Treatment of Oral Cancer

Oral Cancer is the most common malignancy in males in India. It is the second most common cancer in females in our Country. Consumption tobacco in any form i.e. smoking or chewing is the single most important cause for the development of oral cancer. Oral cavity or mouth consists of different subsides for oral description of lesion and for planning treatment.

There are three modalities for treatment of Oral Cancer-

1. Surgery
2. Radiation Therapy
3. Chemotherapy

Oral Cancer Diagnosis: Staging is done before initiating treatment.

Diagnosis is done by-

1. Clinical Examination– It includes Examination of oral cavity, head and neck region, General examination of patient is done. Nutritional assessment, medication history and dental examination are part of overall assessment.
2. Biopsy– Histological confirmation of disease is important. Biopsy of suspected lesion in oral cavity is usually an outpatient procedure. It can be safely done under local anaesthesia in most of the patients. Fine needle aspiration cytology (FNAC) of the lymph nodes in neck may be required in few cases.
3. Imaging– It may include X-ray examination of jaws. Contrast enhanced computed tomography (CECT) or Magnetic resonance imaging (MRI) of the affected area. Depending on the size of the Lesion and condition of lymph nodes in the neck PET (Position Emission Tomography) scan is useful in some cases.

All these workups help in assigning as clinical stage to the disease. Staging describes disease in terms of tumour size (T), Lymph node states (N) or disease spread to other organs (M, metastasis). Considered together it gives TNM staging for the disease.

After diagnosis workup and staging, treatment of the patient is initiated.

Some patients require one modality for the treatment others may need multimodality treatment depending upon the disease stage. Other factors which play a role in the selection of treatment are –

• Age
• General medical condition
• Occupation
• Life style
• Socio-economic status
• Acceptance and compliance

In general smaller lesions are treated by surgery or radiation therapy i.e. single modality treatment. Advanced disease needs combined treatment by surgery and radiation. Chemotherapy in patients with oral cancers is usually reserved for very advanced disease only.

Surgery for Oral Cancers can simply remove cancer with safe margins. At times it may be complex resection combined with reconstructive surgery. Patient needs nutritional support all during this phase of recovery. Tube feedings are very helpful in some patients to meet the need of nutrition. Maintenance of oral hygiene, dental restoration is part of rehabilitation process once the definitive treatment has been done.

Patient needs regular follow up to assess the recovery process and to help him/her to achieve maximum functions with minimal morbidity. Oral cancer patient can develop second cancers or recurrence of the initial disease. It is essential for the patient to stick to follow up routine so that any such recurrence can be timely detected and treated.

Abstinence from tobacco and alcohol are very important. Healthy diet rich in fresh fruits and vegetables helps in maintaining good immune function and decrease any chances of recurrence of disease in the development of second cancer.