What is mouth or oral cavity cancer?
The oral cancer is the cancer located in the oral cavity (the mouth area) and the oropharynx (the throat area of back of the mouth).
Physic exploration must be an integral part of medical and odontologic exams since is early detection is crucial. In general, cancerous lesions smaller than 15 mm of diameter can be easily cured.
The oral cavity is formed by the following parts:
- Lips, teeth and gums.
- Lips and cheeks inner coating (oral mucosa).
- Mouth floor (under the tongue).
- Superior part of the mouth (hard palate).
- A small zone behind the wisdom teeth (retromolar space).
The oropharynx is formed by:
- The back third of the tongue.
- The soft palate.
- The tonsils.
- The rear part of the throat
- Which are the symptoms?
The symptoms may vary from one person to another, however the most common are the following:
- A lip or mouth ulcer that will not heal · A red or white spot on the gums, tongue or the oral mucosa.
- A lump on the lip, mouth or throat.
- Bleeding, pain or numbness on unusual areas of the mouth.
- Mandible swelling.
- Ear pain.
- Chronic throat pain.
- Painful or difficult swallowing or masticating.
Oral cancer symptoms may be preceded by others caused by other disorders or medical problems. A specialist must be consulted in case of any doubt to ensure a correct diagnosis.
- How is it diagnosed?
The specialist will perform a biopsy to extract affected tissue which will be examined through microscope by a pathologist who will confirm the presence of cancerous cells. Radiologic imaging will be required (Tomography, MRI, PET) to verify in which stage the tumour is.
- Oral cancer staging
- Stage I: the tumour is smaller than 2 cm and there is no metastasis.
- Stage II: Tumour between 2 and 4 cm without metastasis.
- Stage III: Tumour bigger than 4 cm, or smaller with metastasis.
- Stage IV: The cancer has spread towards the surrounding tissues or the metastasis is bigger than 3 cm.
- How is it treated?
Small oral cavity or oropharynx tumours will be treated with surgery if possible, as long as the resection required by the tumour does not entail the impossibility of restoring deglutition (swallowing).
In these cases the use of CO2 laser transoral microsurgery facilitates the removal of tumours with less loss of healthy tissues and usually does not need sectioning the jaw, practicing tracheotomy or rebuilding the defect created using the usual flaps, which shortens the postoperative period and leaves less after-effects.
The neck ganglions will be treated by regular surgical dissection. In most of the cases it will be convenient a complementary chemo-radiotherapy after 3-4 weeks to increase the percentage of recovery. If the tumour is very advanced and its resection may endanger deglutition, chemo-radiotherapy will be applied. In case of partial persistence of the tumour CO2 laser transoral microsurgery will be performed to remove it.
Microsurgery through the mouth requires a long formation: the surgeon, first of all, needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.).
The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues).
This surgery requires a learning curve (with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.
In some cases the surgical removal of the tumour must be needed, including all or part of the vocal cords (laryngectomy). Many patients also need deglutition therapy after the treatment in order to help them get used to the changes in the structure of their throat.
Rehabilitation may be different from one patient to another depending on which treatment has been applied, the localization of the cancer and its staging.
Rehabilitation may include:
- Dietetic advising. Many patients who are recovering from oral cancer surgery experience difficulties when eating; hence small meals consisting on soft and damp food are often advised.
- Surgery. Some patients may profit by reconstructive or plastic surgery to rebuild the mouth bones and tissues in order to recover their normal appearance.
- Prostheses. When reconstructive or plastic surgery is not an option, patients may use dental or otherwise facial prostheses to get back their normal appearance. Prostheses may need special training in order to learn how to use them.
- Language. and deglutition therapy If the patient has difficulties with talking or swallowing after the surgery, language and deglutition therapies may help them to relearn how to perform such tasks.
- What must the patient do once the treatment is over?
Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.
Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.
Dr. Máiz has a wide experience in the treatment of oral cavity tumours both by conventional surgery and CO2 laser transoral microsurgery.
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