Aerodigestive cancers: oral cancer

Worldwide, approximately 260,000 new cases of oral cancer occur, and more than 125,000 mortalities are attributed to oral cancers each year. Oral cancers most commonly arise in the tongue, followed by the floor of the mouth and the lower gum. Tobacco and alcohol use are the major risk factors, although human papillomavirus has been identified as an etiology in a small percentage of oral squamous cell cancers. Although the evidence to support routine annual screening for oral cancers is inconclusive, family physicians and dental practitioners should be attentive to precursor lesions, such as leukoplakia and erythroplakia, and strongly consider obtaining or referring for biopsy patients with suspicious lesions. Depending on stage, management of oral cancers often involves surgery, with or without postoperative radiotherapy or chemotherapy. Patients who have been treated for these cancers should undergo close surveillance by otolaryngology subspecialists, but their family physicians primarily will be responsible for their long-term care. Complications relating to management, including difficulties with speech, swallowing, and chewing, will need to be addressed. For patients with advanced-stage disease, family physicians also may be responsible for palliative and end-of-life care.