Treatment Options For Oral Cavity Cancer By Stage

Treatment Options For Oral Cavity Cancer By Stage

Discuss management of anterior two­third tongue carcinoma.

Answer. Carcinoma of the tongue is a common lesion.
Carcinoma of the tongue occurs on the anterior 2/3, 50% of carcinoma is seen in this region.

Management

Following is the management of the carcinoma of anterior two-third of tongue:

“What Are The Treatment Options For Oral Cavity Cancer”

Carcinoma of anterior two-third of tongue Investigations

• Wedge biopsy
• FNAC of lymph nodes
• CT-scan to see the status of lymph node secondaries.
• MRI to assess extent of primary tumor
• Chest X-ray to see bronchopneumonia
• Orthopantomogram

“Side Effects Of Oral Cavity Cancer Treatments”

Carcinoma of anterior two-third of tongue Surgery

• Wide excision with l cm clearance in margin and depth is done in tumour less than l cm in size or in carcinoma in situ. Laser (CO2/diode) can be used.
• Tumor between 1–2 cm in size, partial glossectomy is done with 2 cm clearance from the margin with removal of l/3rd of anterior two-third of the tongue.
• Tumor larger than 2 cm, hemiglossectomy is done with removal of anterior 2/3rd of tongue on one side up to sulcus terminalis.
• Raw area in these procedures can be left alone when area is wide allowing it to granulate and heal by epithelialization. lf area is small like in wide excision it can be closed by primary suturing. Wide raw area can also be covered with PMMF or quilted split-skin graft.
• Larger primary tumor can be given preoperative radiotherapy then later hemiglossectomy is done.Same side palpable mobile lymph nodes are removed by radical neck block dissection.
• Bilateral mobile lymph nodes are dealt with one side radical block and other side junctional block dissection with
  essentially retaining internal jugular vein (on opposite side) to maintain the cerebral venous blood flw. Other option is doing same side radical neck dissection and on opposite side supraomohyoid block dissection.
• Wide excision is done when growth is in the tip of the tongue.
• Reconstruction of tongue and other area after surgery: By deltopectoral flap, forehead flap, pectoralis major muscle flap, skin grafting.
• Prophylactic block dissection is becoming popular at present.

“Oral Cavity Cancer Treatment By Stage Explained”

Carcinoma of anterior two-third of tongue Radiotherapy

• In small primary tumor—brachytherapy using caesium or iridium needles.
• In large primary tumor initial radiotherapy is given to reduce the tumor size so that resection will be bettr later.
• Advanced primary as well as secondaries in neck are controlled by palliative external radiotherapy.
• Postoperative radiotherapy is given in large tumors to reduce the chances of relapse.

“Best Ways To Manage Advanced Oral Cavity Cancer”

Carcinoma of anterior two-third of tongue Chemotherapy

• It is given in postoperative period and for palliation.
• Price –Hillregimenis commonlyused. Drugs are methotrexate,
• Vincristine, adriamycin, bleomycinand mercaptopurine.
  It is either given intra-arterially as regional chemotherapy through external carotid artery using arterial pump or
  through IV. It can be given orally also.