Oral cancer: Review of current management strategies.

Background. India has one of the highest incidences of oral cancer and accounts for about 30% of all new cases annually. A high prevalence of smokeless tobacco use has led to an increasing incidence, which in combination with delayed presentation has made oral cancer a major health problem in India. Limited access to cancer care, relative lack of trained healthcare providers and financial resources are some of the challenges to the management of oral cancer in India despite improvements in diagnostic techniques and management strategies. Methods. We reviewed the literature pertaining to the epidemiology, aetiopathogenesis, pre-malignancy, tumour progression, management of the primary site, mandible, neck lymph node metastases, reconstruction options and screening of oral cancer. The parameters evaluated were overall survival, disease-free survival, recurrence and loco-regional control. Results. Nine studies on surgical intervention were reviewed. There were 23 studies on the management of chemotherapy and 30 trials analysing radiotherapy as an intervention. Conclusion. India has one of the highest incidences of oral cancer and delayed stage presentation is common. Surgery remains the treatment of choice and adjuvant treatment is recommended in high-risk patients. Elective neck dissection is warranted in clinically lymph node-negative neck for patients with thick tumours, imaging-suspected lymph nodes and those who may not have a reliable follow-up. Functional outcomes and treatment-related morbidity needs to be considered, and reconstruction with free tissue transfer provides the best results.

Hypercalcemia and treated breast cancers: the diagnostic dilemma.

The relationship of hypercalcemia with cancer is well described in the literature. Breast cancer is the commonest malignancy associated with hypercalcemia; the detection of hypercalcemia in these patients usually signifies metastatic disease and is associated with a poor prognosis. However, the treating oncologist should keep in mind that a strong correlation exists between breast cancer and primary hyperparathyroidism. We present a case of a patient of treated breast cancer who, in the absence of metastatic bone disease, developed hypercalcemia due to hyperparathyroidism secondary to a parathyroid adenoma.

Squamous cell carcinoma of the maxillary sinus: a Tata Memorial Hospital experience.

BACKGROUND: The optimal treatment of maxillary sinus carcinoma remains to be defined and there is a paucity of Indian studies on the subject. AIMS: To present experience of management of squamous cell carcinoma of the maxillary sinus treated with curative intent at a single institution. SETTINGS AND DESIGN: Retrospective study of patients with squamous cell carcinoma of the maxillary sinus who presented between 1994 to 1999. MATERIALS AND METHODS: The records of 73 patients with squamous cell carcinoma of the maxillary sinus were analyzed. Sixty-two patients were evaluable. Forty patients (65%) were treated with surgery followed by postoperative radiotherapy, five patients (8%) were treated with radiotherapy alone, five patients (8%) were treated with surgery alone; 12 patients (19%) received chemotherapy. Statistical analysis used: Statistical analysis was done using Kaplan-Meier method. RESULTS: The majority of patients presented with locally advanced disease (52, 84%); nodal involvement was observed in five patients (8%). The most common site of recurrence was at the primary site, which was observed in 28 patients (45%) and regional failures occurred in 10 (16%). The 3 and 5-year overall survival was 38% and 35% and the disease free survival was 29% and 26% respectively. The 5-year overall survival after surgery and postoperative radiotherapy was 42%. CONCLUSIONS: The majority of patients present with advanced disease resulting in poor outcomes to conventional treatment modalities. Locoregional tumor progression remains a significant pattern of failure. New approaches such as neoadjuvant or concomitant chemoradiotherapy with aggressive surgery need to be considered and evaluated in prospective studies.