Gingival cancer: 11 year follow-up at Karolinska University Hospital (2000-2010).

5536 Background: In Sweden, approximately 500-600 cases of oral cancer are diagnosed every year. These include cancer of the gingiva, retromolar trigonum, bucca, hard palate, tongue and floor of the mouth. Each year, around 15 cases of gingival cancer (GC) are diagnosed in the Stockholm region. The goal of this study was to study the onset of symptoms, treatment, prognosis, and sequelae of GC in order to optimize the treatment. Methods: The study consists of a retrospective review of medical records of all diagnosed cases of GC in Stockholm region between 2000-2010, identified through the ENT-clinic Karolinska Hospital patient database. Results: Our retrospective study comprised 156 patients diagnosed with GC. The average age was 72 years sharing equally between the sexes, 50% were smokers. 98% had a squamous cell carcinoma (scc). Presenting symptoms were often lump or ulceration in the gums, pain, bleeding or discomfort/misfit of dentures. Around 30% had premalignant lessons in the oral cavity before diagnosis. 3/4-th of all GC was localized in the lower jaw. 66% of the GC-patients presented as aT4 cancer. At presentation, 26% had a regional metastasis and of those 90% had their primary tumor in the lower jaw. Six cases had bilateral neck disease. 81% of the patients with regional metastasis had low to medium grade of scc differentiation of the primary tumor. 84% of all patients with regional metastasis had a T4 primary tumor. Neck dissection was performed in 38% (n=59). Of these 35 cases where staging neck, i.e. N0 at presentation and in 7 cases (20%) a positive neck disease was found. The risk for second primary was 15%. The overall 5-year survival was 24%. Conclusions: Advanced age and high number of T4 cancer at diagnosis partly explains the poor survival statistics. Almost 30% of the patients in our material have had premalignant lessons in the oral cavity before the cancer diagnosis and are at high risk for new tumors (second primary); therefore patients with GC should be followed up for at least 5 years, possibly longer in the presence of premalignant lessons. GC of the lower jaw is more likely to metastasize than GC of the upper jaw. Due to 20% occult metastasis occurrence in the staging neck cases, we recommend staging neck dissection for patients with GC.

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Level I Nodal Positivity as a Factor for Involvement of the Submandibular Gland in Oral Cavity Carcinoma: A Case Series Report

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1709117 ◽

2020 ◽

Author(s):

Hamdan Ahmed Pasha ◽

Rahim Dhanani ◽

Shayan Khalid Ghaloo ◽

Kulsoom Ghias ◽

Mumtaz Jamshed Khan

Keyword(s):

Oral Cavity ◽

Lymph Nodes ◽

Neck Dissection ◽

Submandibular Gland ◽

Primary Tumor ◽

Oral Carcinoma ◽

Care Hospital ◽

Direct Extension ◽

Oral Cavity Carcinoma ◽

Level I

Abstract Introduction The routine practice of neck dissection in the surgical management of oral carcinoma has evolved into a more functionally conservative approach. Over time, the rationale for removal of the submandibular gland has been questioned. Routine extirpation of the submandibular gland can aggravate the xerostomia experienced by many patients, significantly affecting their quality of life. Objective The objective of the present study was to determine the incidence of submandibular gland metastases in oral cavity carcinoma and to identify possible factors that may affect their involvement. Methods A total of 149 cases of oral carcinoma presenting at a private tertiary care hospital in Karachi, Pakistan, over the course of 1 year were reviewed retrospectively. Results Histopathological data showed that the submandibular gland was involved in 7 (4.7%) cases. Involvement of level I lymph nodes was found in all of the cases. Direct extension of primary tumor was noted in two cases when the primary tumor was in the floor of the mouth. Conclusion The results suggest that preservation of the submandibular gland during neck dissection for oral carcinoma can be practiced safely when there is no evidence of direct extension of the primary tumor toward the submandibular gland or when there is no clinical or radiological evidence of neck disease in level I. Presence of pathological lymph nodes in level I requires caution when contemplating preservation of the submandibular gland.

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Comparative study of complications of comprehensive neck dissection in primary neck and irradiated neck

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v19i1.14857 ◽

2013 ◽

Vol 19 (1) ◽

pp. 5-10

Author(s):

Md Mosleh Uddin ◽

Belayat Hossain Siddiquee ◽

Syed Farhan Ali Rajib ◽

Kazi Shameemus Salam

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Neck Dissection ◽

Squamous Cell ◽

Primary Tumor ◽

Perioperative Complications ◽

Cross Sectional Study ◽

Cross Sectional ◽

Marginal Mandibular Nerve ◽

Neck Disease

Due to close relationship of vital structures in the neck, certain complications are inherent to neck dissection (ND) for the treatment of patients with metastatic neck disease of squamous cell carcinoma. Aim: To compare the incidence of complications of Comprehensive ND done in primary neck and in irradiated neck. Methods: A cross sectional study of 267 patients with metastatic squamous cell carcinoma in the neck, with or without primary tumor, under gone ND with a curative intension, was made from January 2007 to December 2011 (five years). It was done to identify perioperative complications and to compare them in NDs done in primary neck and in irradiated neck. Result: Total 267 patients with unilateral Comprehensive ND, with or without en-block of the primary tumor, were studied. There was no death. The most frequent complication was marginal mandibular nerve injury (4.05% in primary neck and 8.51% in irradiated neck) followed by intra operative hemorrhage (1.16% in primary neck and 3.19% in irradiated neck). Conclusion: There were no perioperative death in either category; nerves were the most commonly injured structures. Complications were higher in neck dissection in irradiated neck than in primary neck dissection.DOI: http://dx.doi.org/10.3329/bjo.v19i1.14857 Bangladesh J Otorhinolaryngol 2013; 19(1): 5-10

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A case series of metastatic lateral cervical lymphadenopathy

International Surgery Journal ◽

10.18203/2349-2902.isj20170848 ◽

2017 ◽

Vol 4 (3) ◽

pp. 988

Author(s):

Amit Narayan Pothare ◽

Karuna Ilamkar

Keyword(s):

Head And Neck ◽

Neck Dissection ◽

Primary Tumor ◽

Radical Neck Dissection ◽

Case Series ◽

Cervical Lymphadenopathy ◽

Neck Region ◽

Signs And Symptoms ◽

Selective Neck Dissection ◽

Occult Metastasis

Background: Metastasis is a common cause of lymphadenopathy, seen mainly in patients above 40 years of age. Regional nodes entrap the tumor cells and setup complex immunological reactions within the nodes. The histological appearance of the nodes often suggests the primary tumor. The head and neck cancers spread to regional nodes via embolism and permeation. Primary site is evident most of times. The nodes are initially mobile but later may becomes fixed. The aim was to study the lateral cervical metastasis secondary to either lymphatic spread from distant primary or occult metastasis, their signs and symptoms, diagnostic procedure and treatment modalities.Methods: The study was conducted from July 2012 to June 2015. All patients having cervical lymphadenopathy secondary to metastasis diagnosed by FNAC, are included in study. Patients are evaluated as a whole, starting with clinical history and examinations as per proforma. In cases of lympahdenopathy where the diagnosis was not established with FNAC, biopsy was performed and efficacy of FNAC has been calculated. Results: Total 37 patients are studied. Most cases occurred in 5th decade of life, followed by 4th decade. More common in male 83.70% as compared to female 16.30% due to tobacco and smoking addiction more common in males. Change in voice is most common presentation in 46% of cases, followed by dysphagia in 35.13% of patients. Primary tumor was evident in 83.78% of cases and occult in 16.22%. Fixed nodes present in 54.05%, reduced mobility in 21.62% and mobile in 24.32%. FNAC was done in all the cases and positive results obtained in 91.8% with sensitivity of 90% and specificity of 98%. In patients treated by neoadjuvant chemotherapy followed by modified neck dissection, no recurrence occurred. Out of 10 patients treated by radical neck dissection only 2 patients had recurrence in follow up period and managed by radiotherapy. In 15 patients treated by radical radiotherapy, 5 patients had local recurrence and required selective neck dissection in follow up.Conclusions: Cervical lymph node metastasis was major presentation of malignancies of head and neck region and also from distant site. Whenever presents, it should raise suspicion of metastatic origin. Early diagnosis of primary tumor followed by aggressive treatment via multimodal approach prolongs survival.

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S151 – The Impact of Second Primary Tumors on Survival

Otolaryngology ◽

10.1016/j.otohns.2008.05.325 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P127-P127

Author(s):

Erlend Rennemo ◽

Ulf Kaare Zatterstrom

Keyword(s):

Oral Cavity ◽

Median Survival ◽

Primary Tumor ◽

Second Primary ◽

Primary Tumors ◽

Second Primary Tumor ◽

Patients At Risk ◽

Second Primary Tumors ◽

Second Tumor ◽

The Impact

Objectives 1) Evaluate what impact second primary tumors have on prognosis in HNSCC. 2) Identify patients that run the highest risk of obtaining a second primary tumor after successful treatment of primary HNSCC. Methods A retrospective analysis of 2063 patients treated over a 15-year period for tumors of the oral cavity, larynx, oropharynx, and hypopharynx, was undertaken. Survival was analysed for the group of patients presenting second primary tumors, and the descriptive characteristics of these patients were compared to the remaining group of patients. Results Second primary tumors correlated with low patient age (p=0.02), less advanced disease (p<0.05), and were more common after primary tumors of the larynx and oral cavity. Mean time to diagnosis of a second primary tumor was more than 4 years from the date of the initial tumor. From the date of primary tumor treatment, overall median survival among patients that later developed second primary tumors compared to all other patients was 6 years vs. 3 years. Prognosis was poor after the diagnosis of a second primary, as median survival was 12 months and 5-year survival, 16%. Conclusions Patients at risk of a second primary tumor were younger than median with stage I and II primary tumors of the larynx and the oral cavity. This group had a favorable outcome after treatment of their primary tumor and therefore initially a better overall survival. However, after diagnosis of the second tumor, prognosis was extremely poor.

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Metastasis to Submandibular Salivary Gland in Oral Carcinoma

10.37184/lntbj.2708-7808.2.5 ◽

2020 ◽

Keyword(s):

Oral Cavity ◽

Neck Dissection ◽

Submandibular Gland ◽

Squamous Cell ◽

Primary Tumor ◽

Lymph Node Involvement ◽

Submandibular Salivary Gland ◽

Floor Of Mouth ◽

Direct Invasion ◽

Node Involvement

Objective: To determine the frequency of involvement of the submandibular gland as a metastatic site in squamous cell carcinoma of oral cavity, mechanism of its involvement and factors associated with it. Method: We reviewed the medical and pathologic records of patients who underwent neck dissection (unilateral or bilateral) for oral cavity squamous cell carcinomas (SCC) from January 2009 to July 2017 at the Liaquat National Hospital in Karachi. Cases of histopathologically confirmed SCC of oral cavity and cases of primary tumor in which excision of the submandibular gland (SMG) was done along with neck dissection were included. Those cases with previous surgery for oral cancer and those with previous chemo-radiotherapy were excluded. Results: Median age at presentation was 49.50 years (IQR= 42-58 years). Males were more commonly affected (n=167, 79.5%). The most frequent involved site was buccal mucosa (n=110, 52.4%). Out of 210 neck dissections, SMG was involved by the tumor metastasis in only 8 (3.8%) of the cases. Most common method of involvement was direct invasion by the primary tumor (n=5, 62.5%). Floor of mouth (p<0.001) and level 1 lymph node involvement (p<0.001) were significantly associated with SMG involvement. Conclusion: SMG is the major source of unstimulated saliva. Saliva plays an important role in maintaining oral hygiene and health. Especially in patients of oral cavity SCC who receive post-operative radiotherapy its removal can aggravate xerostomia which can lead to severe discomfort. In this study there was no involvement of SMG in cases in which floor of mouth was not involved and in cases with clinically negative neck. So we concluded that efforts should be made to preserve SMG in these cases to reduce post-operative morbidity associated with its removal.

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Palliative Management of Sarcomatoid Buccal Carcinoma by Laser Ablation

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/46409.14555 ◽

2021 ◽

Author(s):

Rusy S Bhalla ◽

Seemantini Bhalla

Keyword(s):

Laser Ablation ◽

Oral Cavity ◽

Sarcomatoid Carcinoma ◽

Second Primary ◽

Malignant Tumours ◽

Laser Technique ◽

Diagnostic Dilemma ◽

Neck Disease ◽

Indian Male ◽

Aggressive Variant

Sarcomatoid change in buccal carcinoma is a rare and aggressive variant of Squamous Cell Carcinoma (SCC) and most often a diagnostic dilemma. There are some reports of second primary sarcomatous tumours in the oral cavity and nasopharynx post irradiation. Synchronous and metachronous lesions in this category in the oral cavity and neck have also been reported. Spindle cell neoplasms comprise a diverse collection of benign and malignant tumours. These tumours are uncommon in the oral cavity, accounting for <1% of all tumours of oral region. It is an unusual aggressive variant that frequently recurs and metastasises. Herein, the author present a case report of a 45-year-old Indian male with a sarcomatoid lesion according to his previous reports in the oral cavity of five months duration at presentation. The patient presented late as he was not willing for surgery and hence a very extensive 9×5 cm lesion was observed. In addition, he had trismus, multiple, firm, fixed lymph nodes in the ipsilateral neck. The biopsy of the oral cavity tumour showed a histological appearance of spindle shaped cells with penetration of basement membrane suggestive of sarcomatoid carcinoma. He was treated with repeated ablative laser technique for the primary and metastatic nodes in the neck disease and chemotherapy. The patient resumed normal activities 14 days after the laser ablation.

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Complications after Functional Neck Dissection in Head and Neck Cancer Patients: An Observational, Retrospective, Single-Centre Study

ORL ◽

10.1159/000514459 ◽

2021 ◽

pp. 1-9

Author(s):

Carlos M. Chiesa-Estomba ◽

Maria Soriano-Reixach ◽

Izaskun Thomas-Arrizabalaga ◽

Jon A. Sistiaga-Suarez ◽

Jose A. González-García ◽

...

Keyword(s):

Head And Neck ◽

Neck Dissection ◽

Postoperative Period ◽

Surgical Complications ◽

Statistical Correlation ◽

University Hospital ◽

Common Complication ◽

Neck Malignancy ◽

Single Centre Study ◽

Functional Neck Dissection

Introduction: Functional neck dissection (FND) represents a surgical procedure usually associated with less morbidity. Methods: An observational, retrospective, analysis of patients diagnosed with any type of head and neck malignancy was designed to summarize and report the incidence of postoperative complications in patients undergoing FND including just those levels described for selective neck dissections in a tertiary university hospital between June 2016 and June 2019. Results: 131 patients met the inclusion criteria. The total number of sides studied was 200. 40.5% of the patients suffer a complication in the postoperative period, being the spinal accessory nerve (SAN) injury the most common complication (10%). We did not find any statistical correlation between the previous organ-preservation treatments and surgical complications (p = 0.207). An advanced T stage (p = 0.009) and the need of bilateral FND (p = 0.034) were significantly correlated with a higher risk of surgical complications. Conclusion: FND represents a useful technique. In this study, 40.5% of the patients suffer a complication in the postoperative period, being the SAN injury the most common complication. However, these data contribute to increasing our knowledge about surgical complications related to FND.

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Second primary tumours after squamous cell carcinoma of the oral cavity

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2021.03.242 ◽

2021 ◽

Author(s):

Maria T. Brands ◽

Gaby Campschroer ◽

Matthias A.W. Merkx ◽

André L.M. Verbeek ◽

Boukje A.C. van Dijk ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Second Primary ◽

Second Primary Tumours

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Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients

The Journal of Laryngology & Otology ◽

10.1258/0022215011907703 ◽

2001 ◽

Vol 115 (2) ◽

pp. 112-118 ◽

Cited By ~ 18

Author(s):

A. Escribano Uzcudun ◽

P. Bravo Fernández ◽

J. J. Sánchez ◽

A. García Grande ◽

I. Rabanal Retolaza ◽

...

Keyword(s):

Retrospective Study ◽

Head And Neck ◽

Clinical Features ◽

Medical Records ◽

Performance Status ◽

Nasopharyngeal Cancer ◽

University Hospital ◽

Premalignant Lesions ◽

Pharyngeal Cancer ◽

Presenting Symptoms

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypophyarngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment.The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology.All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathlogy, 6) presenting symptoms, 7) time to diagnosis, 8) patients’ general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases.Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.

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