Oral Manifestations in Patients with Gastrointestinal Malignancies: A Systematic Review
Oral manifestations and gastrointestinal malignancies
Keywords:
Oral manifestations, Gastrointestinal Neoplasms, Systematic ReviewAbstract
Introduction: Roughly 1% of malignant lesions in the maxillofacial region are due to metastatic lesions, and 10% of these metastatic lesions are related to primary tumors located in the gastrointestinal tract. This systematic review examines the oral manifestations of metastatic lesions resulting from gastrointestinal malignancies based on age, gender, survival rates, and tumor characteristics. Given the importance of timely and accurate diagnosis of metastatic lesions originating from primary tumors in the gastrointestinal tract in improving patient prognosis and increasing survival time, the main objective of this systematic review is to identify oral manifestations of metastatic lesions in patients with gastrointestinal malignancies worldwide.
Methods: The review was conducted using international databases, including PubMed, Scopus, Web of Science, Google Scholar, and Ovid, with a deadline of June 2023. The search strategy included keywords such as "metastasis," "oral manifestations," "gastrointestinal malignancies," and "oral mucosa," and their synonyms were selected from Mesh to develop the search strategy. Results: Seventy patients were included in this study, with 47 being male and 23 being female, and the average age of the patients was 64.5 years. Forty-four percent of the tumors were related to the colon, and 81% of all tumors were related to adenocarcinoma. The most common clinical symptom was the presence of a tumor or swelling, which was reported in 49% of cases, while the most common patient complaint was pain, experienced by 24% of patients. The mandible was the most commonly affected site of the metastatic lesion. The average survival time after diagnosis of oral metastatic lesions was approximately 6 months, and chemotherapy with or without surgery was the most commonly used treatment.
Conclusion: The prognosis for patients with metastatic lesions resulting from gastrointestinal malignancies is poor, and in some cases, it may be the first sign of gastrointestinal malignancy. Timely diagnosis and treatment can improve the quality of life and prognosis for these patients.
References
Hirshberg A, Berger R, Allon I et al. (2014) Metastatic tumors to the jaws and mouth. Head Neck Pathol 8, 463-474.
Rocha BA, Paranaíba LM, Dantas CD et al. (2020) Two rare cases of oral metastasis arising from lung adenocarcinoma and esophageal carcinoma. J Clin Exp Dent 12, e999-e1004.
van der Waal RI, Buter J, van der Waal I (2003) Oral metastases: report of 24 cases. Br J Oral Maxillofac Surg 41, 3-6.
Murillo J, Bagan JV, Hens E et al. (2013) Tumors metastasizing to the oral cavity: A study of 16 cases. Journal of Oral and Maxillofacial Surgery 71, 1545-1551.
Seoane J, Van der Waal I, Van der Waal RI et al. (2009) Metastatic tumours to the oral cavity: a survival study with a special focus on gingival metastases. J Clin Periodontol 36, 488-492.
Miller KD, Siegel RL, Lin CC et al. (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66, 271-289.
Hirshberg A, Shnaiderman-Shapiro A, Kaplan I et al. (2008) Metastatic tumours to the oral cavity - pathogenesis and analysis of 673 cases. Oral Oncol 44, 743-752.
Shen ML, Kang J, Wen YL et al. (2009) Metastatic tumors to the oral and maxillofacial region: a retrospective study of 19 cases in West China and review of the Chinese and English literature. J Oral Maxillofac Surg 67, 718-737.
Kumar G, Manjunatha B (2013) Metastatic tumors to the jaws and oral cavity. J Oral Maxillofac Pathol 17, 71-75.
Irani S (2016) Metastasis to the oral soft tissues: A review of 412 cases. J Int Soc Prev Community Dent 6, 393-401.
Sauerborn D, Vidakovic B, Baranovic M et al. (2011) Gastric adenocarcinoma metastases to the alveolar mucosa of the mandible: a case report and review of the literature. J Craniomaxillofac Surg 39, 645-648.
Cai J, He B, Li X et al. (2016) Regulation of tumorigenesis in oral epithelial cells by defined reprogramming factors Oct4 and Sox2. Oncol Rep 36, 651-658.
McClure SA, Movahed R, Salama A et al. (2013) Maxillofacial metastases: a retrospective review of one institution's 15-year experience. J Oral Maxillofac Surg 71, 178-188.
D'Silva NJ, Summerlin DJ, Cordell KG et al. (2006) Metastatic tumors in the jaws: a retrospective study of 114 cases. J Am Dent Assoc 137, 1667-1672.
Álvarez Álvarez C, Iglesias Rodríguez B, Pazo Irazu S et al. (2006) Colon adenocarcinoma with metastasis to the gingiva. Medicina Oral, Patologia Oral y Cirugia Bucal 11, 66-68.
Andabak Rogulj A, Tomasovic Loncaric C, Muller D et al. (2018) Solid malignant metastases in the jaw bones. Br J Oral Maxillofac Surg 56, 705-708.
Baranović M, Vidaković B, Sauerborn D et al. (2015) Colorectal Adenocarcinoma Metastasizing to the Oral Mucosa of the Upper Jaw. Srp Arh Celok Lek 143, 314-316.
Bell D, Kupferman ME, Williams MD et al. (2009) Primary colonic-type adenocarcinoma of the base of the tongue: a previously unreported phenotype. Human Pathology 40, 1798-1802.
Bodner L, Sion-Vardy N, Geffen DB et al. (2006) Metastatic tumors to the jaws: a report of eight new cases. Medicina oral, patología oral y cirugía bucal 11, E132-135.
Coad FGH, Thayalasekaran S, Booth J (2013) An unusual presentation of metastasis from a rectal adenocarcinoma. QJM 106, 943-945.
Colombo P, Tondulli L, Masci G et al. (2005) Oral ulcer as an exclusive sign of gastric cancer: report of a rare case. BMC Cancer 5, 117.
Dalirsani Z, Mohtasham N, Samiee N (2020) Metastasis of Colon Adenocarcinoma to Maxillary Gingiva and Palate. Iran J Otorhinolaryngol 32, 327-331.
Dalirsani Z, Pakfetrat A, Saghravanian N et al. (2021) Metastasis of Non-Hodgkin's T-cell lymphoma to the palate and maxillary alveolar ridge: Case report. Tehran University Medical Journal 79, 42-47.
Deutsch M, Wollman MR (2002) Radiotherapy for metastases to the mandible in children. Journal of Oral and Maxillofacial Surgery 60, 269-271.
Di Stasio D, Montella M, Cozzolino I et al. (2018) Multidisciplinary Diagnostic and Surgical Management of Adenocarcinoma Gingival Metastases. J Craniofac Surg 29, e531-e534.
Favia G, Maiorano E, Lo Muzio L (2010) Image of the month. Gingival metastasis from colonic adenocarcinoma. Clin Gastroenterol Hepatol 8, A28.
Fukuda M, Miyata M, Okabe K et al. (2002) A case series of 9 tumors metastatic to the oral and maxillofacial region. Journal of Oral and Maxillofacial Surgery 60, 942-944.
Hadhri A, Abidi R, Rejeb MB et al. (2020) Metastasis of colon adenocarcinoma to the mandible: A case report. Tunisie Medicale 98, 518-521.
Ho DP, Wilkinson PE, Vogel RI et al. (2022) Metastatic Tumors to the Oral Soft Tissues and Jawbones: A Retrospective Analysis of 40 Cases and Review of the Literature. Head Neck Pathol.
Hwang KG, Park CJ, Paik SS et al. (2007) Gingival metastasis from gastric adenocarcinoma. Otolaryngol Head Neck Surg 137, 169-170.
Iida T, Sasaki T, Akita H et al. (2009) Metastatic gingival tumor from rectal cancer diagnosed with CDX2. Clinical Journal of Gastroenterology 2, 175-177.
Jalil ABA, Lau SH (2009) Metastatic tumours of the oral cavity in Malaysians: A retrospective study (1967-2007). Asian Journal of Oral and Maxillofacial Surgery 21, 101-105.
Jham BC, Salama AR, McClure SA et al. (2011) Metastatic tumors to the oral cavity: a clinical study of 18 cases. Head Neck Pathol 5, 355-358.
Kalaitsidou IG, Astreidis IT, Kontos KI et al. (2015) Metastatic Tumours to the Oral Cavity: Report of Three Cases. J Oral Maxillofac Res 6, e5.
Kameta A, Oda T, Ogura I et al. (2017) Metastasis of colon adenocarcinoma to the mandible: A case report. Oral Science International 14, 22-25.
Khazzaka A, El Rassy E, Sarkis R (2016) An Unusual Case of Oral Metastasis from Rectal Adenocarcinoma Precipitated by Iatrogenicity. Journal of Gastrointestinal Cancer 47, 336-337.
Kolk A, Sader R, Zeilhofer HF et al. (2003) Condylar reconstruction after resection of an intracapsular stomach carcinoma metastasis. Mund-, Kiefer- und Gesichtschirurgie : MKG 7, 306-310.
Kuttan NAA, Flemming DK, Dane JN et al. (2006) Metastatic lesion of the anterior mandible with an occult primary: A case report. Special Care in Dentistry 26, 76-80.
Kwon MS, Ko SO, Cho NP et al. (2006) Gastric signet-ring cell adenocarcinoma metastatic to the gingiva: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102, 62-66.
Landeyro J, Raventós A, Mommsen J et al. (2010) Gingival and submandibular lymph node metastasis of sigmoid colon adenocarcinoma. Journal of Clinical and Experimental Dentistry 2, e47-e50.
Lawes KP, Danford M, Di Palma S (2013) Delayed metastasis to the mandible of esophageal adenocarcinoma. Head Neck Pathol 7, 416-420.
Lutz JC, El-Bouihi M, Vidal N et al. (2008) Mandibular metastases from an ileum stromal tumor. Rev Stomatol Chir Maxillofac 109, 399-402.
Majumdar S, Uppala D, Boddepalli R et al. (2016) A rare case of mucous adenocarcinoma with gingival metastasis: A case report and review of literature. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology 28, 197-201.
Maria OM, Alghamdi O, Baabdullah R et al. (2022) Gastrointestinal stromal tumor with maxillary metastasis: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 133, e1-e5.
Miyake M, Takebayashi R, Ohbayashi Y et al. (2015) Metastasis in the gingiva from colon adenocarcinoma. J Maxillofac Oral Surg 14, 279-282.
Mojica-Manosa P, Rigual N, Tan D et al. (2006) An Unusual Case of a Metastatic Adenocarcinoma of the Rectum to the Mandible: A Case Report and Review of the Literature. Journal of Oral and Maxillofacial Surgery 64, 1436-1439.
Neumann ED, León Vintró X, Vega García C et al. (2021) Oral cavity colon adenocarcinoma metastases: case report with surgical approach and review of more than 30 years literature. Oral Maxillofac Surg 25, 99-101.
Qiu YT, Yang C, Chen MJ et al. (2013) Metastatic spread to the mandibular condyle as initial clinical presentation: Radiographic diagnosis and surgical experience. Journal of Oral and Maxillofacial Surgery 71, 809-820.
Ren QG, Huang T, Yang SL et al. (2017) Colon cancer metastasis to the mandibular gingiva with partial occult squamous differentiation: A case report and literature review. Mol Clin Oncol 6, 189-192.
Romanet I, Lan R, Ordioni U et al. (2018) A rare case of oral metastasis of colon adenocarcinoma. J Stomatol Oral Maxillofac Surg 119, 229-231.
Rosbottom KJ, Michie B, Boyce S (2009) Metastasis of recurrent colonic adenocarcinoma to the mouth. BMJ Case Rep 2009.
Salvador JC, Rosa D, Rito M et al. (2018) Atypical mandibular metastasis as the first presentation of a colorectal cancer. BMJ Case Rep 2018.
Shimoyama S, Seto Y, Aoki F et al. (2004) Gastric cancer with metastasis to the gingiva. J Gastroenterol Hepatol 19, 831-835.
Smolka W, Brekenfeld C, Büchel P et al. (2004) Metastatic adenocarcinoma of the temporomandibular joint from the cardia of the stomach: A case report. International Journal of Oral and Maxillofacial Surgery 33, 713-715.
Soares AB, Thomaz LA, Duarte MT et al. (2011) Metastatic adenocarcinoma of the colon: early manifestation in gingival tissue. Head Neck Pathol 5, 140-143.
Soda H, Doi K, Kinoshita T et al. (2010) Mandibular bone metastasis of rectal cancer: Report of a case. Surgery Today 40, 1188-1191.
Su H, Liu WS, Ren WH et al. (2017) Multiple clear-cell sarcomas of small intestine with parotid gland metastasis: A case report. World journal of gastroenterology 23, 2258-2265.
Tomikawa M, Higuchi Y, Saku M et al. (2001) Carcinoma of the colon metastatic to the lower gingiva. Dig Surg 18, 333-335.
Tsakiraki Z, Delides A, Damaskou V et al. (2021) Palatine tonsil metastasis of cecal mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN): A unique case. Clinical Case Reports 9.
Usman N, Kattepur A, Gopinath KS (2014) Metachronous metastasis to the oral cavity from carcinoma rectum - a case report and review of literature. Indian J Surg Oncol 5, 303-306.
Watanabe M, Tada M, Satomi T et al. (2016) Metastatic rectal adenocarcinoma in the mandibular gingiva: A case report. World Journal of Surgical Oncology 14.
Willard CC, Weber CR, Buche W (2002) Metastatic esophageal adenocarcinoma involving the maxilla. J Oral Maxillofac Surg 60, 1496-1499.
Wu Z, Tang J, Li Y et al. (2017) Successful management of rare gingival metastasis from gastric adenocarcinoma: a case report and literature review. World J Surg Oncol 15, 141.
Yang RH, Chu YK, Li WY (2014) Unusual site of metastasis detected with FDG PET/CT in a case of recurrent rectosigmoid cancer. Clin Nucl Med 39, 355-357.
Ziegler A, Thorpe E (2019) Oral tongue cancer in a patient with hereditary nonpolyposis colorectal cancer: A case report and review of the literature. Oral Oncology 92, 92-93.
Santini D, Tampellini M, Vincenzi B et al. (2012) Natural history of bone metastasis in colorectal cancer: final results of a large Italian bone metastases study. Ann Oncol 23, 2072-2077.
Kaplan I, Raiser V, Shuster A et al. (2019) Metastatic tumors in oral mucosa and jawbones: Unusual primary origins and unusual oral locations. Acta Histochem 121, 151448.
Kirschnick LB, Schuch LF, Cademartori MG et al. (2022) Metastasis to the oral and maxillofacial region: A systematic review. Oral Diseases 28, 23-32.
Labrador AJP, Marin NRG, Valdez LHM et al. (2022) Metastasis to the oral and maxillofacial region. A systematic review. J Stomatol Oral Maxillofac Surg 123, e474-e483.
Nakamura T, Ishimaru J, Mizui T et al. (2001) Osteosarcoma metastatic to the mandible: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91, 452-454.
Muttagi SS, Chaturvedi P, D'Cruz A et al. (2011) Metastatic tumors to the jaw bones: retrospective analysis from an Indian tertiary referral center. Indian J Cancer 48, 234-239.
Mantovani A (2005) Cancer: inflammation by remote control. Nature 435, 752-753.
Aggarwal BB, Shishodia S, Sandur SK et al. (2006) Inflammation and cancer: how hot is the link? Biochem Pharmacol 72, 1605-1621.
Meyer I, Shklar G (1965) MALIGNANT TUMORS METASTATIC TO MOUTH AND JAWS. Oral Surg Oral Med Oral Pathol 20, 350-362.
Hirshberg A, Leibovich P, Buchner A (1994) Metastatic tumors to the jawbones: analysis of 390 cases. J Oral Pathol Med 23, 337-341.
Kende AI, Carr NJ, Sobin LH (2003) Expression of cytokeratins 7 and 20 in carcinomas of the gastrointestinal tract. Histopathology 42, 137-140.
Nishide N, Kanamura N (2006) The value of carcinoembryonic antigen staining to determine the primary malignancy in metastatic carcinoma to the gingiva. Am J Clin Oncol 29, 316-317.
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