Oral Cavity Carcinoma: Current Management, Controversies, and Future Directions

Abstract

Oral cavity carcinoma (OCC) remains a major cause of morbidity and mortality in patients with head and neck cancer. Although the incidence has decreased over the last decade, outcomes remain stagnant with only a 5% improvement in overall survival in the last 20 years. Although surgical resection remains the primary treatment modality, several areas of controversy exist with regard to work-up, management of the primary and neck tumors, and adjuvant therapy. As surgical techniques evolve, so has the delivery of radiotherapy and systemic treatment, which have helped to improve the outcomes for patients with advanced disease. Recently, the addition of cetuximab has shown promise as a way to improve outcomes while minimizing toxicity, and this remains an active area of study in the adjuvant setting. Advances in microvascular free-flap reconstruction have extended the limits of resection and enabled enhanced restoration of function and cosmesis. While these advances have led to limited survival benefit, evaluation of alternative modalities has gained interest on the basis of success in other head and neck subsites. Organ preservation with definitive chemoradiotherapy, though proven in the larynx and pharynx, remains controversial in OCC. Likewise, although the association of human papillomavirus is well established in oropharyngeal carcinoma, it has not been proven in the pathogenesis or survival of OCC. Future study of the molecular biology and pathogenesis of OCC should offer additional insight into screening, treatment selection, and novel therapeutic approaches.

Targeting BMI1 + Cancer Stem Cells Overcomes Chemoresistance and Inhibits Metastases in Squamous Cell Carcinoma

“…Currently, the standard of care for HNSCC includes surgical excision and combination of chemotherapy and radiotherapy (Chinn and Myers, 2015; Haddad and Shin, 2008). Nevertheless, the five-year survival rates for patients with HNSCC have remained low due to the high incidence of treatment resistance with consequent recurrence and lymph node metastasis (Hedberg et al, 2015; Polverini and Nor, 1999; Wang et al, 2012).…”

“…Unlike skin SCCs, HNSCC frequently metastasizes to cervical lymph nodes, and many patients with HNSCC are diagnosed at an advanced stage where tumor cells have seeded the cervical lymph nodes. HNSCC with lymph node involvement carries a poor prognosis and is an important factor in predicting recurrence and survival after removal of the primary tumor (Chinn and Myers, 2015; Hedberg et al, 2015). There are several unanswered questions that remain central to understanding the behavior of HNSCC as well as to improving the survival of HNSCC patients: First, are CSCs responsible for HNSCC cervical lymph node metastasis?…”

Blockade of adenosine A2A receptor enhances CD8+ T cells response and decreases regulatory T cells in head and neck squamous cell carcinoma

“…Despite the intense research interest and efforts in developing therapeutic approaches based on surgical intervention, chemotherapy, radiotherapy, and monoclonal antibody-based therapy, the overall survival rate of HNSCC patients has barely improved [2]. Currently, only 50%–60% of patients can survive 5 years after diagnosis [3].…”

Cancer Stem Cells in Moderately Differentiated Lip Squamous Cell Carcinoma Express Components of the Renin–Angiotensin System

“…Oral cavity SCC (OCSCC) affects the lip, oral tongue, floor of mouth, hard palate, buccal mucosa, maxillary and mandibular alveolus, and the retromolar trigone (1, 3). The incidence of lip cancer is highest among white populations in Canada and Australia (2).…”