Oral Cancer: All You Need To Know?

The number of new cases on cancer grows every year even after our knowledge on prevention and treatment of disease is increasing. According to WHO, oral cavity cancer is amongst the most prevalent cancers worldwide whose incidence rates are higher in men than women.

If you have cancer in the mouth, it can affect your day to day routine. Depending on the location, size, and intensity, oral cancer can change your life.
     

What is oral cancer?

Oral cancer is a fairly common cancer that starts in the mouth or throat. This form of cancer can develop in the lips, tongue, gums, floor, the roof of the mouth, and other places.

The abnormal cells often grow and form a lump or mass called a tumor. These cells can spread to the nearby areas and also to other parts of the body. This process is called metastasis. Oral cancer is very much curable if found and treated at an early stage. An expert doctor or dentist usually find oral cancer in its early stages because the mouth can be easily examined. 

Different types of oral cancer:

• Squamous cell carcinoma, which is the most common.
• Verrucous carcinoma
• Salivary gland tumors     

Who is at risk for oral cancer?

A risk factor is anything that may increase the chance of having a disease. Some risk factors may not be in your control. Men tend to be at higher risk than women for oral cancer, which is diagnosed most often in adults between the ages of 55 and 64 years.

    You're more at risk for it if you have:

• Used tobacco in the past
• Drink alcohol heavily.
• Excess sun exposure
• Human papilloma virus (HPV) infection
• Lack of fruits and vegetables in your diet
• Chronic mouth irritation, caused by poorly-fitted dentures
• Betel nut use
• Certain inherited conditions, as Fanconi anemia
• Premalignant conditions of the oral cavity

Discuss with expert oncologists or dentists about your risk factors for oral cancer and what you can do about them.

What are the symptoms?

Oral cancer is often noticed when there are unusual changes in the mouth. Significant signs of oral cancer include:   

• Sore on the lips or in the mouth that will not heal
• Red or white patches in the mouth
• Pain, tenderness, or numbness on the lips or in the mouth
• Lump, thickening, a rough spot, crusty area, or eroded area on the lips, mouth or in the throat
• Difficulty in chewing, swallowing, speaking, or moving the jaw or tongue
• Change in the way your teeth fit together when you close your mouth
• Lump or growth in your or neck
• Cough or sore throat that will not go away
• Ear Pain 
• Trouble swallowing
• Hoarseness or other changes in your voice

Many of the above symptoms can be even caused by other health problems. But it is essential to see your healthcare provider if you have these symptoms. Only an expert doctor can determine if you have cancer.   

How is oral cancer treated?

An expert caregiver decides a cancer treatment depending on the type, stage, and severity of oral cancer. Cancer treatment may be either local or systemic. Local procedures are used to remove, destroy, or control cancer cells in a particular area. Surgery and radiation therapies are considered as local treatments. Systemic treatment is aimed to destroy or control cancer cells that may have spread to other parts of the body. Chemotherapy is deemed to be systemic therapy. Your expert oncologist may provide you with just one treatment or a combination of treatments. 

Most common treatment methods are: 

• Surgery
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Supportive care

Talk with your healthcare providers about your treatment options to know the benefits and possible side effects of each treatment option. Share your concerns with your healthcare provider before making a decision.

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Blog Reviewed By: Dr. Shiva Kumar Uppala

Mail us: oncologistindiadrshiva@gmail.com

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Surgical Breast Cancer Treatments from the Best Laparoscopic Cancer Surgeon

Breast cancer is the most common form of cancer in India, having overtaken cervical cancer. In cities like Mumbai, Delhi, Bengaluru, Kolkata, Chennai, Bhopal, Ahmedabad, breast cancer accounts for 25%-35% of all female cancers.

Breast cancer is also more common in the younger population. Almost 50% of all cases are in the age group of 25-40.  The numbers are staggering and the most disturbing fact is that Indian Council for Medical Research published a report in 2016 which stated that the total number of new cancer cases is expected to be about 15 lakhs. This figure will likely to increase to 18 lakhs in 2020. So, it is of paramount importance to be aware of diagnosis, treatment and surgical options for breast cancer.

Surgical removal of the tumor is the primary treatment for invasive breast cancers. Quite often, radiation therapy will follow to help prevent a local recurrence of the breast cancer depending on the tumor type. There are different types of surgery used to treat breast cancer.

1. Lumpectomy

Lumpectomy is the removal of lump or sweeling, this procedure doesn't require wide mapping, it is done for benign (non cancerous swelling). It involves removing the cancerous breast tissue while leaving as much healthy tissue as possible in place. When a non-malignant tumor such as a fibroadenoma of the breast is removed, it is often called an excisional breast biopsy. Lumpectomy is not suitable for every breast cancer patient, and when it is performed, the amount of tissue removed can vary greatly depending on the extent of the cancer.

The main advantage of lumpectomy is that it can conserve much of the manifestation and sensation of the breast. It is a less invasive surgery and the recovery time is shorter.

After the completion of a lumpectomy, a pathologist will evaluate the tumor margins using the sample of healthy tissue that was removed along with the tumor.  The lumpectomy is considered to be a success if no cancer cells (clear margins) are identified. Nevertheless, if the margins contain malignant cells, further surgery may be required.

2. Breast conservative surgery

It involves removal of cancerous lump with marging and removal of Lymph Nodes. It is less radical surgery, early recover from surgery. Patient undergoing breast conservative surgery require adjuvant radiation therapy irrespective of the pathology, findings.

3. Mastectomy

Mastectomy is a surgical procedure which involves the removal of entire breast. Mastectomy is recommended for benign tumors involving whole of the breast. Ex: Phylloides tumor. Other indicators are as prophalaois in high risk patient to prevent breast cancer. (Ex: Angelina Jolie underwent B/L prophylactic mastectomy to prevent cancer). Mastectomy is also recommended to prevent cancer from occurring in women who have a high risk for breast cancer.

There are several types of mastectomy procedures:

 

Simple or Total Mastectomy:

The entire breast, including the nipple, is removed with the exception of the lymph nodes and muscle tissues.

Double Mastectomy:

A double mastectomy refers to the removal of both breasts due to a high risk of the cancer spreading (metastasize).

Modified Radical Mastectomy:

This is a kind of the total mastectomy that involves the removal of entire breast including the lymph nodes under the arm.

Radical Mastectomy:

This is a variation of the total mastectomy that removes the entire breast, including the lymph nodes under the arm, and the pectoral muscles under the breast. This may be advised only when breast cancer has spread to the chest muscles.

Skin sparing mastectomy: 

This mastectomy approach preserves as much of a patient’s skin as possible. The breast tissue, nipple and areola are removed while the skin on top the breast is left untouched. This type of mastectomy is recommended for those who plan to have immediate breast reconstructive surgery.

Nipple Spearing Mastectomy: 

Sometimes called as total skin-sparing mastectomy, the nipple, areola and skin on top the breast is left intact, while all of the breast tissue, including the ducts to the nipple and areola are removed. Breast reconstructive surgery is done right after the mastectomy.

Cancer cells might have spread into the lymph nodes nearer to the breast and to detect if the breast cancer has spread to axillary (underarm) lymph nodes, one or more of these lymph nodes will be removed and examined.  Lymph nodes may be removed either as part of the surgery to remove the breast cancer or as a separate procedure.

Sentinel Node Biopsy

The surgical procedure to check whether the cancer has spread from primary tumor into lymphatic system is sentinel node biopsy. It is used in finding breast cancer and melanoma. The first few lymph nodes which tumor drains are sentinel nodes.

 

Oncoplastic Surgery for Breast

This surgery begins at the time of breast conservation surgery, or weeks or months to years afterwards (delayed). This is a smooth surgical process, this can be done in one operative setting.

Breast Reconstruction

Those who have been diagnosed with breast cancer are required to go through certain surgeries. The main surgeries for treating breast cancer are mastectomy and lumpectomy. Breast reconstruction surgery is a surgery for rebuilding breasts after mastectomy or lumpectomy. It can be done simultaneously after your breast cancer surgery or at a later time.

There are many different reconstruction techniques available and they can be done months or years after breast cancer surgeries. This is the surgery in which the plastic surgeon reconstructs the breast shape using artificial implants, these implants can be flap of tissue from your body. After the reconstruction surgery proper care has to be taken for recovery. Having reconstruction surgery at the time of mastectomy gives better cosmetic results. However, if one is not sure about having the surgery, it can be done later also. Those who are interested in having a reconstruction, it is better to consult their breast surgeon early on. You may also ask your surgeon for referral to a plastic surgeon so that you can discuss your reconstruction options in advance.

Types

1. Silicon implants for breast augmentation
2. Pedicaled flaps -Latissimus, TRAM flap
3. Free flap transfer
4. Reduction mammoplasty

 

Surgical Oncology in India

Dr. Shiva Kumar Uppala, one of the best laparoscopic cancer surgeon in Bangalore, specializes in minimal access surgical techniques and has performed more than 500 surgeries till now. He received extensive training and has done his residency in surgical oncology from esteemed institutions.

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Mail us: oncologistindiadrshiva@gmail.com
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