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    Cancer of the Lip


Cancer of the lip is usually squamous cancer and is classified an oral cavity (head and neck cancer). It can be serious and carry a risk of spreading to the lymph nodes in the face area. A basal cell skin cancer that spreads from the skin on the face to the edge of the lip would be considered skin cancer (go here). The discussion below is applicable to squamous cancers that arise on the lip.

This can be treated with surgery or radiation, ( NCI site or review here).  NCCN guidelines for early , more advanced and very advanced and radiation guidelines. See neck nodes from lip cancer.

CC Wang reported local control rates for lower lip cancer as: T1 (100%) T2 (91%) T3 (86%) using radiation.
more pictures here and here.

some of the studies on radiation are noted below.

basal cell cancer left upper lip, before and after radiation

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Early stage carcinoma of the lip can be managed with surgery or radiation therapy. However, surgery is generally preferred for small tumors (<2 cm). Although the local control of T1 and T2 squamous cancers of the lip is excellent with surgical resection, disruption of the oral sphincter provided by the orbicularis muscle can lead to oral incompetence if not properly reconstructed. Therefore, a number of reconstructive methods have been developed to help preserve oral sphincteric function even following large excisions for T3 and T4 lesions. For these larger lesions, surgery followed by radiotherapy remains a standard therapy.
 
When primary radiotherapy is used to treat lip cancer, the target volume should include the primary tumor plus a 1.5- to 2-cm margin. For early stage lesions, photons in the orthovoltage range (100 to 200 keV) or electrons may be used. The electron energy should be chosen based on the thickness of the lesion (commonly 6 to 9 MeV). Effort should be made to shield the underlying gum, dentition, and mandible as appropriate. This can be accomplished with the use of oral shields or cerrobend stents. The recommended dose is 50 Gy in 4.5 to 5 weeks for smaller lesions and 60 Gy in 5 to 6 weeks for larger lesions. Some institutions have used an approach where external beam radiation is given to approximately 40 to 50 Gy followed by a brachytherapy boost, or smaller lesions are treated by primary brachytherapy alone. An important consideration in managing lip cancer is the risk of regional metastatic disease. Generally, the risk of regional lymph node metastatic disease for T1 and T2 cancers of the lip is lower than for stage-matched tumors of other oral cavity sites. Thus, elective neck dissection is recommended for patients with T3 and T4 carcinomas of the lip; however, it may not be warranted for all T1 and T2 lesions. Some institutions have used a “moustache field” for elective irradiation of the perifacial lymphatics (approximately 50 Gy) for more advanced upper lip lesions. Sentinel lymph node biopsy may prove to be useful in the management of patients of node-negative lip cancers, but further clinical investigation in this area is needed.

A comparison of results after radiotherapy and surgery for stage I squamous cell carcinoma of the lower lip.

de Visscher JG, Botke G, Schakenraad JA, van der Waal I.  Head Neck 1999 Sep;21(6):526-30

Department of Oral and Maxillofacial Surgery, Medisch Centrum Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The Netherlands.

BACKGROUND: Controversy still exists as to whether radiotherapy or surgery is the preferable therapeutic modality for stage I squamous cell carcinoma of the lower lip. Therefore, a retrospective study was undertaken to compare the results of both treatment modalities. METHODS: The results of 90 patients who received radiotherapy and 166 patients who underwent surgery as the primary form of treatment for their stage I primary squamous cell carcinoma of the lower lip were evaluated. Tumor size and histological grade of differentiation were assessed. RESULTS: Local control rates were the same with radiotherapy or surgery. Overall survival rates for both groups of patients were similar as well. Disease-free survival rates in the patients who underwent radiotherapy were significantly lower compared with the surgically treated group. This was due to a higher occurrence of regional metastases in the patients who received radiotherapy.  The cure rates of stage I squamous cell carcinoma of the lower lip are favorable whether treated by radiotherapy or surgery, and local control rates are similar. The radiotherapeutic treated group showed an increased incidence of cervical metastases, which was due to the more advanced tumor size in these patients

Squamous cell carcinoma of the lip: analysis of the Princess Margaret Hospital experience.

Cerezo L, Radiother Oncol 1993 Aug;28(2):142-7 We reviewed 117 patients with squamous cell carcinoma of the lip who were treated at the Princess Margaret Hospital between 1976 and 1985.  The 5-year actuarial overall and cause-specific survival rates were 81% and 99%, respectively. After a univariate analysis, the only factor which predicted for nodal failure was T stage of the primary lesion, with a 4% risk of nodal failure for T1 lesions vs. 20% for T2/3 lesions. Based on the excellent results of this review, we would continue to recommend radiation therapy as an effective treatment modality for patients with lip cancer because of the ease by which the entire tumour can be encompassed whilst maintaining excellent cosmetic and functional outcome.

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Carcinoma of the lip and selected sites of head and neck skin. A clinical study of 896 patients.

Petrovich Z,Radiother Oncol 1987 Jan;8(1):11-17. Basal cell carcinoma (BCC) was found in 467 (52%) patients, squamous cell carcinoma (SCC) in 362 (40%), and the remaining 67 (8%) had tumors with mixed basal and squamous cell features. This study has again demonstrated the effectiveness of radiotherapy in controlling small and intermediate size epithelial tumors of the skin and lip. Additionally, irradiation, if administered properly, results in excellent cosmesis and a low incidence of treatment complications.

Cancer of the lip.

Fitzpatrick PJ J Otolaryngol 1984 Feb;13(1):32-6 A retrospective review of 361 patients with carcinoma of the lip seen between 1971 and 1976 was performed. There were 348 squamous cell and 13 basal cell carcinomas. The lower to upper lip ratio was 15:1 and the male to female ratio 12:1. The median ages for men and women were 64 and 71 years. The tumors were not staged but four had regional metastases when diagnosed. The primary tumor was controlled by surgery in 76/85 (89%) patients, by surgery and radiation combined in 65/70 (93%) patients, and by radiation alone in 193/206 (94%) patients. Altogether 24 (6.5%) patients developed cervical node metastases and these were controlled in 20 (83%). Tumor related deaths occurred in 11 (3%) patients and the five year cause specific survival rate was 97%.

Radiotherapy for cancer of the lip. A long-term evaluation of 85 treated cases.

Gooris Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998 Sep;86(3):325-30 The results of radiation therapy, both as a single treatment modality and after radical surgery for squamous cell carcinoma of the vermilion surface/border of the lip, are retrospectively analyzed in 85 patients. All recurrences (7%) occurred in T2 and T3 tumors treated with external beam radiotherapy only. The long-term esthetic result and functional morbidity are evaluated. Referral patterns are discussed, and the need for a multidisciplinary treatment protocol is emphasized.

Squamous cell carcinoma of the lip: the role of electron treatment.

Sykes Clin Oncol (R Coll Radiol) 1996;8(6):384. After skin cancer, squamous cell carcinoma (SCC) of the lip is the most common cancer of the head and neck. It can be treated in a variety of ways, including both surgery and radiotherapy. Many centres have reported excellent cure and local control rates for their chosen treatment method. Electron beam treatment is recognized as a method of treatment and has theoretical advantages related to its depth-dose characteristics. We report a retrospective study of the treatment with electrons of 26 patients with Stage T1-2 SCCs of the lip. With a median follow-up period of 31 months (range 1.5-60) 100% local control was obtained, although two patients required surgical salvage, one for a geographical miss. Electron treatment for T1-2 SCC of the lip is an effective, well tolerated treatment for these patients, many of whom are elderly and frail.

Results of radiotherapy for squamous cell carcinoma of the vermilion border of the lower lip. A retrospective analysis of 108 patients.

de Visscher Radiother Oncol 1996 Apr;39(1):9-14 The authors analyzed the clinical history, tumor histology and stage, and outcome of a group of 108 patients with squamous cell carcinoma (SCC) of the vermilion border of the lower lip who underwent radiation therapy in the period between 1980 and 1992. The total tumor dose varied from 48 Gy to 70 Gy, depending on the radiation modality (orthovoltage, electrons, photontherapy and iridium implants). Local control was achieved in 88 out of 89 (98.9%) patients with T1, in 13 out of 17 (76.5%) patients with T2 and in both patients with T3 tumors. Local treatment failures (4.6%) were cured by salvage surgery. During follow-up, regional lymph node metastases at level I (submental and submandibular groups) occurred in 11 out of 89 (12.4%) patients with stage I and in I out of 15 (6.7%) patients with stage II tumors. After salvage treatment of local failures and regional metastases the total group of patients with stage I and II SCCs of the vermilion border of the lower lip showed a definitive control rate of 98.1%.

Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979-88.

McCombe D, MacGill K, Ainslie J, Beresford J, Matthews J.  Aust N Z J Surg 2000 May;70(5):358-61

Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.

BACKGROUND: Squamous cell carcinoma (SCC) of the lower lip is a common malignancy in Australia. Surgical excision and/or radiotherapy are used in treatment, and are regarded as equally effective. METHODS: A retrospective review of 323 patients treated at the Peter MacCallum Cancer Institute with either surgical excision and/or radiotherapy, evaluated disease recurrence, cause-specific mortality, and the incidence of metachronous lesions. RESULTS: Recurrence-free survival at 10 years was estimated to be 92.5%, and cause-specific survival at 10 years was estimated to be 98.0%. Equivalent rates of local control were obtained with surgery and radiotherapy. Recurrence was related to tumour stage and differentiation. A high incidence of metachronous lesions was noted, 25 patients had a lesion prior to presentation and 33 patients developed second lip lesions during the study period. CONCLUSIONS: Squamous cell carcinoma of the lower lip is well treated with surgery or radiotherapy. The preferred treatment for most patients with SCC of the lower lip in the Australian population is surgical excision. This study has shown a significant incidence of metachronous lip neoplasia, except in those patients whose whole lip had been resurfaced.

Carcinoma of the lip and selected sites of head and neck skin. A clinical study of 896 patients.

Petrovich Z,Radiother Oncol 1987 Jan;8(1):11-17. Basal cell carcinoma (BCC) was found in 467 (52%) patients, squamous cell carcinoma (SCC) in 362 (40%), and the remaining 67 (8%) had tumors with mixed basal and squamous cell features. This study has again demonstrated the effectiveness of radiotherapy in controlling small and intermediate size epithelial tumors of the skin and lip. Additionally, irradiation, if administered properly, results in excellent cosmesis and a low incidence of treatment complications.

Cancer of the lip.

Fitzpatrick PJ J Otolaryngol 1984 Feb;13(1):32-6 A retrospective review of 361 patients with carcinoma of the lip seen between 1971 and 1976 was performed. There were 348 squamous cell and 13 basal cell carcinomas. The lower to upper lip ratio was 15:1 and the male to female ratio 12:1. The median ages for men and women were 64 and 71 years. The tumors were not staged but four had regional metastases when diagnosed. The primary tumor was controlled by surgery in 76/85 (89%) patients, by surgery and radiation combined in 65/70 (93%) patients, and by radiation alone in 193/206 (94%) patients. Altogether 24 (6.5%) patients developed cervical node metastases and these were controlled in 20 (83%). Tumor related deaths occurred in 11 (3%) patients and the five year cause specific survival rate was 97%.

Radiotherapy for cancer of the lip. A long-term evaluation of 85 treated cases.

Gooris Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998 Sep;86(3):325-30 The results of radiation therapy, both as a single treatment modality and after radical surgery for squamous cell carcinoma of the vermilion surface/border of the lip, are retrospectively analyzed in 85 patients. All recurrences (7%) occurred in T2 and T3 tumors treated with external beam radiotherapy only. The long-term esthetic result and functional morbidity are evaluated. Referral patterns are discussed, and the need for a multidisciplinary treatment protocol is emphasized.

Squamous cell carcinoma of the lip: the role of electron treatment.

Sykes Clin Oncol (R Coll Radiol) 1996;8(6):384. After skin cancer, squamous cell carcinoma (SCC) of the lip is the most common cancer of the head and neck. It can be treated in a variety of ways, including both surgery and radiotherapy. Many centres have reported excellent cure and local control rates for their chosen treatment method. Electron beam treatment is recognized as a method of treatment and has theoretical advantages related to its depth-dose characteristics. We report a retrospective study of the treatment with electrons of 26 patients with Stage T1-2 SCCs of the lip. With a median follow-up period of 31 months (range 1.5-60) 100% local control was obtained, although two patients required surgical salvage, one for a geographical miss. Electron treatment for T1-2 SCC of the lip is an effective, well tolerated treatment for these patients, many of whom are elderly and frail.

Results of radiotherapy for squamous cell carcinoma of the vermilion border of the lower lip. A retrospective analysis of 108 patients.

de Visscher Radiother Oncol 1996 Apr;39(1):9-14 The authors analyzed the clinical history, tumor histology and stage, and outcome of a group of 108 patients with squamous cell carcinoma (SCC) of the vermilion border of the lower lip who underwent radiation therapy in the period between 1980 and 1992. The total tumor dose varied from 48 Gy to 70 Gy, depending on the radiation modality (orthovoltage, electrons, photontherapy and iridium implants). Local control was achieved in 88 out of 89 (98.9%) patients with T1, in 13 out of 17 (76.5%) patients with T2 and in both patients with T3 tumors. Local treatment failures (4.6%) were cured by salvage surgery. During follow-up, regional lymph node metastases at level I (submental and submandibular groups) occurred in 11 out of 89 (12.4%) patients with stage I and in I out of 15 (6.7%) patients with stage II tumors. After salvage treatment of local failures and regional metastases the total group of patients with stage I and II SCCs of the vermilion border of the lower lip showed a definitive control rate of 98.1%.

Squamous cell carcinoma of the lip: a retrospective review of the Peter MacCallum Cancer Institute experience 1979-88.

McCombe D, MacGill K, Ainslie J, Beresford J, Matthews J.  Aust N Z J Surg 2000 May;70(5):358-61

Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.

BACKGROUND: Squamous cell carcinoma (SCC) of the lower lip is a common malignancy in Australia. Surgical excision and/or radiotherapy are used in treatment, and are regarded as equally effective. METHODS: A retrospective review of 323 patients treated at the Peter MacCallum Cancer Institute with either surgical excision and/or radiotherapy, evaluated disease recurrence, cause-specific mortality, and the incidence of metachronous lesions. RESULTS: Recurrence-free survival at 10 years was estimated to be 92.5%, and cause-specific survival at 10 years was estimated to be 98.0%. Equivalent rates of local control were obtained with surgery and radiotherapy. Recurrence was related to tumour stage and differentiation. A high incidence of metachronous lesions was noted, 25 patients had a lesion prior to presentation and 33 patients developed second lip lesions during the study period. CONCLUSIONS: Squamous cell carcinoma of the lower lip is well treated with surgery or radiotherapy. The preferred treatment for most patients with SCC of the lower lip in the Australian population is surgical excision. This study has shown a significant incidence of metachronous lip neoplasia, except in those patients whose whole lip had been resurfaced.