Cancers de la cavité buccale. Préambule, épidémiologie, étude clinique

Abstract

Oral cancers are part of the upper aerodigestive cancers: they share the same epidemiologic feature. The oral cancer incidence in France has been only evaluated: it appears to be one of the highest worldwide, with around 15400 new lip-oral-pharyngeal lesions registered in 2000. In our country, it's the 5^th location in term of cancerous location and about the 8^th cause of mortality. In over 90% of the cases, histology finds a squamous cell carcinoma. The average age of the patients is 60 years. Main risk factors are tobacco - in particular when the consumption exceeds 20 packages-years - and alcohol consumption. Women are increasingly exposed to these risk factors. These cancers appear mostly on a healthy mucosa. Squamous cell carcinomas appear as a granulated ulceration, resting on a hardened base. The functional signs are late, the pain prevails. Depending on the localization within the oral cavity, localized dental mobility, trismus, limitation of tongue mobility or a reflex ear-pain can be observed. The clinical examination combines the study of the tumour head and neck extension, the screening for a second cancer and for visceral metastases, and the evaluation of general health status. Radiological, endoscopic and biological assessments are carried out. The therapeutic management is collectively decided, during a multidisciplinary consultation: depending on the tumour size and location, the treatment is based on one or several techniques. The therapeutic step is systematically followed by a regular, clinical check-up aimed at establishing cancer continuation or a recurrence, a second cancer, or some therapeutic complications. The 5-year survival, stable for two decades, is about 30% for men and 50% for women.