Oral Cancer Treatments
There are two main treatments for an oral cancer diagnosis: Surgery, and Radiation Therapy.
Surgery is the main stay of treatment for oral cancer. The type of surgery depends on the type and stage of the tumour.
The basic principles of safely removing oral cancers is to remove the tumour itself, without breaching it, and including a cuff of around 1-2cm of ‘normal’ tissue around it in 3 dimensions.
This is because cancers grow and invade tissue with ‘fingers’ or ‘tentacles’ of cells in advance of the main tumour. If these cells are not included or left behind then the tumour will regrow.
This safety margin of tissue means that depending on the position of the tumour, then structures which are nearby – for example the jaw or skin – sometimes have to be taken with the tumour.
Our surgeons use the latest techniques and imaging at their disposal to accurately plan the surgery, in order to achieve the highest rates of clearance of cancer possible.
The head and neck is the most complex anatomical region of the body and is responsible for so many important functions including eating and drinking, speech and swallowing. Our surgeons are also highly trained microvascular reconstructive surgeons which, along with their specific head and neck training and understanding, means they can successfully repair and restore the defects from the cancer removal to help improve function and maintain appearance.
General Surgical Procedure
Surgery is carried out under general anaesthetic (GA) and is often part of a bigger operation including removal of the lymph glands (Neck dissection) and a reconstruction.
Once patients are asleep under GA the extent of the tumour is assessed on examination, and with reference to MRI and CT scans, the surgeons will assess and finalise the margins (i.e. the extent of the tumour including the normal tissue round the circumference).
The tumour can normally be removed with virtually zero blood loss due to the recent advances in surgical technology including the harmonic scalpel and ligasure instruments, along with a highly refined surgical technique.
The tumour is then sent to our pathologists for assessment. They will critically look and assess whether the tumour is clear from the margin or edges of the resection. They also get the chance to fully assess the tumour’s features and grade it.
All of this information adds to the decision as to whether further treatment – i.e. surgery, post-operative radiotherapy or chemotherapy will be beneficial. These results are not normally back for around a week, and they will be fully explained to you by your surgeons.
Patients are normally warned about experiencing some pain and discomfort post-operatively. Our specialist head and neck anaesthetists have guided hundreds of patients safely through these procedures and will ensure that this is kept to a minimum. It may surprise you to learn that in our observations, patients do not normally experience much pain after this procedure.
Best practice and careful surgical technique is adopted to reduce the risks of wound infection and antibiotics are given during your operation. Several post-op doses of antibiotics are usually given too.
With modern day techniques, significant blood loss requiring transfusion is rare in head and neck surgery. This can be case-specific, and will be discussed with you by your surgeons.
Specific Surgical Procedures
Other surgical techniques to treat oral cancer and deal with the side effects of treatment include:
- Removal of the tumour including a safety margin of surrounding normal tissue
- Removal of a superficial part of he jaw or full segment of the jaw
- Maxillectomy (upper jaw)
- Removal of lymph nodes and other tissue in the neck
- Sentinel node biopsy – performed in cases considered low risk for spread to the neck
- Reconstructive surgery, including skin grafts, tissue flaps or dental implants to restore tissues removed from the mouth or neck
In cancer of the mouth, radiation therapy is often used after surgery, either alone or with chemotherapy for more advanced tumors.
The method of radiation treatment used depends on the type and stage of cancer.