1. Mauricio A. Moreno, M.D. Assistant Professor Department of Otolaryngology- Head and Neck Surgery University or Arkansas for Medical Sciences Mauricio A. Moreno, M.D. Assistant Professor Department of Otolaryngology- Head and Neck Surgery University or Arkansas for Medical Sciences Update on Cancer in Arkansas: Oral Cavity Cancer Update on Cancer in Arkansas: Oral Cavity Cancer Arkansas Cancer Coalition, March 2014

2. DisclosuresDisclosures No financial disclosures No financial disclosures Consent for medical photography Consent for medical photography

3. Oral Cavity Pharynx Larynx

4. Mucosal lip Buccal mucosa Upper alveolar ridge Lower alveolar ridge Retromolar trigone Oral tongue - Tip - Lateral borders - Dorsum - Ventral (nonvillous) FOM Hard palate Anatomical Sites

5. HNSCC is the 6th most prevalent cancer in US (3rd in developing countries). Oral cavity cancer represents 50% of all HNSCC. Lifetime Risk= 1.09%, of all men and women born today will develop cancer of the oral cavity pharynx during their lifetime. Currently, the median age for diagnosis is 62 years and for death is 67 years. 2010, in the US there were approximately 275,193 men and women alive with history of- or active disease. Mortality has decreased significantly in the last 3 decades Increasing incidence of tongue cancer in pts< 40y Epidemiology

6. Incidence and Mortality National Cancer Institute. Bethesda, MD, based on November 2012 SEER data submission

7. Tongue Gums & other mouth Lip Floor of mouth

9. National Cancer Institute. Bethesda, MD, based on November 2012 SEER data submission Prognosis Stage at Diagnosis Stage Distribution 5-year Survival Localized (confined to primary site) 31%82.7% Regional (spread to regional lymph nodes) 47%59.2% Distant (cancer has metastasized) 17%36.3% Unknown6%49.3%

10. Tumor Size and Prognosis Early diagnosis is critical to improve outcomes

11. Head and neck cancer has a disproportionate impact in African- Americans. - 47-65% higher incidence - Three times more likely to develop the disease before age 50 - 58-78% present with advanced disease (compared to 40-50% in whites) - Twice the risk of developing distant metastasis after equivalent locoregional control is achieved Overall Survival Whites 56% African American 34% African-Americans

12. A sore in the mouth that does not heal (most common symptom) Pain in the mouth that doesn’t go away A white or red patch on the gums, tongue, tonsil, or lining of the mouth Trouble chewing or swallowing Trouble moving the jaw or tongue Numbness of the tongue or other area of the mouth Ill-fitting dentures Loosening of the teeth or pain around the teeth or jaw A lump or mass in the neck Symptoms

13. Tobacco Alcohol Poor oral hygiene Ill-fitting dentures Betel-Nut (Paan) Exposure to radiation Family history HPV?..not clearly related Risk Factors Betel-Nut

14. Premalignant Lesions Leukoplakia Erythroplakia Erythroleukoplakia Lichen Planus Normal mucosaModerate Dysplasia

15. The Evolution of Treatment in Head and Neck Cancer

16. Radiation therapy + Brachytherapy Surgery +/- Radiation therapy Treatment Options