Oral cancer or mouth cancer is a common neoplasm diagnosed globally with incidence and mortality – that have also increased over the past decades. Oral cancer is characterized by poor prognosis and a low survival rate. This poor outcome is predicted, despite sophisticated surgical and radiotherapeutic modalities.
The advanced stages of oral cancer or Metastasis of mouth cancer is a complex process. It means that the cancer cells have spread to other parts of body. It is involving the mechanism defined as detachment of cells from tumor tissue, regulation of cell motility and invasion, proliferation and evasion through the lymphatic system or blood vessels.
The current knowledge in metastasis from oral cancer or mouth cancer spread and regarding facts, such as incidence; stage, histopathology and grade of primary tumor; clinical manifestations; diagnosis; and treatment- needs to be considered for determining treatment regimen. Certainly, this is achieved by understanding of oral cancer pathogenesis.
After understanding the underlying pathogenesis and staging the cancer spread- allows the treating team to make an educated treatment decision.
The mouth cancer best treatment strategy is designed with predicted good outcome that begins with knowing the stage, or progression, of the disease.
Our best oncologists in Cancer Rounds use a variety of diagnostic work up SOPs to evaluate oral cancer and develop an individualized treatment plan in a multidisciplinary way.
If you have been recently diagnosed, the team ill request for review of your pathology to confirm you have received the correct diagnosis and staging information. This allows you to meet the effective treatment plan and this is tailored to you and your needs which is individual for each case. If the patient reports with recurrence, oncologists will perform comprehensive testing to recommend a treatment approach that is personalized to the cancer type and stage.
Stage oral cancer using the American Joint Committee on Cancer’s TNM system, a commonly accepted method -
T (tumor): This describes the size of the original tumor.
N (node): This indicates whether the cancer is in the lymph nodes.
M (metastasis): This refers to whether the cancer has spread to other parts of the body.
A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. For instance, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information could not be assessed.
Once the T, N and M scores have been assigned, an overall stage is determined.
TX: Primary tumor cannot be assessed; information not known.
TO: No evidence of a primary tumor has been found.
Tis: Carcinoma in situ has been diagnosed, meaning the disease is still localized, or contained within the top layers of cells lining the oral cavity. Cancer cells have not invaded the deeper layers of oral tissue.
T1: Tumor is 2 cm across or smaller.
T2: Tumor is larger than 2 cm across, but smaller than 4 cm.
T3: Tumor is larger than 4 cm across.
T4 is divided into two subgroups:
T4a: The tumor is growing into nearby structures. At this stage, the oral cancer is called a moderately advanced local disease. The areas to which cells have spread vary according to the type of oral cancer.
For oral cavity cancers, the tumor is growing into nearby structures, such as the bones of the jaw or face, deep muscle of the tongue, skin of the face, or maxillary sinus.
For lip cancers, the tumor is growing into nearby bone, the inferior alveolar nerve (the nerve to the jawbone), the floor of the mouth, or the skin of the chin or nose.
T4b: The tumor has grown through nearby structures and into deeper areas or tissues. At this stage, the cancer is called very advanced local disease, and may include any of the following conditions:
The tumor is growing into other bones, such as the pterygoid plates (in the skull) and/or the skull base. This type of spreading may occur with any oral cancer.
The tumor surrounds the internal carotid artery. This type of spreading may occur with any oral cancer.
For lip and oral cavity cancers: the tumor is growing into an area called the masticator space.
NX: Nearby lymph nodes cannot be assessed; information not known.
N0: The oral cancer has not spread to nearby lymph nodes.
N1: The cancer has spread to one lymph node on the same side of the head or neck as the primary tumor. This lymph node is smaller than 3 cm across.
N2: This category is divided into these subgroups:
N2a: The oral cancer has spread to one lymph node on the same side as the primary tumor, and the lymph node measures 3-6 cm across.
N2b: The cancer has spread to two or more lymph nodes on the same side as the primary tumor. No lymph nodes are larger than 6 cm across.
N2c: The oral cancer has spread to one or more lymph nodes on both sides of the neck or on the side opposite the primary tumor. No lymph nodes are larger than 6 cm across.
N3: The cancer has spread to a lymph node that measures more than 6 cm across.
M0: No distant spread has been detected.
M1: The oral cancer has spread to distant sites outside the head and neck region (for example, the lungs, liver or bones).
Stages of mouth cancer:
Stage 0: A stage 0 oral cancer tumor means the cancer is only growing in the epithelium. No cancer cells are present in deeper layers of tissue, nearby structures, lymph nodes or distant sites (carcinoma in situ).
Stage 1 oral cancer: A stage 1 oral cancer tumor means the primary tumor is 2 cm across or smaller, and no cancer cells are present in nearby structures, lymph nodes or distant sites.
Stage 2 oral cancer: A stage 2 oral tumor measures 2 cm to 4 cm across, and no cancer cells are present in nearby structures, lymph nodes or distant sites.
Stage 3 oral cancer: A stage 3 oral tumor means one of the following:
Tumor is larger than 4 cm across, and no cancer cells are present in nearby structures, lymph nodes or distant sites.
The oral tumor is any size but has not grown into nearby structures or distant sites.
Cancer cells are present in one lymph node, which is located on the same side of the head or neck as the primary tumor and is smaller than 3 cm across.
Stage 4 oral cancer: There are three categories in this stage:
stage 4A oral cancer, one of the following applies:
T4a, with or without lymph node involvement. Cancer has not spread to distant sites.
N2, with any size tumor: The tumor is any size and may or may not have invaded nearby structures, it has not spread to distant sites, and
Cancer cells are present in one lymph node, are located on the same side of the head or neck as the primary tumor, and measure 3-6 cm across (N2a).
Cancer cells are present in one lymph node on the opposite side of the head or neck, and measure less than 6 cm across (N2b).
Cancer cells are present in two or more lymph nodes, are smaller than 6 cm across, and are located on either side of the head or neck (N2c).
Stage 4B oral cancer, one of the following applies:
T4b, any N, M0: tumor has invaded deeper areas and/or tissues, that may or may not have spread to lymph nodes and has not spread to distant sites.
Any T, N3, M0: The tumor is any size and may or may not have grown into other structures. It has spread to one or more lymph nodes larger than 6 cm across, but has not spread to distant sites.
Stage 4C oral cancer, with any T, and any N, M1: cancer cells spread/ metastasis with a tumor of any size or lymph node involvement. Cancer cells have spread to distant sites, most common to the lungs.
