Introduction

Throughout the world, the incidence of oral cavity cancer varies widely. Malignancies within the confines of the oral cavity represent approximately 30% of all head and neck cancers, and 95% of these malignancies are squamous cell carcinoma (1). Globally, a variety of local customs, a myriad of tobacco uses, and chronic alcohol consumption increase the risk for oral cancer (2).

Within the United States, oral and pharyngeal cancer represents about 3% of all cancers (3), and roughly 30,000 new cases are diagnosed annually (4), accounting for approximately 4000 deaths per year. Oral and pharyngeal cancers have one of the lowest five-year survival rates (53%) which unfortunately have remained constant for the last three decades (5), likely due to the fact that most oral cancer patients present with advanced stage disease (T3, T4): 40% have regional disease, and 10% have distant metastasis (6).

Ninety percent of oral cancers occur in males older than 45 years of age. In the last several decades; however, the ratio of male to female cancer cases has decreased from 6:1 in 1950 to 2:1 in 1987 until the present (7,8). This change may reflect greater numbers of aging females and an increased use of tobacco products and alcohol among women.

As noted above, approximately 75% of oral cancers are associated with two important risk factors, alcohol ingestion and use of tobacco in any form (9). When alcohol and tobacco are used in combination, the deleterious effects are synergistic (3,10). Data suggest additional risk factors for oral cancers, such as smoking of marijuana (11), presence of the human papilloma virus (12), and malnutrition (13).

Epidemiologic studies have shown not only an increased risk for oral cancer in populations with increased consumption of alcohol and tobacco products but also a risk for a second primary tumor in patients previously cured of a first head and neck primary (9). Within the confines of the oral cavity, cancer patients with primary tumors located in the floor of mouth (FOM), retromolar area, or lower alveolar process have the greatest risk for a second primary squamous cell carcinoma (14).

Research continues in pursuit of meaningful screening tests to identify and monitor patients at risk for this form of carcinoma. Although, oncology surgeons have improved multi-modality treatment options and reconstructive surgery to increase patients' quality of life and function, screening tests lag behind these advances. Each oral cavity area presents its own challenge to obtaining the optimal resection of cancer, restoration, and maintenance of function and continued assessment for new or recurrent disease.

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