Stage II Oral Cancer: Recurrence, Metastasis, and Survival Rates

Stage II oral cancer

Hello Doctor, my sister was diagnosed with stage II left oral mucosal cancer in September last year.
Bone scans and neck CT scans showed no metastasis.
After the primary physician surgically removed the tumor and sutured with artificial skin (without performing lymphadenectomy), she has been regularly scheduled for follow-up visits.
In early May this year, my sister felt a painful, immovable lump on the left mandible, and a CT scan suggested possible metastatic lymph nodes.
She is currently scheduled for lymphadenectomy, and we have been informed that we will need to wait for the pathology results to determine if it is indeed metastasis.

Dr.
Chen, is it possible for stage II oral cancer, which has had the tumor surgically removed and is still considered early stage, to metastasize to lymph nodes in less than a year? If it is metastatic, how is the cancer stage reassessed? Additionally, does recurrence of oral cancer refer to regrowth at the original site, while growth in other locations is considered metastasis? Will the survival rate also change? Thank you, Dr.
Chen, for your patience in reading this.

Niming, 40~49 year old female. Ask Date: 2023/06/26

Dr. Chen Sirong reply Oncology

Anonymous / 46 years old / Female
Hello, I have been diagnosed with stage II oral cancer, and after the tumor was removed, it has been less than a year, and now it has metastasized to the lymph nodes.
Is this possible?
A: Yes, it can occur.
If metastasis happens, how is the cancer stage assessed?
A: Because the location varies, and it can differ between the left and right sides, imaging studies such as CT scans, MRIs, and PET scans are necessary to determine the clinical staging.
Ultimately, the pathological staging is decided based on the surgical results.

Is recurrence defined as the cancer growing back in the original location, while growth in other locations is considered metastasis?
A: You are correct.
Recurrence refers to the cancer reappearing in the original location, while growth in other areas is classified as metastasis.
However, it can be categorized as: local lymph node metastasis, which is what you are currently experiencing, or distant metastasis.

Does this change the survival rate?
A: Yes, changes in staging can affect survival rates.
The AJCC staging system uses the TNM classification to determine the stage: T represents the primary site, N represents lymph nodes, and M represents distant metastasis.

N0 indicates stage I or II, N1 indicates at least stage III, N2 indicates at least stage IV A, N3 indicates at least stage IV B, and M1 indicates distant metastasis, which is classified as stage IV C.

As for your case, with N123, whether there is spread to other areas and M1 status must be answered by her physician.
Thank you for your inquiry, and I wish you a smooth treatment process.
Taoyuan Hospital
Chen Sih-Rong

Reply Date: 2023/06/26

More Info

Understanding Stage II Oral Cancer: Recurrence, Metastasis, and Survival Rates
Oral cancer, particularly at Stage II, presents a complex clinical picture that requires careful monitoring and management. Your sister's diagnosis and subsequent treatment raise several important questions regarding recurrence, metastasis, and survival rates, which I will address in detail.

Recurrence and Metastasis
Recurrence in oral cancer refers to the return of cancer at the original site after treatment, while metastasis indicates the spread of cancer to other parts of the body, such as lymph nodes or distant organs. In your sister's case, the initial diagnosis of Stage II oral cancer suggests that the tumor was localized and had not spread to lymph nodes or distant sites at the time of diagnosis. However, the emergence of a painful lump in the left jawbone less than a year after surgery raises concerns about possible metastasis.

The fact that her imaging studies indicated no initial lymph node involvement is reassuring, but it does not eliminate the possibility of recurrence or metastasis. The lymphatic system is a common pathway for cancer spread, and even in cases where initial imaging shows no involvement, cancer can still recur or spread later. If the upcoming lymph node dissection reveals cancerous cells, this would indicate a metastasis, and the cancer stage would be re-evaluated based on the new findings.

Staging and Evaluation
If metastasis is confirmed, the cancer would be classified as Stage III or IV, depending on the extent of spread. The American Joint Committee on Cancer (AJCC) staging system considers factors such as tumor size, lymph node involvement, and distant metastasis. For oral cancers, the presence of cancer in lymph nodes typically escalates the stage, which can significantly affect treatment options and prognosis.

Recurrence vs. Metastasis
It's crucial to differentiate between recurrence and metastasis. If the cancer returns to the original site (the oral cavity), it is classified as a recurrence. If it appears in a different location, such as lymph nodes or other organs, it is considered metastasis. This distinction is vital for determining the appropriate treatment strategy and understanding the prognosis.

Survival Rates
Survival rates for oral cancer can vary significantly based on several factors, including the stage at diagnosis, the presence of metastasis, and the effectiveness of treatment. For Stage II oral cancer, the five-year survival rate is generally favorable, often exceeding 70-80%. However, if metastasis occurs, the prognosis can change dramatically. The five-year survival rate for Stage III and IV cancers drops significantly, often falling below 50%.

Conclusion
In summary, your sister's situation is concerning, and the upcoming lymph node dissection will be crucial in determining whether the cancer has metastasized. If it has, her cancer stage will be re-evaluated, and this will impact her treatment options and prognosis. Continuous follow-up care is essential, as early detection of recurrence or metastasis can lead to more effective interventions.
Encourage your sister to maintain open communication with her healthcare team, as they can provide personalized guidance and support throughout her treatment journey. Additionally, lifestyle factors such as a balanced diet, regular exercise, and avoiding tobacco and alcohol can contribute positively to her overall health and recovery.

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