The Relationship of Oral Cancer and Lymph Nodes

The objective of my STEAM project is “relate how the lymphatic system can cause disease.” I would like to discuss the topic of oral cancer and the lymph node relationship that can exist with oral cancer. I will discuss oral cancer statistics, symptoms, what the lymph nodes tell us about patients with oral cancer and finally treatments and recommendations for oral cancer. For my project I have painted my friend Sarah’s face. I have painted the muscles red and pink, the nerves blue, the submandibular and parotid glands are yellow and the lymph nodes are shown in green.  I wanted to show the location of the lymph nodes in relation to the maxilla and mandible. The proximity of the oral cavity to the lymph nodes in the head and neck is a contributing factor to the ease of spread.

  All cancer has the potential to be deadly but Oral Cancer is one not talked about as much in the United States. Approximately 30% of head and neck cancers are represented by tumors arising in the oral cavity with 95% being composed of squamous cell carcinoma (SCC) (Tsai). Cancer arising in the head and neck region is the 6th most common malignancy worldwide, being diagnosed more than half a million patients per year. In the US 23,840 cases will be newly diagnosed this year and an estimated 5470 will die from this disease (Kim). Cancer in the oral cavity mostly appears on the tongue. The presentation is a red or white patch that does not heal or disappear. The most affected sites are the tongue, inferior lips and floor of the mouth (Doshi). Other symptoms include, mouth pain, a persistent sore throat or even a bump on the tonsils or neck. 

A later finding of oral cancer is swollen lymph nodes. When the lymph nodes of the neck are swollen, this is a signal that the cancer has spread to the lymph tissue. Lymph nodes exist all over the body; there are over 300 in just the head and neck alone. Oral squamous cell carcinoma has a great predisposition to produce metastasis in lymph nodes (Bugshan). The primary lymph nodes we see metastasized are the ones located in the neck region. There have been several studies performed on what the oral cancer associated lymph node metastases tells us and the research states that “The most common site for OSCC metastasis is cervical lymph nodes, and it reduces the survival rate by 50%” (Bugshan) In other words, if the cancer has spread to the lymph nodes, the chances of survival are lower.  This is because by the time the oral cancer has spread to the lymph nodes, it is usually in the later stages, “Oral squamous cell carcinoma, may be accompanied with cervical lymph node metastases in advanced stages” (Koerdt) Of course there are other factors involved with survival rate of Oral Cancer such as “clinical stage at diagnosis, tumor size and invasion depth, and histological type” (Patel) 

Additionally, “Lymph node density can potentially assist in identifying patients with poor outcomes and therefore for whom more aggressive adjuvant treatment is needed. Lymph node density is the number of positive lymph nodes/total number of excised lymph nodes (Patel) Researcher S G Pastel has concluded that the number of infected lymph nodes can help determine the path of treatment because it is a sign of severity.

In clinical practice, the treatment plan and prognosis of oral squamous cell carcinoma is mainly based on the primary tumor, regional lymph node metastasis, and distant metastasis (TNM) staging system (Doshi). Treatment can include a glossectomy, chemo and radiation therapies. A glossectomy is a procedure in which the tongue is reconstructed from tissue from other parts of the body. 

Finally, it is recommended to get oral cancer screenings yearly at your local dentist office. “A thorough head and neck lymph node inspection and palpation for all first-time patients should be performed to help in early detection of cancer, which will increase the chances for successful treatment and improve prognosis” (Bugshan). Additionally, if you feel that you have a suspicious lesion in your mouth, you should go to your dentist for further examination.