Squamous Cell Carcinoma of the Oral Cavity in the Elderly

Factors to consider for surgical in elderly patients with oral cancer

At present, in Korea, due to developments in medicine and technology and an increasing mean lifespan, the expected lifetime for elderly people is increasing (at 70 years, the expected additional lifespan is 14.8 years for males and 18.3 years for females). However, among all causes of death, malignant neoplasm is ranked first for all ages. Further, the incidence rate of oral cancer tends to increase with age. Thus, oral and maxillofacial surgeons have increased opportunity to experience the ‘oldest old’ patients with oral cancer. Elderly patients commonly have several comorbidities, poor general condition, limited socioeconomic support, fear of various postoperative complications, and perception of short for the rest of their life. In this situation, the patient, caregiver, and surgeon often choose undergraded treatment rather than standard treatment for oral squamous cell carcinoma owing to patient age. In elderly patients with oral cancer, ablation of tumor or reconstructive surgery is challenging for surgeons. Oral and maxillofacial surgeons must evaluate carefully the patient’s medical condition and make a decision regarding treatment plans after sufficient discussion with patient and caregivers. We review the literature to consider the factors involved for deciding on a treatment plan regarding surgery in elderly patients with oral cancer.

Uncommon site of metastasis from renal cell carcinoma: Case report

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Renal carcinoma represents 1–3% of visceral malignancies.

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Metastases of renal tumors may manifest up to a decade after initial injury.

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Gallbladder represents a rare site of metastatic site, with few reports in the literature.

Background

Renal cell carcinomas (CCR) account for 90% of renal tumors. Presence of latent distant metastasis is characteristic of RCC and may manifest more than a decade after nephrectomy. Gallbladder (GB) is a rare site of metastasis, with few reports in the literature. A case of metastasis from RCC to GB nine years after initial diagnosis is reported herein.

Case report

Male patient, 74 years, nine years post right radical nephrectomy for grade 2 clear-cell adenocarcinoma, T3BN0M0. During onset, Magnetic Resonance Imaging (MRI) evidenced T2-weighted hypointense and T1-weighted hyperintense lesion, with early and persistente contrast enhancement and exophytic bulging of the underlying outer vesicular margin. T1-weighted hypointense and T2-weighted slightly hyperintense nodular formation was also evidenced in the body portion of the pancreas, with 1.5 × 1.2 cm. The patient was subjected to videolaparoscopic cholecystectomy associated to endoscopic ultrasound (EUS) intraoperatively for investigation of the pancreatic nodule. The anatomopathological examination of the gallbladder was compatible with infiltrating metastasis from clear-cell carcinoma of primary renal site. A solid, hypoechoic, oval nodule with 14 mm was found at EUS, which cytology was suggestive of clear-cell Carcinoma. Because this is an indolent disease with oligometastasis, local ablative treatment with fractionated stereotactic radiation therapy with a dose of 40 Gy was selected. The patient is found with stable disease one year after radiation therapy.

Conclusion

Gallbladder is an unusual site of RCC metastasis. In patients with history of this disease, all vesicular lesions should be given attention, even where the primary tumor has been treated many years before.