Mouth Cancer: the Maxillofacial Surgeon's perspective

General dental practitioners play a key role in the detection and early management of oral cancer, referring approximately 40% of all cases to secondary care, as well as the post-treatment phase of cancer care.¹ Head and neck cancer in general is the eighth most common cancer in the UK and is four times more common in men than in women. The incidence has increased in both sexes since the 1990s with a greater percentage increase among females, closing the gender difference in incidence over time.² Late-stage disease is a more common presentation than early-stage disease (62% are stage III/IV at presentation versus 38% at stage I/II).³ In the case of oral cancer specifically (anterior to the hard/soft palate junction and tonsils), surgery is the commonest and most effective form of curative treatment, often requiring wide local resection of soft tissues with bone, if needed, ensuring a clinical margin of 1 cm. This can have significant consequences for oral function, dental rehabilitation and facial aesthetics. For advanced squamous cell carcinomas (SCCs), combined treatment modalities (surgery and radiotherapy with/without chemotherapy) offer the highest chance of cure.⁴ In some cases, typically because of patients' fitness for surgery, radiotherapy (with/without chemotherapy) may be the primary treatment modality for curative intent. For oropharyngeal and hypopharyngeal cancer (posterior to the hard/soft palate junction, tonsils and tongue base), treatments are more variable, with the use of radiotherapy, chemoradiotherapy and surgery to varying degrees, depending upon the patient, tumour and local resources. Oropharyngeal tumours are much more radiosensitive to radiotherapy, particularly if associated with human papilloma virus (HPV).⁵