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.
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.
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.
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