구강암 (Oral Cavity Cancer): Comprehensive Overview for Medical Professionals

출처 : 서울대 암연구소

개요 (Overview)

구강암은 입술, 혀, 잇몸, 구강저, 구개, 구강 후벽 등 구강 내에서 발생하는 악성 종양을 포함합니다. 가장 흔한 형태는 편평세포암(squamous cell carcinoma)입니다. 주요 위험 요인으로는 흡연, 알코올 남용, 인유두종 바이러스(HPV) 감염 등이 있습니다.

Oral cavity cancer includes malignant tumors that arise in the lips, tongue, gums, floor of the mouth, palate, and the posterior oral cavity. The most common type is squamous cell carcinoma. Major risk factors include smoking, alcohol abuse, and human papillomavirus (HPV) infection.

원인 (Etiology)

1. 흡연 (Smoking): 구강암의 주요 원인.

2. 알코올 남용 (Alcohol Abuse): 흡연과 함께 위험을 증가시킴.

3. 인유두종 바이러스(HPV) 감염 (Human Papillomavirus Infection): 특히 HPV 16형.

4. 구강 위생 불량 (Poor Oral Hygiene): 만성 자극과 염증.

5. 영양 결핍 (Nutritional Deficiency): 비타민 A와 C 결핍.

6. Smoking: Major cause of oral cavity cancer.

7. Alcohol Abuse: Increases risk when combined with smoking.

8. Human Papillomavirus (HPV) Infection: Especially HPV type 16.

9. Poor Oral Hygiene: Chronic irritation and inflammation.

10. Nutritional Deficiency: Deficiencies in vitamins A and C.

임상증상 (Clinical Presentation)

1. 구강 내 궤양 (Oral Ulcer): 치유되지 않는 궤양.

2. 통증 (Pain): 특히 삼킬 때.

3. 출혈 (Bleeding): 자발적 또는 외상 후.

4. 목소리 변화 (Voice Changes): 혀 또는 구개에 종양이 있을 때.

5. 삼킴 곤란 (Dysphagia): 종양이 식도를 압박할 때.

6. Oral Ulcer: Non-healing ulcer.

7. Pain: Especially when swallowing.

8. Bleeding: Spontaneous or post-traumatic.

9. Voice Changes: When tumor is on the tongue or palate.

10. Dysphagia: When the tumor compresses the esophagus.

진단 (Diagnosis)

1. 임상 평가 (Clinical Evaluation): 철저한 구강 검사 및 병력 청취.

2. 영상 검사 (Imaging Studies):

   • CT/MRI: 종양의 크기와 침범 범위를 평가.
   • PET/CT: 원격 전이 평가.

3. 생검 (Biopsy): 조직학적 확인을 위한 생검.

4. Clinical Evaluation: Thorough oral examination and history taking.

5. Imaging Studies:

   • CT/MRI: Assess the size and extent of the tumor.
   • PET/CT: Evaluate for distant metastases.

6. Biopsy: Biopsy for histopathological confirmation.

병리조직 (Pathology)

• 조직학적 유형 (Histological Types): 편평세포암이 가장 흔함.

• 면역조직화학 (Immunohistochemistry): 종양의 기원과 특성을 확인.

• Histological Types: Squamous cell carcinoma is the most common.

• Immunohistochemistry: To confirm the origin and characteristics of the tumor.

영상검사 소견 (Imaging Findings)

• CT/MRI 소견 (CT/MRI Findings): 종양의 크기와 위치, 주변 조직 침범 평가.

• PET/CT 소견 (PET/CT Findings): 대사 활동을 통해 원격 전이 평가.

• CT/MRI Findings: Evaluate the size, location, and invasion of surrounding tissues by the tumor.

• PET/CT Findings: Assess metabolic activity to evaluate distant metastases.

수술 (Surgery)

• 적응증 (Indications): 주로 초기 및 국소 진행성 종양에 사용.

• 목표 (Goal): 종양의 완전 절제 및 기능 보존.

• 기술 (Techniques): 광범위 절제술, 목 림프절 절제술.

• Indications: Mainly used for early and locally advanced tumors.

• Goal: Complete resection of the tumor and preservation of function.

• Techniques: Wide local excision, neck dissection.

방사선치료 (Radiation Therapy)

1. 적응증 (Indications): 수술 후 보조 치료, 국소 진행성 또는 재발성 질환.

2. 기술 (Techniques):

   • 강도 변조 방사선 치료(IMRT) (Intensity-Modulated Radiation Therapy): 정확한 종양 표적화.

3. 선량 (Dose):

   • 원발 종양 (Primary Tumor): 60-70 Gy.
   • 림프절 (Lymph Nodes): 50-60 Gy.

4. Indications: Adjuvant therapy post-surgery, locally advanced or recurrent disease.

5. Techniques:

   • Intensity-Modulated Radiation Therapy (IMRT): Precise tumor targeting.

6. Dose:

   • Primary Tumor: 60-70 Gy.
   • Lymph Nodes: 50-60 Gy.

항암제 (Chemotherapy)

1. 적응증 (Indications): 방사선 치료와 병행하거나 전이성 질환에 사용.

2. 약제 (Agents): 시스플라틴, 5-플루오로우라실, 도세탁셀.

3. 프로토콜 (Protocols): 동시 화학방사선 치료 (CCRT), 보조 화학요법.

4. Indications: Used concurrently with radiation therapy or for metastatic disease.

5. Agents: Cisplatin, 5-fluorouracil, docetaxel.

6. Protocols: Concurrent chemoradiotherapy (CCRT), adjuvant chemotherapy.

예후 (Prognosis)

1. 5년 생존율 (5-year Survival Rate):
   • 초기 단계 (Early Stage): 약 70-80%.
   • 진행 단계 (Advanced Stage): 약 30-50%.
2. 국소 재발율 (Local Recurrence Rate): 약 20-40%.

The prognosis for oral cavity cancer varies by stage at diagnosis, with early-stage disease having a much better outcome compared to advanced-stage disease. Long-term follow-up is essential for monitoring recurrence.

구강암의 예후는 진단 시기에 따라 다르며, 초기 질환은 진행성 질환에 비해 훨씬 좋은 결과를 보입니다. 장기적인 추적 관찰이 재발 모니터링에 중요합니다.

참고문헌 (References)

1. Petersen, P. E. (2009). Oral cancer prevention and control–The approach of the World Health Organization. Oral Oncology, 45(4-5), 454-460.
2. Chaturvedi, A. K., Engels, E. A., Anderson, W. F., & Gillison, M. L. (2008). Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. Journal of Clinical Oncology, 26(4), 612-619.
3. Rivera, C. (2015). Essentials of oral cancer. International Journal of Clinical and Experimental Pathology, 8(9), 11884.
4. Johnson, N. W., Jayasekara, P., & Amarasinghe, A. A. H. K. (2011). Squamous cell carcinoma and precursor lesions of the oral cavity: epidemiology and aetiology. Periodontology 2000, 57(1), 19-37.

구강암 (Oral Cavity Cancer) 요약표 (Summary Table)

항목 (Item)한국어 (Korean)영어 (English)

참고문헌 (References)

1. Petersen, P. E. (2009). Oral cancer prevention and control–The approach of the World Health Organization. Oral Oncology, 45(4-5), 454-460.
2. Chaturvedi, A. K., Engels, E. A., Anderson, W. F., & Gillison, M. L. (2008). Incidence trends for human papillomavirus-related and -unrelated oral squamous cell carcinomas in the United States. Journal of Clinical Oncology, 26(4), 612-619.
3. Rivera, C. (2015). Essentials of oral cancer. International Journal of Clinical and Experimental Pathology, 8(9), 11884.
4. Johnson, N. W., Jayasekara, P., & Amarasinghe, A. A. H. K. (2011). Squamous cell carcinoma and precursor lesions of the oral cavity: epidemiology and aetiology. Periodontology 2000, 57(1), 19-37.

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