Oral & Maxillofacial Surgery

Support Group - Facts - Oro-facial Cancer

Oro-facial Cancers

What are Orofacial cancers?

Orofacial cancers are the 6th most common cancer worldwide and it has risen in the oral cavity and adjacent structures. Over 80% are squamous cell carcinomas (SCC) arising from the skin of the mouth and lip.

Some facts and statistics

There are about 2,000 new cases per year registered in the United Kingdom but they may be under-reported by up to 25%. Despite progress in cancer diagnosis and treatment during the last decades, the prognosis of Orofacial SCC remains poor with a 5-year survival rate of less than 55%. This poor prognosis has not changed over the past few decades. Oral SCC kills at least 1,400 people each year in England and Wales; nearly two thirds of patients with this cancer will die of their disease. This is similar to the death rate for other cancers, such as breast cancer, but Orofacial cancer also shows a worsening trend in the last decade against, for example, cancer of the cervix where early diagnosis has improved the prognosis for many patients. This grim reading is largely due to patients' late presentation to specialist care via their doctors or dentists where very often the cancer has become invasive and advanced.
There is also an increasing trend in Orofacial cancer especially tongue cancer. It is of particular concern because the increase in tongue cancer seems to affect the younger age group of less than 40 years old and more so in women.

NOTE: Any suspicious lesions (patch, ulcer or swelling) of face, jaw, mouth, head and neck which have not healed within three weeks should be seen by an Oral and Maxillofacial Surgeon. Early diagnosis and prompt management of small cancers is of vital importance to ensure good survival rate and functional outcome.

Further information is available on Facial Skin Lesions and Mouth Patches on this website.

Pre-Cancerous Lesion and its diagnosis

What is a precancerous lesion?

A precancerous lesions is an identifiable local sign or abnormality which has an increased risk to develop into a cancer

Some facts

Although Orofacial SCC can arise against a background of clinically normal mucosa, some appear to be preceded by recognizable pre-invasive lesions. The reasons for this are not known. However, it is proposed that cancer arises through a series of discrete genetic events (e.g. mutations), which eventually develop into an invasive cancer. Pre-cancerous lesions may represent the consequences of a number of distinctive mutational events, which are sufficient to cause changes to the mouth lining, but are not yet fully transformed into invasive cancer.
Although there is a possibility of malignant change among the premalignant lesions or conditions, the percentage quoted in many research reports is often irrelevant to individual patients because it is well known that some early premalignant lesions are reversible in early stages if the initial stimulus such as smoking and drinking is removed.
The difficulty in managing premalignant lesions often relates to the criteria used for assessing the presence or degree of premalignant features under microscope after a biopsy.

Further information is available on Facial Skin Lesions and Mouth Patches on this webside.

NOTE: In summary, there is at present no reliable diagnostic procedure to guide surgeons and pathologists which premalignant lesions will progress to invasive carcinoma. Regular review and biopsy by an Oral and Maxillofacial Surgeon are therefore paramount in monitoring any change to the premalignant lesions. Hence prompt treatment can be commenced once early signs of invasion become apparent.

Management

Management

Patients with suspicious Orofacial cancer should be seen by an Oral and Maxillofacial Surgeon for diagnostic investigation. Once the diagnosis is certain, the patient will be referred to a multi-disciplinary team i.e. Combined Head and Neck Oncology (Cancer) Clinic for treatment. The team consists of surgeons and radiotherapists/oncologists and they are supported by Maxillofacial technicians, dental hygienists, restorative/prosthetic dental surgeons, dietitians, speech therapists, physiotherapists, trained nurse practitioners/counselors (e.g. MacMillan nurses) and have access to specialist histopathology and radiology services.The types of treatment are either surgery, or radiotherapy or chemotherapy or a combination of these as jointly decided at the Combined Head and Neck Oncology Clinic.
Surgery would be carried out in a Specialist Unit which has full anaesthetic and intensive care support. Trained nurses and other support staff are also important in providing specialist patient care as part of our 'whole patient care' approach.

Further information is available on Facial Skin Lesions and Mouth Patches on this website.

The Role of Oral and Maxillofacial Surgeon in the Management of Orofacial Cancer

Oral and Maxillofacial Surgeons are doubly qualified in Medicine and Dentistry with specialist training and experience which gives an unparalleled understanding of the surgical anatomy and pathology of Orofacial cancer. Therefore they are ideally qualified to take a lead role in the management of Orofacial cancer.

Oral and Maxillofacial Surgeons expertise

• The diagnosis, treatment and long term review of precancerous lesions. They also organise oral screening program in Orofacial or Mouth Cancer Awareness Week nationally.
• The diagnosis and treatment of cancer of the face, mouth, head and neck.
• The management of dental and gum disease and the bite, (occlusion), which is of paramount importance in preparing patients for reconstruction and rehabilitation stages of treatment. This is vital in restoring the function and form of the Orofacial structures.
• The surgical removal of Orofacial cancers, with the expertise in reconstructing the defect created using local or distant flaps and grafts, including the use of microvascular and microneural techniques.
• The prosthetic reconstruction using plates and mesh techniques for bone flaps and grafts and for jaw reconstruction.
• The provision of surgical plates, obturators, facial prostheses and dentures with or without implants, and restoration of teeth. This wholesome treatment plan is closely liaised with Maxillofacial technicians, Restorative/Prosthetic dental surgeons, Dental Hygienists and the patient's Dental Practitioner.

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