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Anaesthesia for oral and maxillofacial malignancy 

Anaesthesia for oral and maxillofacial malignancy
Chapter:
Anaesthesia for oral and maxillofacial malignancy
Author(s):

Anjum Ahmed-Nusrath

, Seema Pathare

, and Stephen Bonner

DOI:
10.1093/med/9780199564217.003.0016
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date: 26 February 2020

Oral cancer is the sixth most common cancer worldwide and accounts for approximately 2% of all cancerrelated deaths. Approximately 5000 new cases are diagnosed annually in the United Kingdom. In recent years, trends show a significant increase in the incidence of oral cancer in young males (aged under 40 years).

Squamous cell carcinoma accounts for 90% of all malignant head and neck tumours, but a wide variety of other tumours and premalignant states may also present in this region. Patients with oral cancer have a 10% risk of having a synchronous primary elsewhere in the aerodigestive tract. Almost 60% of patients present with advanced disease. Lesions in the head and neck region spread primarily by the lymphatic system and distal metastasis occur relatively late in the course of the disease. In all, 30 40% of patients with head and neck cancer have persistent or recurrent locoregional disease after completion of definitive treatment. Despite advances in cancer treatment, the overall 5-year survival rates for cancer of the oral cavity and pharynx have remained unchanged at around 55%.

The main predisposing factors are smoking and alcohol, which seem to have a synergistic effect. Chewing betel nut, tobacco, and poor oral hygiene are significant risk factors for oral cancer. In addition, more recent evidence is emerging of a link between viral infection with human papilloma virus 16 and oral cancer. Immunosuppression in solid-organ transplant recipients is also an important risk factor in a small subgroup. Head and neck cancer occurring in transplant patients tends to affect a younger group of patients and is more aggressive with a poorer outcome as compared to the general population. Cancer progression has been associated with loss of tumour suppressor oncogenes p16 and p53 and an increase in epidermal growth factor receptor, which is being investigated as a biomarker for the disease.

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