Mouth cancer

Standard curative treatment modalities for mouth cancer, oral squamous cell carcinoma, are:

Chemotherapy is generally accepted to not be curative for oral squamous cell carcinoma. It is mainly used as a palliative tool or in combination with radiotherapy to enhance its effectiveness (known as chemoradiotherapy). It can sometimes be used as a test of tumour responsiveness: if the tumour regresses after a cycle or two of chemotherapy radical radiotherapy is added (induction chemotherapy).

Surgical tools are principally cutting implements, scalpel, cutting diathermy, laser or coblater. These are simply different ways of cutting tissue, they are not an anticancer tool although some surprising properties have been ascribed to lasers of different types. Some surgical procedures for the treatment of mouth cancer may require the temporary surgical opening of the windpipe (trachea) for direct access, a tracheostomy; this may be necessary during the surgical procedure (for simple reasons of space and accessibility) and/or afterwards to protect the airway where major post-operative swelling is anticipated.

It is important to respect the key principle of adequate excision margins whichever tool is used. For oral cancer this macroscopic margin is 1-1.5 cm. The aim of surgery is to have a histopathological clearance of 5mm. This would appear straightforward if such a large macroscopic clearance is being taken but mucosal shrinkage often narrows these margins. There is some evidence to suggest that a clear margin of 2 mm after shrinkage produces the same statistically significant survival as a 5mm margin. A positive margin equates to a poor prognosis.

Radiotherapy uses high-energy radiation in order to destroy malignant growth tissue. The mainstay of treatment and that of proven effectiveness for most head and neck cancers is irradiation with high-energy photons, if possible by using selectively targeted imaging modulated radiation treatment (IMRT) schemes with the intent to spare healthy tissue as much as possible. The dose required to cure head and neck cancer is sometimes augmented by chemotherapy. This dose is extremely close to the point where necrosis of tissue occurs and both soft and hard tissue necrosis is a complication of radiation treatment in the head and neck region.

Non-standard treatments are treatments which have been demonstrated to be effective anti-cancer strategies but are not universally available or applicable. They should not be confused with ‘alternative therapy’ which are treatments which may or may not be useful adjuncts to overall patient management but have no anti-cancer effect (such as aromatherapy, homeopathy).

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