Palliative surgery for lung metastasis to the mouth

OBJECTIVES: Oral metastases of primary tumors elsewhere in the body are infrequent. Most patients with a metastatic tumor in the oral cavity also developed metastases at other sites, often leaving no other option than palliation. The aim of the present article was to present and discuss the diagnosis and palliative management of an oral metastasis from a primary lung cancer.

MATERIALS AND METHODS: A 58-year-old woman was referred for the assessment of a sessile, round, exophytic lesion of 4-5 cm of diameter in correspondence of the vestibular gingiva of the mandibular symphysis. A total body CT scan confirmed the presence of an irregular mass in correspondence of the vestibular gingiva of the mandibular symphysis, with erosion and involvement of the mandibular bone, and revealed the presence of numerous laterocervical and supraclavicular lymphadenopaties, nodular cavitated lesions in the upper lobe of the right lung; several dishomogeneous masses suspected to be metastatic in correspondence of the pancreas, the spleen, and the adrenal gland bilaterally, and multiple osteolytic lesions with pathological fractures were found in correspondence of
the vertebrae. An incisional biopsy of the oral mass allowed to perform, together with imaging findings, a diagnosis of adenocarcinoma of pulmonary origin with multiple metastatic localizations. The palliative surgical resection of the oral lesion was decided, together with the patient, in order to allow the patient to eat more easily.

DISCUSSION: Several surgical indications to improve quality of life in advanced cancer patients have been described, such as malignant fluid re-accumulation, obstructions, tumor
bleeding or other local complications, and pain. These conditions may determine debilitating symptoms for cancer patients. The benefits of palliative surgery should always focus on quality of life, symptom control, and symptom prevention. Anyway, prognosis is poor for patients who have metastatic lesions to the oral soft tissue.

CONCLUSIONS: The diagnosis and management of metastatic oral lesions from distant carcinomas is challenging for dental practitioners. The importance of a therapeutic alliance
with cancer patients and their families is fundamental.

CLINICAL SIGNIFICANCE: Palliative surgery should be considered as an option to relief symptoms and/or to avoid a further worsening of quality of life in such patients, under the indication of a cancer multidisciplinary team headed by an oncologist.

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