The treatment plan for oral cancer varies from patient to patient and is established according to the following five main factors:
A better treatment outcome is achieved in patients diagnosed with oral cancer at an early stages.
The main treatment approach in patients with oral cancer are: surgery and radiotherapy with or without Chemotherapy.
Surgery is a procedure aimed to completely remove the tumor tissue together with adjacent healthy tissue in order to prevent relapse of cancer.
THE COMMONLY PERFORMED SURGERIES FOR ORAL CANCER ARE :
Conservative resections are done for early cancers of the oral cavity. Main objective is to preserve organs and attain good quality of life for the patient For early tongue cancers only wide excision with reconstruction can be done. For lesions of buccal mucosa (Inner lining of cheek) only resection and preservation of part of mandible (marginal mandibulectomy) can be done. This can be achieved with good results using CO2 laser for surgical Resection. For cancers of upper gum only removal of part of maxillary bone can be done with prosthodontic rehabilitation.
These extensive surgeries are done for locally advanced tumours of oral cavity (mouth) which are caused by tobacco chewing and are very common in south Asia (India). This involve removal of part of jaw / whole jaw with adjoining buccal mucosa (Inner lining of cheek) with or without removal of skin of cheek. Removal depends on adequate margin of resection.
For cancer of tongue, removal of tongue is done with or without removal of jaw and along with this neck dissection (removal of lymph glands in neck) is done. The gap appearing after the resection is repaired by plastic surgery (local / regional / free flaps). After that patient is rehabilitated by physiotherapist, prosthodontic surgeon, speech and swallowing therapist.
For cancers of cheek bone (maxilla), radical maxillectomy is done, which involves removal of cheek bone (maxilla) with or without preservation of eye depending on involvement of eye or not. If, cheek skin is involved, that is also removed. These tumours may extend to skull base i.e. near the brain, Resection involves removal of the tumour with preservation of vital nerves, which is technically demanding and involves team of experienced Head And Neck Cancer Surgeons. Neuro Surgeons, Plastic and Reconstructive Surgeons to achieve good cancer control and good functional and cosmetic outcome.
These challenging surgeries for advanced loco-regional tumours of the jaw, involve removing the entire tumour including jaw, neck dissection for removal of lymph nodes, removing fibula (leg bone) of the patient and reconstructing the jaw with fibula. This is done to ensure that patient′s original facial appearance is maintained and functions of chewing, swallowing and speech are preserved. In this fibular reconstructed Jaw, teeth can be put at later date, so that patient can chew.
Free Flap Reconstruction is a novel plastic reconstruction technique. After cancer resection (removal), large gaps appear in the resected part of the body, which have to be reconstructed by using skin / muscle / bone of the patient. Before the surgery, the part of the body of the patient is chosen as a donor area, ensuring that it aptly matches the area being resected. After taking the graft from the donor area, it is harvested and used for replacing the gap caused by resection. Bone is replaced by a bone from area, where it has minimal function.
This also involves anastomoses (rejoining) of very small blood vessels to restore blood supply and joining of nerves to restore sensory and motor functions of the body. High magnification microscope and very fine sutures (thinner than hair) are used for anastomoses. This procedure is very technically demanding and takes 4 - 10 hours. Dharamshila Hospital is the only hospital in North India performing these surgeries regularly with very good results.
For early vocal cord and laryngeal cancers (voice box cancer) treatment of choice is laser resection of the vocal cord with minimal thermal damage. This is achieved with endoscopic CO2 laser resection. There is no external cut, the neck surgery is done from inside the oral cavity. The advantage of this procedure is that "patient can be discharged the next day and can resume work within few days". This procedure has got minimal side effects with good voice preservation. CO2 laser surgeries at Dharamshila Hospital are a boom for patients of North India. If CO2 laser surgery is not possible, voice conserving open surgeries are performed, Preserving the voice of a person.
There is hope for patients with advanced cancer of the Larynx (Voice box). Treatment of choice is Total Laryngectomy, a procedure by which the voice box is totally removed. To restore the speech and communication, patients are trained on voice prosthesis or Electro larynx. All patients are suitably rehabilitated and satisfied by our surgical oncologists (Head & Neck Unit) at Dharamshila Hospital.
When performed in early stages, the surgery is small with less post-surgery scars or disfiguration. Patients can eat speak and have normal facial appearance. When performed in advanced stages, the surgery is complex, a substantial amount of tissue needs to be removed, and in most cases requires future reconstruction work.
The side effects are also influenced by the complexity of the surgery and the tumor size. The most common post-surgery side effects include:
When the tumor is too big and the procedure involves removing surrounding tissues or organs (such as palate, tongue, or jaw), the patient can experience the following side effects:
Radiation therapy uses high-energy rays or particles to destroy cancerous cells at the local site. The purpose of this treatment is to destroy cancerous tissues preserving the healthy tissue. Radiation therapy is used :-
There are two types of radiation therapy performed in patients with oral cancer:
In some cases, a patient can receive both types of radiation therapy for a better treatment outcome.
Radiation therapy side effects depend mainly on the radiation dosage and the targeted area. The most common side effects displayed by oral cancer patients that undergo radiation therapy are:
Most of these side effects can be controlled and diminished with medication and are reversible i.e. they will disappear after the radiation is stopped. Dharamshila Hospital uses the third generation linear accelerator with VMAT technology with the new technology radiation dose is 1/10 of the conventional linear accelerator, therefore, side effects are minimal.
This is a systemic type of treatment (affects cells throughout the entire body) that uses drugs either to stop the abnormal growth and dividing process of the cancerous cells, or to kill them. This treatment also has the ability to interfere with the cancerous cells′ replication.
Chemotherapy can be administrated in combination with surgery and radiation therapy for a better treatment outcome. The chemotherapy drugs can be given intravenous or as pills.
Chemotherapy side effects include:
These side effects are temporary, vary from patient to patient according to the drugs and the body reaction to these drugs. Some side effects can be controlled with medication to increase the patient′s comfort during the treatment. All these side effects disappear after chemotherapy is stopped.