Pre-cancerous or Cancer Diagnosis

Dr. Kademani and Dr. Claiborne, along with their team, understand that this is a life-changing and frightening diagnosis. We are all here to help you. We will help educate and guide you through diagnosis, staging, and treatment. We strive to provide the highest level of services in the state. Dr. Kademani has spent almost 20 years building a large head and neck oncology and maxillofacial surgery practice in Minnesota. Together they have the privilege of seeing patients from every corner of the state and region, and has practices located throughout Minnesota to aid in availability. Our surgeons are fellowship trained and credentialed Oral and Maxillofacial surgeons. It is the desire of their entire team to provide you and your family compassion and comprehensive care during this time of uncertainty. 

Precancerous lesions or dysplasia

A pre-cancerous lesion, sometimes called dysplasia, is considered a very important find. Depending on the type of lesion, they often require monitoring and may require management to lower the risk of malignant transformation. Pre-cancerous lesions are typically categorized according to color and severity. Lesions may have characteristics that include leukoplakia (white), erythroplakia (red), and erythroleukoplakia (red and white mixed lesion). There may be a recommendation for a biopsy which is one way to confirm this diagnosis. A biopsy may classify the lesion as mild, moderate or severe, with the risk of malignant transformation increasing with severity. The finding of a pre-cancerous lesion often requires a treatment team for frequent and long-term follow up to monitor for changes that could require further treatment. 

Oral cancer

Approximately 90% of the cancers in the oral mucosa are squamous cell carcinoma, originating in the tissues that line the mouth and lips. Oral cancers can present with many different symptoms including a non-healing wound, pain at the site or surrounding teeth, difficulty with speech &/or swallow. Generally, it is important that any lesion or sore in the mouth that has not healed within two weeks be evaluated. 

Discovery and treatment of an oral cancer in the earliest stage provides the best possible prognosis, the least invasive surgical treatment, and highest quality of life. Squamous cell carcinoma, and other cancers, will continue to progress without treatment. Each cancer is unique and there is no way of predicting the speed and spread in individuals. Many patients present with a biopsy or tissue sample of the suspected area to confirm the presence of oral cancer. It is important to understand that an OMFS provider will perform a more extensive (oncological) surgery for definitive treatment of the cancer.

Staging 

Once a diagnosis is confirmed, several additional tests and scans will likely be indicated. This will help to stage the tumor based upon the American Joint Committee on Cancer (AJCC) TNM staging system. TNM stands for tumor size (T), lymph node involvement (N), and distant metastasis or spread (M). Staging helps to predict the treatment options and prognosis. Stages I and II are considered early disease. Advanced cancer stages, stage III and IV, include larger sizes (>4cm) and/or those that have spread into the lymph nodes in the neck. More treatment modalities, such as radiation and chemotherapy, may be required for advanced staged disease. 

CT scans, MRI and PET scan imaging are the tools used to help stage cancer. They may show if lymph nodes are enlarged or if there are other areas of concern. The Positron Emission Tomography (PET) scan is a more sensitive test to help identify possible areas of cancer from eye to thigh. A PET scan will look for metastasis to the lymph nodes and other structures such as the lungs. There is no single reliable test that will determine if the cancer has spread, making ongoing clinical examination and surveillance very important after treatment. 

Treatment

Early staged head and neck cancer is typically managed with either surgery or radiation therapy alone. Due to the long-term side effects of radiation, this is not typically the first line treatment recommendation. Every patient who is diagnosed with cancer by our service is presented to tumor board for a collaborative discussion with multiple specialists to ensure the best individual treatment. 

Ultimately, the goal of treatment is to remove the primary site of the cancer including uninvolved tissue surrounding the cancer called “margins.” To obtain clear margins may require removal of bone, tissue and teeth. This can be a very stressful realization. Your options will be discussed at length, including diagnostic results and exam findings, with you and your family. We provide team contact information and ongoing support throughout diagnosis, treatment and recovery. Although overwhelming, we want you to be comfortable and empowered placing your care into our hands. Dr. Kademani and his entire staff are here to help you and your family. 

Oropharyngeal cancer

Oropharyngeal cancer is cancer of the base of tongue &/or oropharynx, which is the middle part of your throat (pharynx). Symptoms include a sore throat that doesn’t go away; a lump in the throat, mouth or neck; coughing up blood; white patch in the mouth and other symptoms. According to the American Cancer Society estimated 2022 statistics, about 54,000 people in the U.S. will develop oropharyngeal cancer. There are many factors that may increase the risk of oropharyngeal cancer including tobacco and alcohol use, history of cancer or radiation, and being infected with HPV. Oral HPV is transmitted to the mouth by oral sex and possibly in other ways. Many people are exposed in their life. Most people clear HPV within one to two years, but HPV infections persist in some people. The most common treatment for this type of cancer can be radiation but can include surgery. Dr. Kademani, Dr. Claiborne, and their team will educate you, guide you through the options, and assist in every step. They use a collaborative, team-based approach to ensure optimal care and outcomes. 

Salivary gland tumors

Salivary gland tumors are a rare disease in which benign or malignant cells form in the tissues of the salivary glands. Saliva has enzymes that help digest food and antibodies that help protect against infections of the mouth and throat. There are 3 pairs of major salivary glands that include the parotid, sublingual, and submandibular glands. The largest and most common site of salivary gland tumors is the parotid glands. There are also hundreds of small, minor salivary glands lining parts of the mouth, nose, and throat. Most small salivary gland tumors begin in the palate (roof of the mouth). More than half of all salivary gland tumors are benign (not cancerous) and do not spread to other tissues. Symptoms may include a lump or mass, change in swallow, numbness or weakness in the face, and/or pain. Initial management is often surgery although additional treatment may be indicated. There are many factors that determine treatment including size of the tumor, type of disease, and stage of cancer. Minnesota Oral & Facial surgeons are skilled in diagnosis and management of this relatively rare type of tumor. 

Thyroid tumors

The thyroid is the butterfly-shaped gland at the base of the neck. A diagnosis of thyroid cancer occurs in the cells of the thyroid. Your thyroid produces hormones that regulate your heart rate, blood pressure, body temperature and weight. The cause of thyroid cancer is poorly understood, but may involve a combination of genetic and environmental factors. Some people have no symptoms although, as it grows, it can cause pain and swelling in your neck. Others may first notice a lump in the neck. Thyroid cancer rates seem to be rising which may be related to new technology that allows doctors to find small thyroid cancers that may not have been detected in the past. When discovered early, thyroid cancer treatment can be very successful. Treatment options include surgery, hormone therapy, radioactive iodine, radiation, and in some cases chemotherapy. Our service will guide you through the complex decisions, staging, and management options that arise upon diagnosis of a thyroid tumor. We use a collaborative approach, which includes participating in a tumor board, to ensure you are receiving the highest level of treatment available. 

Reconstructive surgery

Reconstruction after surgery is often desirable to minimize the functional and cosmetic changes to the patient as a result of cancer, trauma, or other surgical defects. The goal of reconstruction is for wound closure and to reestablish functions such as speaking, eating and appearance as quickly as possible. There are many considerations in determining which reconstructive option is best and having a well-trained and highly skilled surgeon is critical to success. Our surgeons have an experienced team educated in the reconstructive options and obtaining optimal outcomes. The options will be presented to you, along with risks and benefits, recovery, and reasonable expectations, to allow you and your support system to make a confident choice for your health considerations. 

One of the major advancements in the treatment of patients has been the use of vascularized bone and/or tissue transplantation. With this technique, the tissue needed for reconstruction is harvested from a donor site along with the vein and artery. These are then transplanted and connected to the vein and artery near the defect and used to reconstruct the removed tissue. Drs. Kademani and Claiborne have the ability to create complex, individualized surgical plans to provide the most optimal outcome. The reconstructive decision is made prior to surgery with patient and family input, may involve surgical planning, and will be discussed in detail. 

Microvascular free flaps: radial free forearm flap

There are a number of reconstructive options that may be presented to you during pre-operative appointments and individualized based on many factors. Use of the radial free forearm flap is an ideal reconstructive soft tissue option for areas such as the tongue that do not require bone for stability. A radial flap is removal of skin and tissue from inside of one wrist. The artery and vein are also harvested and transplanted to an artery and vein near the surgical site with a microscope. This is very precise and highly skilled surgery that requires a team of specialized surgeons. However, the end result is vascularized tissue that is able to heal and function within the defect. Use of a radial flap may allow you to have improved speech and swallow after a glossectomy. Since bone is not removed, it is often a quicker surgery. Surgery may be 4-6 hours long with anticipated length of hospitalization from 4-7 days. Recovery of the arm function is very likely although some people experience numbness or restricted movement often improved with physical therapy. 

Microvascular free flaps: fibula flap

A fibula flap is a method of reconstruction which allows for placement of vascularized bone into the surgical site. Dr. Kademani likes to say that the fibula bone is in our body just for the purpose of rebuilding the jaw. A segment of the fibula is harvested along with the artery and vein. This is then precisely shaped to recreate the mandible or other area of the jaw. Once fully healed, it may be possible to place implants into this bone and restore the bite. This surgery is more extensive, typically lasting 8-12 hours, with anticipated length of hospitalization from 7-12 days. A leg brace and crutches are needed on the effected leg for several weeks. Physical therapy may be encouraged to restore function. Full recovery of the leg function is the norm. Although facial appearance is often altered, it is possible for full recovery of a bite after a fibula flap.