TREATMENT
Surgery
What do I need to know about surgery for oral cancer?
For oral cancer it is extremely important to remove the entire cancer with a rim of normal tissue all the way around it. Removing some normal tissue reduces the chance of leaving a tiny part of the cancer behind. Surgery for oral cancer is usually done in the operating room under general anesthesia. If the cancer involves or comes close to the gums, the surgeon might have to remove teeth or a portion of the jaw bone in order to completely remove the cancer.
Will there be an external incision?
Most of the time, an experience head and neck surgeon will be able to remove an oral cavity cancer by working through the open mouth, but in some cases a skin incision will be required. If removal of lymph nodes is necessary, then a skin incision will be required.
Do I need to have lymph nodes removed? Why do I need the lymph nodes removed if my neck is normal?
Oral cancer commonly spreads to lymph nodes in the neck. These lymph nodes are examined by touch in the clinic, and are also usually evaluated by a CT scan. If there are suspicious lymph nodes, they should be removed as part of treatment. For some oral cancers, a surgeon might recommend removing lymph nodes even if they appear normal. This is done because oral cancer can be microscopically present in the lymph nodes – too small to be seen by CT scan or felt by touch. The status of the lymph nodes is important for cancer staging and for determining whether or not additional treatment is needed after surgery. Lymph nodes do not need to be removed in every oral cancer.
What are the risks of lymph node surgery?
Bleeding, infection, and scarring are risks of any neck surgery. The nerves that move the corner of mouth, move the tongue, give sensation to the tongue, and move the shoulder are all at risk during this surgery because they are close to the lymph nodes. For many patients, surgery has few side effects. If cancer is known to involve lymph nodes in the neck, the risks of lymph node surgery are increased.
Will I need reconstructive surgery?
Some form of reconstruction is usually needed after surgery for oral cancer. The type and complexity of reconstruction depends heavily on the location of the cancer. For example, reconstruction of the tongue is often different than reconstruction of the roof of the mouth.
What kinds of reconstructive surgery are performed after removal of oral cancer?
The plan for reconstruction is determined by your surgeon or surgical team and can range from simple stitches to skin grafts to complex procedures that transfer tissue from another part of the body. In some cases, no reconstruction is required. Your surgeon should anticipate the expected reconstruction and discuss it with you.
Who performs reconstructive surgery for oral cancer?
Reconstructive surgery is sometimes performed by the same surgeon who removes the cancer. Other times, usually for more advanced cancers, reconstruction is performed by another surgeon or group of surgeons.
Radiation and chemotherapy
What is radiation treatment (radiotherapy) for oral cancer?
Radiation is the application of energy to kill cancer cells. It is the same energy used in X-rays, except applied in an extremely precise. Radiation oncologists are doctors who specialize in using radiation to treat cancer. Your surgeon may ask you to meet with a radiation oncologist.
Will I need radiation after surgery?
Giving radiation after surgery is appropriate in select circumstances. Every cancer case is unique. However, generally speaking radiation is appropriate after surgery when the cancer has worrisome findings under the microscope, or is advanced stage.
Could I have radiation instead of surgery?
Surgery is the most common first step in the treatment of oral cancer. Radiation can be used as an alternative to surgery. However, surgery is usually favored over radiation because the side effects from radiation to the mouth are high. Any decision regarding surgery or radiation should be made with your treatment team with a review of risks/benefits and potential side effects.
What is the difference between radiotherapy and chemotherapy?
Radiotherapy uses energy, in the form of X-rays, to kill cancer cells. Chemotherapy is a drug, most often given through an I.V. that kills cancer cells.
Will I need chemotherapy after surgery?
Chemotherapy is sometimes recommended after surgery with radiation for advanced or worrisome oral cancers. Your treating team should be able to explain risks/benefits and potential side effects of chemotherapy.