Surgery for other orofacial issues like oral cancer.

 

Some of the oral surgeons, head-and-neck experts,  and plastic craniofacial surgeons I often write about also deal with accident victims and cancer patients. Let’s look now at one of the conditions these patients endure, oral cancer. (I’ll deal with patients with skin cancer and gunshot or auto crash trauma another time.) Before getting to the surgical issues regarding oral cancer, let’s examine the basics of this cancer that strikes about 43,000 new Americans each year, according to The Oral Cancer Foundation.

A few of the symptoms of oral cancer: A mouth sore that doesn’t go away. Unexplained numbness in the face, mouth, or neck. Problems chewing, speaking or swallowing. The causes* can include smoking cigarettes and using smokeless tobacco, drinking heavily, overexposure to the sun, and a family history of cancer. Oral cancer has also been linked to the human papillomavirus (HPV).

Do you have oral cancer?

If you’re lucky, your dentist has already begun checking you for oral cancer. If not, you should ask her to. If you can’t get to a dentist right away, try examining yourself at home. 

Oral cancer DIY exam.

Checking the face for oral cancer signs.

Checking the face for oral cancer signs.

Here’s what to look for during an exterior exam, courtesy of the National Institute of Dental and Craniofacial Research:

” The face, ears, and neck are observed, noting any asymmetry or changes on the skin such as crusts, fissuring, growths, and/or color change. The regional lymph node areas are bilaterally palpated to detect any enlarged nodes. If enlargement is detected, the examiner should determine the mobility and consistency of the nodes.”

Examine by moving tongue around.

Examine by moving tongue around.

Go here for a step by step exam that you can do in front of a mirror. Look for cold-sore like spots on the outside (the lips) and on the inside of the oral cavity look for reddish or whitish patches/areas that don’t go away after two weeks. The tricky part—and why you generally need a dental pro— is identifying what cancer and especially precancerous conditions look like. And of course, to be certain lab tests need to be done on tissue from suspicious areas.  If you’ve got a strong stomach (the kind that can handle ISIS beheading photos/videos), go here or here for some images of early and late oral cancer.

Other symptoms include: bleeding, loose teeth, swallowing problems, new denture problems, lumps or bumps on the neck, and earaches.

 Oral cancer facts.

According to medical author Charles P. Davis, MD, PhD, further key facts about oral cancer include:

The oral cavity is complex and consists of lips, cheek lining, salivary glands, hard palate, soft palate, uvula, area under the tongue, gums, teach, tongue, and tonsils.
Oral cancer is abnormal (malignant) growth of body cells in any part of the oral cavity; oral cancer is sometimes termed head and neck cancer.

Oral cancer is diagnosed by the patient’s history and physical exam and definitively by a biopsy of oral tissue; occasionally, CT scans, MRI scans or PET scans may be used.
Methods of treatment for oral cancer include surgery, radiation therapy, and/or chemotherapy.”

Don’t let fear keep you from the doctor — oral cancer that is caught early is treatable and curable.

TREATMENT

Surgery for oral cancer.

Surgery to remove a growth on the tongue or a tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck and other tissues in the mouth and neck. Patients may have surgery alone or in combination with radiation therapy.

You may want to ask the doctor these questions before having surgery:

  • What kind of operation do you recommend for me?
  • Do I need any lymph nodes removed? Why?
  • How will I feel after the operation? How long will I be in the hospital?
  • What are the risks of surgery?
  • Will I have trouble speaking, swallowing, or eating?
  • Where will the scars be? What will they look like?
  • Will I have any long-term effects?
  • Will I look different?
  • Will I need reconstructive or plastic surgery? When can that be done?
  • Will I lose my teeth? Can they be replaced? How soon?
  • Will I need to see a specialist for help with my speech?
  • When can I get back to my normal activities?
  • How often will I need checkups?
  • Would a clinical trial be appropriate for me?

Radiation therapy

Radiation therapy (also called radiotherapy) is a type of local therapy. It affects cells only in the treated area. Radiation therapy is used alone for small tumors or for patients who cannot have surgery. It may be used before surgery to kill cancer cells and shrink the tumor. It also may be used after surgery to destroy cancer cells that may remain in the area.

Radiation therapy uses high-energy rays to kill cancer cells. Doctors use two types of radiation therapy to treat oral cancer:

  • External radiation: The radiation comes from a machine. Patients go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks.
  • Internal radiation (implant radiation): The radiation comes from radioactive material placed in seeds, needles, or thin plastic tubes put directly in the tissue. The patient stays in the hospital. The implants remain in place for several days. Usually they are removed before the patient goes home.

Some people with oral cancer have both kinds of radiation therapy.

More wisdom from Dr.Davis:

“The side effects of oral cancer treatment may include pain, weakness, altered facial appearance, difficulty in swallowing or chewing food, dry mouth, tooth decay, sore throat, sore gums, bleeding, infections, denture problems, voice quality, thyroid problems, fatigue, hair loss, nausea, vomiting, and diarrhea.
Rehabilitation after oral cancer surgery consists of regaining strength, developing a healthy diet the patient can tolerate, and possibly dental implants or facial reconstruction surgery.
After treatment and rehabilitation, checkups are needed to maintain health and make sure that the cancer does not recur.
Oral cancer treatment can result in significant lifestyle changes; most patients are advised to discuss lifestyle problems with professionals such as social workers to help patients get the care they may need.”

Support groups are essential.

 

________
* Further info about risk factors for oral cancer ( Many risk factors can be modified but not all can be avoided):

Tobacco and alcohol use: Tobacco use (cigarettes, pipes, cigars, and smokeless tobacco) is responsible for most cases of oral cancer.
Alcohol, particularly beer and hard liquor, are associated with an increased risk of developing oral cancer.
The risk of developing oral cancer is higher in people who use both tobacco and alcohol.
Avoiding or stopping the use of tobacco decreases the risk of oral cancer. It is not known if stopping the use of alcohol decreases the risk of oral cancer.

Sun exposure: Exposure to sunlight may increase the risk of lip cancer, which occurs most often on the lower lip.
Avoiding the sun and/or using a sunscreen or colored lipstick on the lips may decrease the risk of lip cancer.

Other factors: Some studies suggest that being infected with the HPV16 strain of the human papilloma virus (HPV) may increase the risk of oral cancer.

Chemoprevention: Chemoprevention is the use of drugs, vitamins, or other agents to prevent or delay the growth of cancer or to keep it from coming back.
Tobacco users who have had oral cancer often develop second cancers in the oral cavity or nearby areas, including the nose, throat, vocal cords, esophagus, and windpipe.