oral cavity cancer. [23][24][25] In light of these studies, our approach of using induction chemotherapy to convert potentially unresectable tumors to resectable disease could theoretically produce better results than nonsurgical treatment.…”

Pathways involved in the spread of buccal carcinoma on contrast-enhanced multislice CT

“…Superficial buccal mucosa carcinoma might spread superiorly and inferiorly, thereby infiltrating the gingivobuccal sulcus, buccal gingiva and the RMT, and these three parts were called the gingivobuccal complex. 9,10 Buccal SCCA could also spread medially, cross the alveolar ridges and involve the lingual gingiva ( Figure 2) and hyomandibular furrows. Involvement in the superficial gingivobuccal sulcus and gingiva could be directly screened in clinical practice, and the extent of mucosal spread could be estimated on physical examination; however, submucosal spread could not be evaluated so easily.…”

Indian cancer: Our experience with review of literature

“…Sometimes it can be combined with magnetic resonance imaging (MRI) which can be helpful in knowing soft tissue extension and early periosteal invasion of mandible. Positron emission tomography (PET) scan is finding many uses in early detection of recurrences, treatment failures and distant spread [2] [3]. Wherever warranted the appropriate radiological investigations were done in all our patients to map and stage the disease.…”

“…5 year survival with advanced lesions can anywhere be between 30% to 40%. Stage IVb and IVc tumors require palliative care and pain management [2] [7].…”

“…The widespread use of smokeless tobacco consumption is the main etiological factor which is quite prevalent in the northern states of Uttar Pradesh, Bihar and Gujrat. Various legislations have been initiated to curb this social menace and an attempt is being made to bring about a change in recent days [1] [2].…”