Oral Tongue Squamous Cancer in Never Smokers

Are the outcomes of patients treated for oral cancer different if the patient has never had exposure to tobacco?

Background: Squamous cell carcinoma (SCC) of the upper aerodigestive tract has long been considered a smoker’s disease. Epstein Barr virus is associated with squamous cancer of the nasopharynx and clearly has biologic differences. More recently, the human papillomavirus has been associated with yet another head and neck cancer that appears similar, but behaves differently. Head and neck oncologists continue to investigate the potential that yet another clinical subgroup exists in the world of squamous cell carcinoma.

Study design: A retrospective study evaluated 120 patients with oral tongue squamous cell carcinoma using the records at the university medical center. To be considered a “never smoker,” the patient had to have consumed fewer than 100 cigarettes lifetime. Other factors evaluated included tumor grade, depth of invasion, margin status, pattern of invasion, lymphovascular invasion, and perineural invasion. Recurrence and overall survival were calculated from the date of treatment. The never smokers had poor prognosis.

Setting: Academic medical center.

Synopsis: The development of squamous cell carcinoma involving the oral tongue in never smokers has been a topic of debate for many years. It has been argued, based upon some small retrospective studies, that young, female patients who have never smoked have poorer prognosis than chain-smoking older men with cancer at a similar stage. This observation has never been fully corroborated; however, the relatively recent recognition that human papillomavirus produces a squamous cancer that is histologically similar but biologically very different cannot help but kindle this issue once again.

Why do never smokers get oral tongue cancer? Is the development of SCC of the tongue in never smokers an indication for a different approach to treatment?

Bottom line: The issue of SCC in never smokers remains a challenge.

Citation: Durr ML, van Zante A, Li D, Kezirian EJ, Wang SJ. Oral tongue squamous cell carcinoma in never smokers: Analysis of clinicopathologic characteristics and survival. Otolaryngol Head Neck Surg. 2013;149:89-96.