(include figure of NCCN guidelines here after we obtain permission)
Treatment of oral cavity cancer can be divided into management of early stage, defined as stage I/II, and late stage, defined as stage III/IV, disease. For early stage disease, surgery is the mainstay of treatment. For late stage disease, surgery with adjuvant therapy is the preferred treatment for resectable disease. Adjuvant therapy may be radiation therapy alone, or adjuvant chemotherapy and radiation therapy for high risk disease. For the remainder of this document, we will be discussing only squamous cell carcinomas of the oral cavity. Other pathologies may have different treatment strategies.
Early stage oral cavity cancer encompasses any primary tumor less than 4cm (T1 and T2 tumors), without evidence of nodal metastasis. The NCCN guidelines recommend single modality treatment, favoring surgery for these lesions. Primary radiation therapy may be considered, and is discussed further below.
As a general rule, functional outcomes following resection of early stage tumors are favorable. Patients can be expected to have temporary postoperative dysphagia and dysarthria, but with expected return to baseline function within weeks. The severity and duration of dysfunction, along with ultimate ability to return to preoperative function, are related to tumor size and location. Because of the distinct characteristics of the oral cavity subsites, each anatomical subsite has special considerations. Broadly, tumors can be defined as arising from the oral tongue, floor of mouth, hard palate/maxilla, buccal mucosa, and retromolar trigone, though tumors may occupy multiple sites.
Resection of early oral tongue cancers is generally well tolerated as the tongue has a remarkable ability to heal physically and functionally. Larger cancers necessitating greater loss of tongue muscle are more likely to have residual dysphagia and/or dysarthria. Tongue cancers that extend posteriorly may be difficult to access per orally and may necessitate additional techniques for complete resection. Small tongue defects can be closed primarily, skin grafted, or left to granulate secondarily, all generally with good functional results. Large tongue defects generally require a more extensive reconstruction, including possible free tissue transfer, to maximize long-term function.