A review of oral/pharyngeal cancer and a review of 328 cases of lingual squamous cell carcinoma

Between 1979 and 1994, 328 cases of squamous cell carcinoma (SCC) of the tongue were admitted to the BCCA, Vancouver Branch. These cases were reviewed by Drs. Hay, Epstein and van der Meij who also established the data fields that were used in statistical analyses performed by Dr. Le. The analyzed data set comprises Chapter 3, Results, and the data set is critiqued in Chapter 4, Discussion. The major component of the thesis is Chapter 1, Introduction which offers a broad overview of oral/pharyngeal cancer with respect to carcinogenesis, premalignancy, and treatment. In addition, Chapter 1 includes a brief review of epidemiological concepts and provides a perspective for the balance of the thesis in terms of understanding the strengths and shortcomings of previous investigations into the diagnosis, epidemiology, treatments and outcomes of oral/pharyngeal SCC. Conclusions across studies over time for trend data of oral/pharyngeal cancer cannot easily be drawn because of inconsistencies in criteria defining cancer cases and risk factors, and in data analyses and reporting. Nevertheless, analyses of the 328 lingual SCCs revealed that this case series was consistent with other reports of lingual SCC with respect to patient demographics, risk factors, tumour characteristics and survival. Among 328 patients, the mean age was 61 years with a male:female ratio of 1.5:1.0. The majority of patients had a history of alcohol and tobacco use, and the most common symptom was a sore tongue. Most cancers were early stage, well-differentiated keratinizing tumours of the oral tongue. Treatment was primarily radiation alone, followed by a combination of surgery and radiation; complications included necrosis of the soft tissues (10%) and mandible (6%). Patient follow-up ranged from 0 to 154 months. The overall all-cause survival was 41% and the stage of disease was significantly (p