Oral Cancer Treatment: Surgical, Radiation, and Chemotherapy Modalities Explained

Mouth Cancer

Write short note on *modalities of treatment of oral cancer.

Answer. Oral cancer is treated by surgery, radiotherapy and chemotherapy or by combination of these.

The other developing techniques in the treatment of oral cancer are laser therapy, hormonal therapy, hyperthermia, etc.

“Surgical Treatment For Oral Cancer Explained”

Oral Cancer Surgery

• The surgical treatment oforal cancer as a primary modality is excisional in nature.
• All clinical detectable tumor must be excised with adequate margins of adjacent normal tissue, to ensure that the residual element of the microscopic disease do not remain within the surgical fild.
• The surgical treatment of oral carcinoma includes three important steps:

1. Wide excision of primary tumor
2. Neck dissection, i.e. surgical removal of involved lymph nodes present in the neck
3. Reconstruction ofthe resected region in the oral cavity.

Lesion In Mandible

Surgical procedures that can be done for the resection of tumors in the mandible include:

• Alveolectomy: This is an intraoral procedure in which alveolus is removed alone.
  This is done for small alveolar lesions in the mandible.
• Marginal mandibulectomy: It is the surgical procedure which involves the removal of body of the mandible in the involved area leaving lower border of the mandible intact.
  This procedure is done in cases where the tumor involves body of the mandible but does not involve the lower border of the mandible.
• Segmental resection: It is the surgical procedure in which a segment of mandible including the lower border should be excised.
  Depending on the location of the tumor, this procedure is divided into two parts, i.e. anterior segmental or posterior segmental resection. Since the lower border of the mandible is also resected, it causes discontinuity of the mandible.

“Comprehensive Overview Of Oral Cancer Treatment Modalities”

• Hemimandibulectomy: In this procedure excision of one half of the mandible is done.
  This is carried out in extensive tumors which involve the mandible.
  This could be for a tumor of the buccal mucosa or floor of the mouth infiltrating into the mandible.
  The soft tissues involved in the tumor are resected along with the mandible.
  The condyle is usually spared in these cases.
• Disarticulating hemimandibulectomy: In this surgical procedure, one half of the mandible including the condyle is excised.

“Risk Factors For Complications In Oral Cancer Treatment”

Lesion In Maxilla

The different surgical options in the maxilla depending upon the size and extent of the tumor include:

• Alveolectomy: This is an intraoral procedure which involves removal of the involved part of the maxillary alveolus.
• Subtotal maxillectomy: In this removal of maxilla excluding the flor of the orbit and infraorbital rim.
• Total maxillectomy: Removal of maxilla including orbital flor as well as rim.
• Radical maxillectomy: It involves removal of orbital contents along with the maxilla.
• T1, T2 lesions involving only the maxillary alveolus should be incised with an adequate margin of normal tissue intraorally.
  Alveolectomy is done for these lesions. T3, T4 lesions with invasion into the maxillary antrum or nasal cavity require subtotal maxillectomy.
• Larger lesions eroding the floor of the orbit require total maxillectomy. Invasion of the tumor into the orbit requires removal of orbital contents and is called a radical maxillectomy.
  Alveolectomy can be done intraorally.
• For all other procedures, a wide exposure of the maxilla is required. This can be achieved by the Weber Ferguson incision.
  This incision may have a subciliary or a brow extension for a bettr exposure of the maxilla.

“What Tests Are Done Before Oral Cancer Treatment”

Oral Cancer Reconstruction

• Although cure rates have not changed much over the years,better function and appearance of the patient have been made possible by reconstructive techniques.
• Various surgical advances have provided means for soft tissue and hard tissue reconstruction of the excised region.
• Soft tissues used for reconstruction include:

• Deltopectoral flap
• Sternocleidomastoid flap
• Pectoralis major flap
• These and various other flaps have revolutionized the reconstructive procedures.

Oral Cancer Radiotherapy

• Radiotherapy is the treatment of the disease with ionizing or non-ionizing radiation.
• Following methods are to be followed for radiotherapy:

X-ray therapy:

• Superficial X-ray therapy 45 100 kV
• Kilovoltage X-ray therapy 300 kV.

“Can Oral Cancer Recur After Treatment”

Electron therapy

Surface applicator.

• Interstitial implantation
• Radiation is given externally by the use of X-ray generators.
• Uninvolved areas of patient should be prevented by doing shielding.
• Host tissues of patient should be protected from radiation by two methods, i.e. fractionation and multiple ports.
• In fractionation instead of giving maximum radiation patients given radiation in small increments for several weeks which provides time for normal tissues for recovery between dosages.
  In multiple ports multiple beams are used which provide radiation to tumor from diffrent angles.
  In this radiation delivery is on every 5th day a week.

“Understanding The Benefits Of Oral Cancer Surgery”

Oral Cancer Chemotherapy

• It is used in the treatment of malignant tumor. It selectively kill’s tumor cells by virtue of cell kinetic proliferation character and cell biology.
• Chemicals which interferes with rapid growth of tumor cells are used for treating oral cancer.
• Vincristine, bleomycin and methotrexate in various combinations are used.
• Chemotherapy should be given intravenously but nowadays its intra-arterial injections can be given It produces only partial or temporary tumor regression.
• It may be used in combination with radiotherapy or surgery or as palliative treatment.
• Chemotherapy is most effctive in the lesions which are confied to the soft tissues.