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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Cancer of the mouth and tongue, a head and neck cancer, is caused mainly by tobacco, alcohol and betel quid and is usually visible or feelable early, yet often diagnosed late. Surgery is the mainstay, with radiotherapy or chemoradiation after operation for higher-risk disease, and reconstruction to restore speech and swallowing.
Oral cavity squamous cell carcinoma arises on the tongue, floor of mouth, gums, buccal mucosa, palate and lips, often from a white or red patch (leukoplakia or erythroplakia). Unlike oropharyngeal cancer it is rarely HPV-driven; tobacco, alcohol and, in South and South-East Asia, betel quid with areca nut are the causes, and a screening trial in Kerala showed that visual inspection by trained health workers reduces mouth cancer deaths in high-risk people. Treatment is surgical resection with neck dissection and free-flap reconstruction, with postoperative radiotherapy or cisplatin chemoradiation for advanced stage, positive margins or nodal spread with extranodal extension. Depth of invasion now determines stage and the need to treat the neck. Recurrent or metastatic disease is treated as for other head and neck cancers with pembrolizumab-based therapy, and metronomic methotrexate-celecoxib from Tata Memorial Hospital offers a low-cost option.
| Setting | Approach | Guideline |
|---|---|---|
| Screening in high-risk populations | Visual oral examination by trained workers reduced mouth cancer deaths in the Kerala trial; opportunistic examination by dentists elsewhere. | not mapped |
| Early disease | Wide excision with elective neck dissection when depth of invasion exceeds about 3 to 4 mm; sentinel node biopsy in selected cases. | not mapped |
| Locally advanced disease | Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for positive margins or extranodal extension. | not mapped |
| Recurrent or metastatic | Pembrolizumab with or without chemotherapy (KEYNOTE-048); low-cost metronomic methotrexate and celecoxib where access is limited. | not mapped |
| Prevention | Tobacco and betel quid cessation, alcohol reduction, treatment of premalignant patches. | not mapped |